Effectiveness of an innovative mHealth intervention to improve coverage of proven maternal and new...
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effectiveness of an innovative mHealth intervention to improve coverage of proven maternal and
newborn health (MNH) interventions in rural India: A quasi-experimental
study
Dr Dhiren Modi
SEWA RURAL, Jhagadia
Gujarat
Date: 10-11-16
Study Design
Quasi Experimental Study
Methods• This study was conducted among all 32 intervention (population:
28,000) and 51 control villages (population: 30,000) in tribal areas of Gujarat, India using quasi-experimental study design in May, 2014 after completing one year of implementation.
• The mHealth intervention is a mobile-phone application in form of a job-aid to village-level frontline workers called ASHAs.
• Primary outcome of interest was coverage of proven MNH interventions.
• A household survey was done by interviewing all women who recently delivered using a structured, pre-tested questionnaire.
• Data analysis was done using STATA IC 10.
“ImTeCHO”(3 COMPONENTS)
Mobile phone as
job aid to….
ASHAs for ensuring her
routine MCH services
Mobile phone as
a job aid to…..
ASHAs/FHWs/
Helpline for better
morbidity management
Web interface at…
PHC level toprovide timely and
accurate information
for better
Support to ASHAs
ImTeCHO = I am support
Daily Login in Morning
Main MenuProvider work planning and scheduling
Data Collection And Reporting
Electronic Decision Support
( Information, Protocols, Algorithm, Checklist)
Electronic Decision Support
( Information, Protocols, Algorithm, Checklist)
Client Education & Behaviour Change Communication ( BCC)
List of videos
1. Mamta Divas
2. Antenatal Complication
3. Birth preparedness and complication Readiness
4. Breast Feeding
5. Early New Born Care
6. New Born Complications
7. Malnutrition Part One
8. Malnutrition Part Two
9. Immunizations
High risk tracking and Follow up
Financial transaction & Incentives
Supply Chain Management
Results
During pregnancy Intervention
Frequency (%)
N=50
Control
Frequency (%)
N=49
Unadjusted
Odds ratio
(95%
Confidence
interval)
Early registration of pregnancy within first three
months 41 (82) 28 (57)
3.42
(1.37-8.55)
At least four ANC examinations by an ANM or doctor
48 (96) 45 (91)
2.13
(0.37-12.22)
Visited at home by an ASHA at least 3 times during last
pregnancy 45 (90) 28 (57)
6.75
(2.28-19.94)
Received satisfactory counseling for antenatal care from
an ASHA during home visit 43 (86) 18 (36)
10.58
(3.94-28.41)
Respondent able to state at least 3 danger signs of
pregnancy 34 (68) 28 (57)
1.59
(0.70-3.62)
Respondent took more than 100 tablets of iron-folic
acid during pregnancy 25 (50) 21 (42)
1.33
(0.60-2.94)
During delivery and postpartum period Intervention
Frequency (%)
Control
Frequency (%)
Unadjusted
Odds ratio
(95%
Confidence
interval)
Hospital delivery 38 (76) 35 (71) 1.27
(0.52-3.11)
Early initiation of breast feeding 45 (90) 36 (73) 3.25 (1.06-9.97)
ASHA visited at home within 24 hours of delivery (in
case of home delivery) or within 24 hours of return to
home from hospital in case of hospital delivery
42 (84) 34 (69) 2.32
(0.89-6.11)
At least 2 home visits by an ASHA within the first week
of delivery
41 (82) 25 (51) 4.37
(1.75-10.90)
At least 5 home visits by an ASHA within the first
month of delivery & 2 home visits within the first week
28 (56) 5 (10) 11.2
(3.80-32.99)
Received satisfactory counseling for postnatal care
from an ASHA during home visit
34 (68) 9 (18) 9.45
(3.70-24.08)
Mother able to state at least 3 danger signs of newborn 45 (90) 36 (73) 3.25
(1.06-9.97)
Care seeking for complications
Intervention
Frequency (%)
Control
Frequency (%)
Unadjusted
Odds ratio
(95%
Confidence
interval)
Sought help from ASHA for antenatal maternal
complication
24 out of 31
cases (77)
19 out of 33
cases (57)
2.53
(0.85-7.51)
Sought help from ASHA for postnatal maternal
complication
8 out of 13
cases (61)
1 out of 11
cases (9)
16.0
(1.54-166.05)
Sought help from ASHA for neonatal
complication
15 out of 19
cases (78)
5 out of 18
cases (27)
9.75
(2.15-44.14)
Child 6 to 9 MonthsIntervention
Frequency (%)
N=95
Control
Frequency
(%)
N=92
Unadjusted Odds Ratio
(Confidence interval)
Exclusive breast feeding during first
six months
42 (44) 22 (23) 2.5 (1.29-4.98)
Child was fed solid, semisolid or
soft food at least once within last 24
hours
73 (74) 71 (79) 0.77 (0.37-1.62)
Mother knew status of child on WHO
growth chart
28 (29) 5 (5) 7.20 (2.56-25.17)
Mother obtained ORS from ASHA for
child’s diarrhea
6 out of 44
cases (14%)
2 out of 32
cases (6%)
2.3 (0.38-25)
Mother sought help from ASHA for
child’s pneumonia/fever
45 out of 111
cases (41%)
21 out of 89
cases (24%)
2.2 (1.14-4.33)
Conclusion
MHealth interventions can help ASHAs significantly improve coverage of MNH interventions along continuum of care in hard to reach areas. Scaling up mHealth interventions in other tribal areas might be considered.
What next….
Cluster Randomized Trial is going on with the technical and financial help from ICMR: Delhi, WHO: Geneva , Mac Arthur Foundation: USA
Acknowledgements
• ASHAs and PHC staff of the two PHCs in Jhagadia..
• Jamsetji Tata Trust , Mumbai for financial support of this project. Allsupervisors and employees at SEWA Rural for training, mentoring,and providing support and motivation to all ASHAs. Department ofHealth and Family Welfare for facilitating implementation ofImTeCHO.
• IT team Argusoft India Ltd. for tirelessly working closely with SEWARural to develop and improvise the ImTeCHO application.
Thanks…