• Maternal, child and reproductive health
  • Burkina Faso’s MOS@N muestra el valor de compromiso

    Para alcanzar la Cobertura Universal de Salud (UHC)  se necesita que el acceso a la atención médica sea mas amplio. En Burkina Faso, MOS@N, un proyecto de mHealth está ayudando a las poblaciones vulnerables del distrito de Nouna a mejorar su acceso y lograr una mejor salud. Tambien, al superar los prejuicios de género, ha mejorado el estatus de las trabajadoras de la salud. 

    Las altas tasas de mortalidad materna son un importante desafío de la salud pública para Burkina Faso. Nouna tiene 341 muertes maternas por cada 100.000 nacidos vivos. Solo el 70% de las mujeres recibe atención prenatal y el 34% da a luz en el hogar. Las tasas de VIH / SIDA siguen siendo altas, con alrededor del 30% de las personas infectadas que no siguen el tratamiento requerido. 

    El acceso a la atención materna enfrenta numerosos obstáculos. Incluyendo las distancias a los centros de salud, la escasez de personal de salud calificado, la falta de información sobre la salud sexual y reproductiva y los altos costos del tratamiento médico. La información de salud para mujeres embarazadas y proveedores de servicios de salud a menudo no se entrega en el momento adecuado y podria estar desactualizada. Los valores sociales paternalistas profundamente arraigados pueden llevar a que muchos hombres prohíban a sus esposas asistir a los centros de salud en lugar de trabajar en los campos. 

    Lanzado en 2013, el nombre de MOS@N se deriva de móvil y santé. Su objetivo es mejorar el acceso de la atención de calidad para madres, niños y personas con VIH / SIDA. Al principio, los investigadores del Centro de Investigación en Salud de Nouna, un instituto de investigación del Ministerio de Salud, se dispusieron a determinar si las TIC y los teléfonos móviles podrían mejorar la administración de la salud para un acceso más equitativo a la asistencia sanitaria. Financiado por el Centro Internacional de Investigaciones para el Desarrollo (IDRC) y llevado a cabo en colaboración con la Universidad de Montreal, MOS@N se desplegó en centros de salud que prestaban servicios en 26 aldeas.

    El estudio, Posicionamiento de la Salud Movil: un estudio cualitativo de las expectativas de mHealth en el distrito de salud rural de Nouna, Burkina Faso, publicado en Springer, confirmó el éxito de MOS@N en el fortalecimiento del sistema de salud y la mejora del acceso. A fines de 2016, 2.161 mujeres embarazadas habían recibido atención prenatal. Los partos asistidos aumentaron en un 50% a más del 97%. Los trabajadores de la salud pudieron rastrear a casi 260 pacientes que viven con el VIH y lograron una baja tasa de abandono de solo el 1.6% de los casos. 

    MOS@N también aumentó la equidad y la participación en la administración de la salud. Las mujeres fueron fundamentales para la implementación del proyecto y ayudaron a determinar los servicios de salud materno e infantil ofrecidos. Unos contactos directos más fuertes con los centros de salud y un fácil acceso a la información les ayudará a mantener los logros alcanzados. 

    Un artículo del IDRC en la web de Relief dice que “marraines”, madrinas, que usan teléfonos móviles, se han convertido en actores centrales en la educación y movilización de la salud, roles que anteriormente desempeñaban los trabajadores de la salud de la comunidad masculina. Elegidos por los líderes de las aldeas para acompañar a las mujeres durante el embarazo y el parto, las “marraines” son intermediarias entre su comunidad y los trabajadores de la salud.

    MOS@N enfatiza el papel de la comunidad en la entrega de tratamiento, el seguimiento de pacientes y la entrega de mensajes y recordatorios de concientización. Integra los roles de los centros de atención primaria de salud local, trabajadores de salud, técnicos de TIC, “marraines”, líderes comunitarios e investigadores de salud pública. 

    Se desarrolló localmente utilizando software de código abierto y permite el acceso a la información sobre atención médica materno e infantil y la vida con VIH. Los sistemas de mensajes de texto e interactivos brindan mensajes en cinco idiomas locales, personalizados para satisfacer sus necesidades específicas, que incluyen recordatorios de citas para madres, asegurando la inclusión y una mayor accesibilidad. Todo el contenido cumple con las pautas nacionales para una amplia gama de atención médica. Incluye atención pre y posnatal, parto asistido, vacunación contra la polio y el tétanos, prevención del paludismo y seguimiento de pacientes. Otras características son un sistema central de información de salud desarrollado e integrado en las instalaciones de salud del distrito para recopilar los datos necesarios para el seguimiento y toma de decisiones.

    MOS@N y los hallazgos del estudio ayudarán a guiar las iniciativas de mHealth. El diseño y la implementación que satisfagan las necesidades específicas de los usuarios optimizarán las posibilidades de éxito. Proporciona lecciones para mHealth de África.

  • Burkina Faso’s MOS@N to improve access to quality care for mothers, children and people with HIV/AIDS

    Achieving Universal Health Coverage (UHC) needs expanded healthcare access. In Burkina Faso, MOS@N, an mHealth project’s helping vulnerable populations in the Nouna district improve their access and achieve better health. By overcoming gender biases, it’s enhanced women health workers’ status too.

    High maternal mortality rates are a major public health challenge for Burkina Faso. Nouna has 341 maternal deaths per 100,000 live births. Only 70% of women receive prenatal care and 34% give birth at home. HIV/AIDS rates remain high, with about 30% of people infected not following up required treatment.

    Accessing maternal care confronts numerous obstacles. They include distances to health centres, shortages of skilled health staff, lack of information on sexual and reproductive health and high medical treatment costs. Health information for pregnant women and health providers is often not delivered at the right time and can be out-of-date. Deep-rooted paternalistic social values can lead many men forbidding their wives attend health centres instead of working in the fields. 

    Launched in 2013, MOS@N’s name’s derived from mobile and santé. Its goal’s to improve access to quality care for mothers, children and people with HIV/AIDS. At the outset, researchers at the Centre de Recherche en Santé de Nouna, a Ministry of Health research institute, set out to determine if ICT and mobile phones, could improve health governance and more equitable healthcare access. Funded by the International Development Research Centre (IDRC) and carried out in collaboration with the University of Montreal, MOS@N was deployed in health centres serving 26 villages. 

    The study, Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso,published in Springer, confirmed MOS@N’s success in strengthening the health system and improving access. By the end of 2016, 2,161 pregnant women had received prenatal care. Assisted childbirths increased by 50% to over 97%. Health workers were able to track almost 260 patients living with HIV and achieve a low drop-out rate of only 1.6% of cases. 

    MOS@N also increased equity and participation in health governance. Women were central to the project’s implementation and helped determine the maternal and child health services offered. Stronger direct contacts with the health centres and ready access to information will help them maintain the gains made 

    An article by IDRC in Relief web says marraines, godmothers, using mobiles, have become central players in health education and mobilisation, roles previously played by male community health workers. Chosen by village leaders to accompany women through their pregnancy and childbirth, marraines are intermediaries between their community and health workers.

    MOS@N emphasises the community’s role in delivering treatment, monitoring patients and delivering awareness-raising messages and reminders. It integrates the roles of local primary healthcare centres, health workers, ICT technicians, marraines, community leaders and public health researchers.

    It was developed locally using open source software, and enables access to information about maternal and child healthcare and living with HIV. Text and interactive voice messaging systems provide messages in five local languages, customised to meet their specific needs, including appointment reminders for mothers, ensuring inclusiveness and greater accessibility. All content complies with national guidelines for a wide range of healthcare. It includes pre and postnatal care, assisted delivery, vaccination against polio and tetanus, malaria prevention, and patient follow-up.

    Other features are a core health information system developed and integrated in district health facilities to collect data needed for follow-up and decision-making.

    MOS@N and findings from the study will help guide mHealth initiatives. Design and implementation that meets users’ specific needs will optimise the chances of success. It provides lessons for Africa’s mHealth.

  • Indian Ministry of Health pilots mHealth services

    Indian Health Ministry has stepped up its mHealth and eHealth services. The programme currently focuses on two districts. Baglung and Ilam. mHealth uses mobile apps and text messaging services to track pregnant mother´s ante-natal visits.

    An article in the Kathmandu Post says Medic Mobile, an organisation operating in 23 countries, signed a Memorandum of Understanding (MoU) to scale up the programme in several districts. The MoU will strengthen health systems by promoting mHealth access, especially in isolated communities. Medic Mobile will also provide technical advice and support so eHealth and mHealth solutions are implemented and leveraged more effectively.

    So far, it’s been implemented by 83 Village Development Committees (VDC) in Gorkha and Dhading districts. Other districts will be able to build from the initial scale.  

    In Baglung, the Female Community Health Volunteers (FCHV) use mHealth to remind expecting mothers of their health facility schedules and visits. The service has been successful. The Family Health Division director, Dr Naresh Pratp KC, said the mHealth and SMS services “Have been effective to increase ante-natal visits.” 

    The service includes:

    Details of pregnant mothers are  entered onto an appReminders are forwarded periodically to FCHVsFCHVs are kept up to date of any complicated cases.

    Ante-natal care ensures a reduced risk of complications in pregnancy. However, irregular attendance by pregnant mothers on their mandatory four visits to health facilities’s an issue. Only 69% of women visited health facilities four times. It drops to 62% in rural areas. In urban areas, the figure’s 75%. 

    Bhogendra Dotel, the ministry spokesperson, said the mHealth services will soon be extended to track immunisation and disease surveillance. The initiative has important lessons for Africa’s health systems. Their maternity services share equivalent challenges and priorities.

  • An SMS service improves HIV mothers’ and babies health

    The UN’s SDG 3 has two goals to improve health and wellbeing for pregnant women and babies. A study reported in Taylor and Francis Online shows that SMSs can help to improve these.

    An international research team from the University of Witwatersrand, the Karolinska Institutet, Johns Hopkins University, Princeton University and the United Nations Foundation evaluated the effectiveness of an SMS service aiming to improve the maternal health and HIV outcomes of HIV+ pregnant women. 

    Twice a week, SMSs were sent to 235 HIV+ pregnant women. They continued until their children’s first birthday. Content included maternal health advice and HIV support information.

    Outcomes were measured as Ante-Natal Care (ANC) visits, birth outcomes and infant HIV testing. They were compared to a control group of 586 HIV+ pregnant women who received no SMSs. Results showed marked benefits. Intervention group women attended more than 31% more ANC visits, and were more likely to attend at least the recommended four ANC visits.

    Birth outcomes of the intervention group improved too. The women had an increased chance of a normal vaginal delivery and a lower risk of a low-birth weight baby. 

    The intervention group had a trend towards higher infant polymerase chain reaction (PCR) testing for HIV within six weeks of birth. It also had a lower mean infant age in weeks for HIV PCR tests.

    The team concluded that its results add to the growing evidence that mHealth can have a positive impact on health outcomes. It should be scaled nationally after comprehensive evaluation. For a large-scale mHealth programme, Africa’s health systems may have to invest in extra ANC and PCR testing capacity.

  • Protecting our children from HPV

    One in every eight women in South Africa die from complications of  cervical cancer. Each year, 5,743 new cases of cervical cancer are reported. Almost half of these, 3,027 cases are fatal.

    About 80% of cervical cancers are caused by the Human Papilloma Virus (HPV). It infects the genital area and causes anything from a small genital wart to cervical and other cancers. Vaccination can prevent the virus infection developing on the cervix. 

    In 2014, the South African National Departments of Health (NdoH) and Basic Education launched a national vaccination campaign to prevent cervical cancer by vaccinating girls aged over nine against HPV. The vaccination was aimed at 500 000 girls from 17 000 public and special schools to provide them with protection before they can be exposed to HPV infection. 

    In co-ordination with the government’s Integrated School Health Programme (IHSP), school health nurses visit schools twice a year to vaccinate the girls. None of them are vaccinated without parental consent.

    As the vaccination campaign grew, collecting data became more complex and challenging. NDoH approached the Health Information Systems Program South Africa (HISP-SA) to lead implementation of a mobile data capturing application. It supports data capture during the campaigns. 

    The app’s part of the NDoH's routine health information system, DHIS2, sometimes referred to as webDHIS. It was customised for the campaign by HISP-SA’s Lusanda Ntoni and piloted in three provinces. Then, it was developed further using findings from field visits, and implemented during the 2016 campaign. 

    A Standard Operating Procedure (SOP) document helps vaccinators and data capturers to transfer HPV data from registers into the tracker capture app. There’s also a guideline for programme managers and information officers on accessing dashboards with information from the campaign on  webDHIS. These were updated as the app was implemented. 

    To date, the app’s been implemented in all nine provinces in South Africa, a task co-ordinated by HISP SA’s HPV project manager, Margaret Modise. It’s simplified HPV dashboards for monitoring and reporting and shows how a simple mHealth initiative can enhance the productivity of vaccination campaigns. Will this way of capturing data lead to more large-scale campaigns in South Africa?   

  • MAF’s film empowers girls and women with better puberty knowledge

    Having a period is natural. It’s part of normal life for girls and women. For many girls, their journeys into adolescence can be challenging, and having to face significant pressures and stigma.

    Filmed in Kibera, Kenya, the latest release from Medical Aid Films (MAF) provides an overview of menstruation and the processes that occur during puberty. It’s designed to empower girls with simple knowledge, including basic biology and hygiene practice, and encourage them to integrate this natural process into their daily routines and life styles and standing in society. It aims to help keep them in education too. 

    The lack of effective reproductive health education and sanitary products are some of the key factors resulting in as many as 1 million girls in Kenya missing out on school. Some girls in Uganda miss up to eight days each school term, 11% of their total learning days each year. For the same reasons, it’s been estimated that 10% of girls across Africa miss school when they have their periods.

    The combined lack of access to information with the need for sanitary pads and stigmatisation leaves young girls susceptible to disease, unplanned pregnancies, early marriage and female genital mutilation. Any of these can result in unnecessary dropout rates amongst teenage girls in school. To put it simply, adolescence can lead to the end of education for many girls around the world.

    The film was filmed alongside Carolina for Kibera, an international NGO that uses sports to teach healthy life choices and promote peace across gender and ethnic divides in Kibera. Both MAF and Carolina for Kibera hope that communities and health workers use this film around the world to show young females that menstruation’s normal and shouldn’t affect their access to education and quality of life.

  • 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 productsFree health content from the TV series Hello DoctorVodacom’s infotainment platform Video PlayEducational 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.