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RoadMApp: a feasibility study for a smart travel application to improve maternal health delivery in a low resource setting in Zimbabwe.

ABSTRACT: BACKGROUND:Travel time and healthcare financing are critical determinants of the provision of quality maternal health care in low resource settings. Despite the availability of pregnancy-related mHealth and smart travel applications, there is a lack of evidence on their usage to travel to health facilities for routine antenatal care and emergencies. There is a shortage of information about the feasibility of using a custom-made mobile technology that integrates smart travel and mHealth. This paper explores the feasibility of implementing a custom-made geographically enabled mobile technology-based tool (RoadMApp) to counter the adverse effects of long travel times for maternal care in Kwekwe District, Zimbabwe. METHODS:We frame the paper using the first two steps (listen & plan) of the Spiral Technology Action Research (STAR model). The paper uses an exploratory case study design and Participatory Learning Approaches (PLA) with stakeholders (community members) and in-depth interviews with key informants (health care service providers, pregnant women, transport operators). One hundred ninety-three participants took part in the study. We conducted focus group discussions with pregnant women, women of childbearing age, men (household heads), and elderly women. The discussion questions centered on travel time, availability of transport, cellular network coverage, and perceptions of the RoadMApp application. Data were analysed thematically using Nvivo Pro 12. RESULTS:Most parts of rural Kwekwe are far from health facilities and have an inefficient road and telecommunications network. Hence, it is hard to predict if RoadMApp will integrate into the lives of the community - especially those in rural areas. Since these issues are pillars of the design of the RoadMApp mHealth, the implementation will probably be a challenge. CONCLUSION:Communities are keen to embrace the RoadMApp application. However, the feasibility of implementing RoadMApp in Kwekwe District will be a challenge because of maternal health care barriers such as poor road network, poor phone network, and the high cost of transport. There is a need to investigate the social determinants of access to maternity services to inform RoadMApp implementation.

SUBMITTER: Nyati-Jokomo Z

PROVIDER: S-EPMC7457488 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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RoadMApp: a feasibility study for a smart travel application to improve maternal health delivery in a low resource setting in Zimbabwe.

Nyati-Jokomo Zibusiso Z Dabengwa Israel Mbekezeli IM Makacha Liberty L Nyapwere Newton N Dube Yolisa Prudence YP Chikoko Laurine L Vidler Marianne M Makanga Prestige Tatenda PT

BMC pregnancy and childbirth 20200831 1

<h4>Background</h4>Travel time and healthcare financing are critical determinants of the provision of quality maternal health care in low resource settings. Despite the availability of pregnancy-related mHealth and smart travel applications, there is a lack of evidence on their usage to travel to health facilities for routine antenatal care and emergencies. There is a shortage of information about the feasibility of using a custom-made mobile technology that integrates smart travel and mHealth. ...[more]

PMID: 32867716

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Project description:BackgroundIn low-resource settings, patient referral to a hospital is an essential part of the primary health care system. However, there is a paucity of study to explore the challenges and quality of referral coordination and communication.ObjectiveThe purpose of this research was to analyze the existing paper-based referral registration logbook for maternal and child health in general and women of reproductive age in particular, to improve referral coordination and evidence-based services in Low-Resource Settings.MethodsThis study analyzed the existing paper-based referral registration logbook (RRL) and card-sheet to explore the documentation of the referral management process, and the mechanism and quality of referrals between the health center (Jimma Health Center-case, Ethiopia) and the Hospital. A sample of 459 paper-based records from the referral registration logbook were digitized as part of a retrospective observational study. For data preprocessing, visualization, and analysis, we developed a python-based interactive referral clinical pathway tool. The data collection was conducted from August to October 2019. Jimma Health Center's RRL was used to examine how the referral decision was made and what cases were referred to the next level of care. However, the RRL was incomplete and did not contain the expected referral feedback from the hospital. Hence, we defined a new protocol to investigate the quality of referral. We compared the information in the health center's RRL with the medical records in the hospital to which the patients were referred. A total of 201 medical records of referred patients were examined.ResultsA total of 459 and 201 RRL records from the health center and the referred hospital, respectively, were analyzed in the study. Out of 459, 86.5% referred cases were between the age of 20 to 30 years. We found that "better patient management", "further patient management", and "further investigation" were the main health-center referral reasons and decisions. It accounted for 40.08%, 39.22%, and 16.34% of all 459 referrals, respectively. The leading and most common referral cases in the health center were long labor, prolonged first and second stage labor, labor or delivery complicated by fetal heart rate anomaly, preterm newborn, maternal care with breech presentation, premature rupture of membranes, malposition of the uterus, and antepartum hemorrhage. In the hospital RRL and card-sheet, the main referral-in reasons were technical examination, expert advice, further management, and evaluation. We found it overall impossible to match records from the referral logbook in the health center with the patient files in the hospital. Out of 201, only 13.9% of records were perfect matching entries between health center and referred hospital RRL. We found 84%, 14.4%, and 1.6% were appropriate, unnecessary and unknown referrals respectively.ConclusionThe paper illustrates the bottlenecks encountered in the quality assessment of the referrals. We analyzed the current status of the referral pathway, existing communications, guidelines and data quality, as a first step towards an end-to-end effective referral coordination and evidence-based referral service. Accessing, monitoring, and tracking the history of referred patients and referral feedback is challenging with the present paper-based referral coordination and communication system. Overall, the referral services were inadequate, and referral feedback was not automatically delivered, causing unnecessary delays.

Project description:OBJECTIVES:To improve maternal health services in rural areas, the Palestinian Ministry of Health launched a midwife-led continuity model in the West Bank in 2013. Midwives were deployed weekly from governmental hospitals to provide antenatal and postnatal care in rural clinics. We studied the intervention's impact on use and quality indicators of maternal services after 2?years' experience. DESIGN:A non-randomised intervention design was chosen. The study was based on registry data only available at cluster level, 2?years before (2011and2012) and 2?years after (2014and2015) the intervention. SETTING:All 53 primary healthcare clinics in Nablus and Jericho regions were stratified for inclusion. PRIMARY AND SECONDARY OUTCOMES:Primary outcome was number of antenatal visits. Important secondary outcomes were number of referrals to specialist care and number of postnatal home visits. Differences in changes within the two groups before and after the intervention were compared by using mixed effect models. RESULTS:14 intervention clinics and 25 control clinics were included. Number of antenatal visits increased by 1.16 per woman in the intervention clinics, while declined by 0.39 in the control clinics, giving a statistically significant difference in change of 1.55 visits (95%?CI 0.90 to 2.21). A statistically significant difference in number of referrals was observed between the groups, giving a ratio of rate ratios of 3.65 (2.78-4.78) as number of referrals increased by a rate ratio of 3.87 in the intervention group, while in the control the rate ratio was only 1.06.Home visits increased substantially in the intervention group but decreased in the control group, giving a ratio of RR 97.65 (45.20 - 210.96) CONCLUSION: The Palestinian midwife-led continuity model improved use and some quality indicators of maternal services. More research should be done to investigate if the model influenced individual health outcomes and satisfaction with care. TRIAL REGISTRATION NUMBER:NCT03145571; Results.

Project description:BackgroundPerinatal depression and anxiety (PDA) is prevalent in new and expectant mothers, affecting millions of women worldwide. Those with a history of mood and anxiety disorders are at the greatest risk of experiencing PDA in a subsequent pregnancy. Current safety concerns with pharmacological treatments have led to a greater need for adjunctive treatment options for PDA. Changes in the composition of the microbiome have been associated with various diseases during pregnancy, and these changes are thought to play some role in perinatal mood disorders. While the relationship between PDA and the microbiome has not been explored, evidence suggests that nutritional interventions with fiber, fish oils, and probiotics may play a favorable role in neuropsychiatric outcomes during and after pregnancy. The primary objective of the present study is to assess the feasibility and acceptability of a combination of nonpharmacological interventions to maintain stability in pregnant women who have a history of depression and/or anxiety. This study will also aim to understand ease of recruitment and protocol adherence in this cohort.MethodsThis is a single-centered, partially randomized, placebo-controlled, double-blind feasibility trial. One hundred pregnant women with a history of depression and/or anxiety/PDA will be recruited and randomized into one of four arms, which could include the following: receiving a daily dose of both investigational products and dietary counseling on increasing dietary fiber, receiving a daily dose of both investigational drugs only, receiving fish oil investigational product and placebo, and a control arm with no intervention. The study involves six study visits, all of which can be conducted virtually every 3 months from the time of enrollment. At all study visits, information on diet, mental health, physical activity, and sleep quality will be collected. Additionally, all participants will provide a stool sample at each visit.DiscussionIt is anticipated that pregnant women with a history of depression and anxiety will be particularly interested in partaking in this trial, resulting in favorable recruitment rates. Given the positive findings of omega-3 fatty acids (O3FAs) and probiotic supplements on mental health symptoms in nonpregnant adults, we expect a similar trend in PDA symptoms, with a low likelihood of adverse events. This study will build the foundation for larger powered studies to further contribute evidence for the efficacy of this potential preventative treatment option.Trial registrationThis trial was registered at ClinicalTrials/gov on October 6, 2023; NCT06074250. Trial Sponsor: The Canadian College of Naturopathic Medicine, 1255 Sheppard Ave E, Toronto, ON M2K 1E2, 416-498-1255.

Dataset Information

RoadMApp: a feasibility study for a smart travel application to improve maternal health delivery in a low resource setting in Zimbabwe.

Publications

RoadMApp: a feasibility study for a smart travel application to improve maternal health delivery in a low resource setting in Zimbabwe.

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