• Maternal, child and reproductive health
  • 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 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.