• Maternal, child and reproductive health
  • Magee and CMU’s app can combat pre-term birth

    Pre-term births are before babies have completed their 37 weeks of gestation. WHO has estimated that 15 million babies are pre-term each year, and it’s rising. Complications associated with pre-term births are the leading cause of the high mortality rates of children under five. Three-quarters of these deaths could be prevented with current, cost-effective interventions.

    An article in Medicalxpress says that maternal-fetal specialists at Magee-Women’s Hospital has collaborated with scientists at Carnegie Mellon University (CMU) to develop and test a personalised smartphone app to combat pre-term birth. It engages pregnant women living in remote locations.

    Research in the Journal of Medical Internet Research mHealth and uHealth, found that the app was successful in providing accessible and personalised obstetric care designed specifically to target risks of pre-term births. Tamar Krishnamurti explained that

    "Mobile phone apps are a great way to engage a vulnerable population in their health care because approximately 86 percent of American adults own a mobile phone, regardless of racial and ethnic groups."

    Users voluntarily logged into the app every one and a half days to complete daily risk assessments. Algorithms then provided specific, personalised risk feedback, with bespoke recommendations. If the app detects a decrease in self-reported cigarette use, it provides encouraging messages and resources about quitting resources. It  also provides basic pregnancy education, reminders about appointments and fetal health monitoring aids like a kick counter.

    When the app detects high-risk events, such as intimate partner violence or thoughts of suicide, it sends real-time alerts to medical staff. Women are then contacted directly and linked to appropriate medical and social service resources.

    While there are several apps to support pregnancies, few are developed through a  patient-centred scientific process and grounded in behavioural decision research. The next step in this technology is to conduct randomised controlled trials over entire pregnancy cycles to evaluate  the app’s benefits for behavioural and clinical outcomes, including adverse birth outcomes. It seems to offer Africa’s health systems and pregnant women effective opportunities to reduce substantially the number of pre-term births.  

  • New Medical Aid film celebrating the vital role of midwives globally

    International Day of the Midwife celebrates the vital role midwives play in supporting women around the world through their pregnancy and childbirth. In many parts of the world however, there is an increased medicalisation of pregnancy and childbirth, with some women experiencing unnecessary treatments and procedures that can have negative effects on both the mother and child. Most women can give birth without intervention under the care of experienced trained midwives. 

    Medical Aid Films (MAF) latest film “A Midwife Like Me” shows how dedicated and skilled midwives can help women have the best experience before, during and after child birth, encouraging them to make their own informed decisions around normal birth practice. Produced in partnership with the International Confederation of Midwives (ICM) and voiced by Her Excellency Toyin Saraki, Founder and President of The Wellbeing Foundation Africa and long term advocate of maternal and child health, the film shows the incredible work which midwives across Sub-Saharan Africa, Europe and Southeast Asia, are doing to inform and empower women and families.

    “I am tremendously grateful to be part of this video as the Global Goodwill Ambassador for ICM. Midwives are at the heart of the solution for maternal and newborn healthcare. They are the first hands and eyes to hold and see our babies. We must champion them; equip them and train them, for better health outcomes internationally” said Her Excellence Toyin Saraki.

    The ICM aims to strengthen Midwives Associations and advance the profession of midwifery globally by promoting autonomous midwives as the most appropriate caregivers for childbearing women. By encouraging normal birth procedures the ICM aims to enhance the reproductive health of women and their new-born babies.

    “This video will be a good advocacy tool and another opportunity to raise the profile of midwives and the wonderful work they do in promoting and protecting normal birth and providing safe and competent midwifery care. Well educated, supported and equipped midwives not only support women to deliver their babies but also prevent complications, save lives and promote health to entire families and communities” said Sally Pairman, Chef Executive International Confederation of Midwives.

    The film is also available in French and Spanish.

  • Vodacom Siyakha launches mHealth for expecting mothers

    Siyakha means ‘we are building’ in isiZulu. It’s also a platform used by Vodacom South Africa, and offers prepaid customers free access to a range of zero-rated sites, including:

    • Vodacom insurance products
    • Free health content from the TV series Hello Doctor
    • Vodacom’s infotainment platform Video Play
    • Educational portals and careers and jobs websites.

    Vodacom Siyakha has an mHealth service for pregnant mothers too.  Mum and Baby builds on Siyakha’s health service to offer maternal support to pregnant mothers. It provides educational articles videos and health information containing stage-based pregnancy information and advice. An article in IT News Africa says Mum and Bay also provides free health information and videos for childhood development too, extending across children’s first five years. Expecting mothers receive three weekly SMS’s to keep them undated on the progress of their pregnancies. These videos and SMS’s cover a range of health topics including:

    • Sexual and reproductive health
    • Breastfeeding
    • Immunisation
    • Early childhood development
    • Mother and child bonding
    • Nutrition
    • HIV/AIDS.

    A publication at My News Room, says Mum and Baby’s available in several languages, making it more accessible. The solution targets expectant mothers who lack easy access to healthcare facilities, It can be used by family caregivers too, who’ll be empowered with information and tools to use in their daily work setting.

    Vodacom customers can access Mum and Baby by dialing *111*88#, a prepaid number, or visiting the Siyakha mobi site.

  • Babyscripts allows doctors to track pregnant patients remotely

    Maternal mortality is a top priority for all health systems. In the US, seeking improvements has spawned several mHealth solutions that may benefit Africa too.

    An editorial by the Association of Reproductive Health Professional says that the US‘s 50th in the world for maternal mortality. Most countries reduced their maternal mortality between 1990 and 2008. There was a 34% decrease globally. But, in the US, maternal mortality doubled.

    To improve the pregnancy experience and maternal mortality in the US, Babyscripts was founded. The start-up focuses on maternal health and has developed an mHealth tool allowing obstetricians to monitor their pregnant patients' health and progress remotely. Obstetricians receive a Mommy Kit with a WiFi and Bluetooth-enabled blood pressure cuff and weight scale. These collect data, sending it back to doctors to monitor using the app. Women use this to replace some pre-natal appointments, saving time and money by not having to pay for a prenatal checkup. These are very valuable benefits for Africans.

    MedCity has a report saying the app's algorithms detect abnormal readings and notify providers to schedule any required visits with patients. Forbes has said the kit and app have already detected cases of pre-eclampsia earlier than conventional diagnoses. The team’s now working on a kit that includes a glucometer to help monitor patients at risk of gestational diabetes.

    This app is unique to existing apps such as Ovia Health App, Text 4 Baby, Due Date Plus and MomConnect. It's aimed at clinicians, while these other apps focus mainly on providing women with information regarding pregnancy and helping women to track their milestones. These don't share data with doctors.

    With Babyscripts receiving more funding, it’s now working with ten health systems. Six more will be added in the next month. The next project’s to track children's health remotely, moving the company into paediatrics. It seems like a very valuable addition to Africa’s health systems’ mHealth portfolios.

  • Premature babies to benefit from better patient management at Groote Schuur Hospital

    T-Systems South Africa helps to combine ICT into replicable, cost effective solutions. As part of their Nation Building Initiative, and an extension of their partnership with Wayde van Niekerk, 400m world record holder and Olympic gold medal winner, and his Wayde Dreamer Foundation, the company’s donated a patient management solution to the Newborns Groote Schuur Trust.

    An article in IT-Online says Newborns Groote Schuur Trust, an independent NGO, raises funds to support the Neonatal unit at the Groote Schuur Hospital in Cape Town. The money goes towards care and treatment of over 2,000 of the 40,000 babies born each year in the Metro West.

    The Neonatal Unit’s has been using a manual system for management of communication, especially to track patients, update contact details and schedule appointments. Keeping track of appointments and ensuring parents were notified and reminded of times and cancellations proved difficult, often resulting in missed appointments. Inefficiencies and errors didn’t help.

    T-System’s solution provides better Customer Relationship Management (CRM) using Microsoft Dynamics CRM Online. It manages contact information, patient bookings, appointments, confirmations and generates appointment reminders. It can schedule and manage staff standby rosters too, reducing pressure on doctors and nurses and ensuring their availability.

    Gert Schoonbee, MD at T-Systems South Africa, says “Our involvement in this project is a natural fit, particularly when considering our motto of ‘in South Africa, for South Africa’. We are proud to be involved in this initiative and, together with Wayde, are committed to contributing positively towards reducing the high mortality rate caused by complications in premature babies. We are extremely proud of the role of our partner, Microsoft, who contributed by reducing license fees for their platforms.”

    This is an important development for neo-nateal care at Groote Schuur Hospital. Other hospitals across the country, and all Africa could benefit from it too.

  • MamaYe provides MNH benchmarks and lesson

    Two stark statistics from Nigeria are “Each day in Nigeria, 109 women lose their lives due to pregnancy-related issues and 660 newborns die from preventable causes.” MamaYe has a clear goal to improve it by making “Life-saving change for mothers and babies in Nigeria.” It’s one of six countries in the Evidence for Action (E4A) programme, E4A-MamaYe. The other five are Ethiopia, Ghana, Malawi, Sierra Leone and Tanzania. The initiative aims to use better information, advocacy and accountability to save lives. It’s financed by the Gates Foundation

    Five project reports are published in the International Journal of Gynecology and Obstetrics. They describe accountability arrangements and publicise E4A-MamaYe experiences and achievements in Maternal and Neonatal Health (MNH) that are essential to achieve Sustainable Development Goal (SDG) 3

    The first paper provides a review of the MNH accountability mechanisms in sub-Saharan Africa that have been implemented and assessed. It offers a conceptual framework to guide discussion.

    The second paper discusses political accountability using a review of three global and regional mechanisms used to monitor and track MNH progress. It draws on how global and regional commitments have impacted national responses, as shown in the E4A countries.

    The third paper deals with performance and accountability of Maternal Death Surveillance and Response (MDSR) systems, especially response and action components. It includes describe describes the E4A-MamaYe country experiences in implementing MDSR systems.

    The fourth paper sets out a case study on a pilot for social accountability to improve MNH services in Ghana. The project uses scorecards and engaging stakeholders in districts.

    The fifth paper provides another case study on how evidence supported a campaign on budget advocacy in Sierra Leone. It advocates financial and budget monitoring to ensure financial commitments for MNH are sustained.

    MDSR Technical Guidance proposes several actions to increase effectiveness and sustainability. They include:

    1. A supportive institutional culture fostering a learning environment
    2. Multidisciplinary teams at different health system levels to review, communicate and act on findings
    3. Leadership and commitment of government and healthcare staff
    4. Aggregate data from facility and community to higher levels to provide a deeper understanding of gaps in care quality and system-wide challenges
    5. Recognising that local and less resource-intensive solutions can save lives.

    These are relevant for Africa’s eHealth governance. An example is Nigeria’s Commission on Information and Accountability (COIA) tracking progress on maternal and child health. It reviews MNH features such as the latest MNH numbers, their variations between urban and rural areas, and impact of education on young women using contraception. There’s much more evidence on MamYe’s progress that provide benchmarks and lessons for all Africa.

  • eHealth for sexual and reproductive health has challenges

    As a solution for better health, eHealth may not always be straightforward. A team from Mexico and Colombia reviewed the evidence for eHealth and Sexual and Reproductive Health (SRH) and found clear progress for eHealth for SRH in Latin America and the Caribbean (LAC), many persistent institutional and technological challenges too, and the need for more studies should test eHealth’s beneficial effects on improving access to SRH services. It has an important value for Africa’s health systems and their strategies and plan for eHealth in SRH.

    The team describes its study in an article in the Journal of Public Health Policy, Health information technologies for sexual and reproductive health: Mapping the evidence in Latin America and the Caribbean. It includes an evidence map of articles published between 2005 and 2015 about using eHealth to enhance SRH services in LAC countries. Most documents retrieved correspond to information provided by technology developers and primarily for sexually transmitted infection prevention and adolescent health.

    Maternal mortality rates in LAC have dropped by 38% over the past 15 years. Despite this success, LAC faces many challenges in guaranteeing good quality and affordable SRH services, including controlling HIV infection in vulnerable groups, reducing adolescent pregnancies, and high caesarean section delivery rates. eHealth’s widely proposed as an element of a complementary strategy to strengthen health systems.

    There’s a substantial number and type of eHealth and mHealth services available. The percentage distribution across eHealth from the 31 reports included in the study shows SMS and websites as the most used for SRH.

    There were five main health categories in the review, but they’re not mutually exclusive because eHealth covers more than one. HIV is set apart as the main emphasis.

    About two-thirds of the studies focused on free eHealth. Their distribution across SHR service access priority group focus was wide. The international priority was greatest, communities second.

    The study provides a valuable eHealth status for SRH and a foundation to build from for the next stages of eHealth development. There’s more to do. The report shows that the LAC’s recent efforts to increase the use of eHealth for SRH isn’t derived from a general strategy to expand and evaluate eHealth’s use. Learning from successes in other developing countries should be part of the next steps. This’s good advice for Africa’s health systems too.

  • IHE releases a white paper on family planning

    Maintaining confidentiality when de-identifying data’s important for healthcare’s credibility.  Integrating the Healthcare Enterprise (IHE) has released a white paper, Analysis of Optimal De-Identification Algorithms for Family Planning Data Elements, proposing a new technical framework for comment. It describes the rationale for selecting de-identification algorithms for each IHE Quality, Research and Public Health (QRPH) Family Planning data element. The Family Planning Annual Report (FPAR) de-identification analysis balanced two conflicting perspectives:

    1. Clinical subject matter expert who tends to want to keep as many data elements as possible at as high a level of fidelity as possible
    2. Security and privacy subject matter expert who aim to apply the most restrictive algorithm possible to safeguard the overall data set as much as possible.

    To do this, IHE:

    1. Identified whether each data element is a direct identifier, indirect identifier, or data that does not need to be de-identified
    2. Discussed the purpose and need for each data element.

    Simple so far, but it triggered 32 questions about de-Identification family planning spreadsheet data. After the first set of answers and revised method selected, the set of de-identification algorithms was reviewed to evaluate their effectiveness at reducing risk and identifying if any de-identification algorithms went too far and negatively impacted the performance measures relying on the data. Further passes through the data set and algorithm fine-tuning are set out in the white paper.

    As HIV/AIDS policies and strategies are directly associated with family planning services, it’s important that Africa’s health systems informatics teams working in family planning contribute to IHE’s new technical framework. Participating offers considerable opportunities for learning and personal development, so double benefits.

  • MomConnect’s improved maternity services

    South Africa’s mHealth service, MomConnect has used SMSs to provide pregnant women information with health advice for nearly a year and a half. The team has analysed its compliments and complaints and scrutinised the databases containing information on its operation. The result’s an improved service, showing the benefits of M&E.

    In an article in of the Journal of Public Health Policy, The MomConnect mHealth initiative in South Africa: Early impact on the supply side of MCH services, the MomConnect review team from the School of Public Health, University of Witwatersrand, South Africa National Department of Health (NDoH) and South Africa MEASURE Evaluation Strategic Information for South Africa (SIFSA), says more than 580,000 pregnant women registered on MomConnect, less than half pregnant women booking their pregnancies in South Africa’s public health sector. About 4,170, 0.7%, provided compliments. There were 690 complaints, 0.1%, of which 74% were resolved, leading to better quality such as fewer drug stock-outs and improved behaviour of some health workers.

    Once registered, women receive free SMSs linked to the stage of their pregnancy. They receive messages postnatally, linked to the age of their infant, up to one year. Pregnant women can also interact in three ways with a DoH health desk:

    1. A rating system the day after registration comprising ?ve basic questions about quality
    2. Women can ask for additional information on any topic about their pregnancy
    3. They can log a complaint or compliment about the service they’ve received.

    These activities should be seen in the context of MomConnect’s aims to:

    1. Connect pregnant women to health services
    2. Enable these women to interact with the health system
    3. Improve service delivery
    4. Encourage pregnant women to attend antenatal clinics as early as possible, preferably before 20 weeks of pregnancy.

    The review deals mainly with aims one to three. The findings lay down benchmarks for a subsequent review. Improvements should be expected in the ratio of compliments to complaints by exceeding the 6:1 rate, a general levelling of complaints across the nine provinces and fewer drug stock outs.

    Equivalent benchmarks could be set on the socio-economic and health impact on mothers, babies, infant, families and communities of goal four. These are much more challenging to set and to measure, but provide important information.

    eHNA reported on the MomConnect presentation at eHealth ALIVE in September. The audience was very responsive.

  • South Africa’s MomConnect’s expanding

    Mothers and babies are long-standing health priorities for Africa. South Africa’s MomConnect’s been a source of support for many of its mothers and babies in an effort to reduce their mortality rates, which, up to 2014 and 2015, had been higher than Africa’s average.

    At this year’s eHealth ALIVE conference, Peter Barron, mHealth Advisor to South Africa’s National Ministry of Health set out MomConnect’s history and future. There are several themes to the concept:

    1. South Africa has significant avoidable maternal and child mortality
    2. It has not achieved its Millennium Development Goals (MDG) targets for Maternal Mortality Rates (MMR) and Under Five Mortality Rates (u5MR) and will need a big push to achieve its Sustainable Development Goal (SDG) targets
    3. Strong political leadership from the government and health minister has set in train several initiatives to improve progress towards MDGs and SDGs
    4. MomConnect’s one, aiming to strengthen health system in a number of ways
    5. MomConnect’s built on:
    • Very strong political support and leadership of the National Department of Health (NDoH)
    • mHealth programmes already in place in SA that harness support of a range of stakeholders including funders, technical experts, mobile network operators and training partners, so a true Public Private Partnership (PPP).

    Four activities are:

    1. Strengthen information systems by registering electronically all pregnancies in the public health system as early as possible using unique ID number
    2. Strengthen the demand side of health system by sending targeted health promotion messages to these pregnant women to help them to improve their health and their infants’ health
    3. Provide pregnant women with an interactive mechanism to feedback on the service they’ve received
    4. Use NurseConnect to empower and support nurses with regular content, encourage study and peer support groups and provide feedback mechanism for nurses to make suggestions and improve their performance.

    There are six steps in MomConnect. They’re:

    1. Nurses confirm pregnancies at clinics
    2. Nurses help expectant mothers to register on their mobiles using Unstructured Supplementary Service Data (USSD)
    3. Expectant mothers answer questions about their pregnancies
    4. MomConnect then registers them and links them to their clinic
    5. Their pregnancies are registered in the national database
    6. They receive weekly SMSs appropriate to the stages of their pregnancies about their health and their babies and infants health until their child’s one, and they can opt out at any time.

    MomConnect’s voluntary. In its first two years, nearly 900,000 women registered on MomConnect. The MomConnect Helpdesk has received over 6,000 compliments and 1,000 complaints a ratio of 6:1 often seen as a health service benchmark. Complaints are fed back to relevant facility managers to ensure that problems are addressed. These are matched by answers to more than 200,000 routine questions that arrive at the Help Desk at a rate of about 1,000 a day.

    A survey response of nearly 10,000, about 22%, in 2015 found that:

    1. Over 98% felt that MomConnect messages had helped them
    2. Over 80% shared SMSs with friends or partners, so extending MomConnect’s reach
    3. Over 75% said the SMSs helped them feel more prepared for childbirth and delivery
    4. Over 70% wanted more SMSs than the 100 plus messages they already receive during pregnancy and the first year of their child's life.

    Alongside pregnant mothers, staff are positive about MomConnect. They think it’s a beneficial programme to mothers. Their views were reinforced in February 2016 when MomConnect was ranked as second prize in the African Association for Public Administration and Management Innovation Awards (AAPAM).

    Many lessons have been learned since MomConnect started. They include:

    1. Ministerial and senior NDoH management vision and leadership
    2. Need for full time co-ordination
    3. Harness skills, resources and energy from numerous partners to achieve scale-up
    4. Manage many stakeholder agendas so everyone benefits
    5. Flexible funding for the start-up phase was critical
    6. Appropriate technical solution forms the basis but isn’t enough
    7. Links to the health system are critical
    8. Sharing data with the provincial and district staff important for their commitment.

    Looking forward, MomConnect has several initiatives underway:

    1. An additional service for HIV positive pregnant women to ensure they have additional support, especially those who are at high risk
    2. An overall, formal, independent evaluation is due for completion by independent academic institutions, with results soon
    3. Network issues and time-outs are a barrier to MomConnect registrations, so need fixing
    4. Extending messaging to partners and children up to five years
    5. Other parties are interested in teenage pregnancy, early childhood development and adherence for TB and HIV
    6. Moving to data from SMS as smartphone coverage increases and testing Facebook Messenger and WhatsAPP for communications
    7. Improving the Help Desk to support women and enable the supply side to respond to complaints and address these
    8. Extend support and empowerment of nurses with a mobisite with materials and access to online support
    9. Ensuring sustainability by reducing operational costs of MNOs and setting a mainstream budget into routine NDoH financial management.

    The future’s looking positive for MomConnect. It’s set to take its place with other initiatives as an integrated package to help to reduce maternal and child mortality.