The role of mHealth intervention on maternal and child health service delivery: findings from a randomized controlled field trial in rural Ethiopia.
The role of mHealth intervention on maternal and child health service delivery: findings from a randomized controlled field trial in rural Ethiopia.
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DOI：
10.21037/mhealth.2017.08.04
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发表时间：
2017-01-01
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影响因子：
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通讯作者：
Herbst, Christopher H
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文献类型：
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作者：
Atnafu, Asfaw;Otto, Kate;Herbst, Christopher H
背景技术背景：提供一致和高质量的妇幼保健服务是埃塞俄比亚的一项挑战，因为大多数人口生活在农村。保健服务的提供主要受到保健专业人员短缺、资源贫乏、社会认识有限和官僚程序的限制。据信，产前保健、分娩服务和产后保健等保健服务利用率低是造成孕产妇和儿童死亡率高的原因。创新的方法，如基于mHealth的技术干预，被认为可以减轻像我们这样的国家的挑战。然而，目前，很少有证据表明移动健康技术应用对服务利用率水平的影响。因此，我们的研究的目的是评估移动的电话配备了短消息服务（SMS）为基础的数据交换软件连接社区卫生工作者在农村地区的卫生中心的作用，影响选定的妇幼保健outcomes.METHODS：一个基于社区的随机对照试验（RCT）进行了三个县的Guraghe区（Ezha，部分和Abeshge全面干预，Sodo控制）。向所有卫生推广工作者（HEW）分发了移动的手机，手机配备了基于FrontlineSMS的本地开发的应用程序，HEW填写了孕产妇、儿童和库存相关表格，并提交给中央服务器，中央服务器反过来发送有关ANC访问的预定日期、预产期、PNC、免疫接种时间表以及疫苗和避孕药具库存状态的提醒。此外，在Abeshge，两个干预区的志愿卫生工作者和卫生保健监督员都得到了一部电话，以方便与卫生保健联络。未向对照区提供移动的设备a.对有5岁以下和1岁以下儿童的母亲进行了干预前[2012]和干预后[2013]基于社区的调查，以评估移动的干预对选定妇幼保健过程指标的影响。采用结构化预测试问卷收集数据，使用SPSSv 16统计软件进行分析。结果：调查了三个县的3240名母亲，各1，080名。研究表明，在两个干预区，接受产前护理四次以上的母亲比例显著增加。此外，在Ezha县（T1），卫生保健工作者提供产前护理的比例有所提高（从19.01%提高到28.27%），在所有县，由熟练卫生工作者接生的比例有所增加，在家分娩的比例有所下降;据报告，在Ezha和Abeshge，卫生保健工作者从保健站转诊到保健中心的比例增加最明显。干预还导致Ezha（T1）首选避孕产品缺货率从16.96%显著降低至8.24%，但在对照区和其他干预区，避孕普及率和免疫接种率均无变化。该研究证实了基于短信的移动的电话干预对大多数选定的妇幼保健服务指标的积极贡献，例如，提高产前护理建议就诊次数的百分比、卫生工作者参与分娩的百分比以及促进埃塞俄比亚农村卫生工作者的工作流程。
BACKGROUND: The provision of consistent and quality maternal and child health (MCH) services is a challenge for Ethiopia where most of the population lives in the rural setup. Health service delivery is constrained mainly by shortage of health professionals, meager resources, limited awareness among the society and bureaucratic procedures. Low health service utilization of antenatal care (ANC), delivery services, and postnatal care (PNC) are believed to contribute for high maternal and child mortality rates. Innovative approach like mHealth based technological intervention believed to alleviate such challenges in countries like ours. However, currently, there are few evidences that demonstrate the impact of mHealth technology applications on the level of service utilization. Therefore, the objective our study is to assess the role of mobile phone equipped with short message service (SMS) based data-exchange software linking community health workers to Health Centers in rural Ethiopia affect selected MCH outcomes.METHODS: A community-based randomized control trial (RCT) was conducted in three woredas of Guraghe zone (Ezha, partial &Abeshge full intervention, Sodo Control). Mobile phones equipped with FrontlineSMS based, locally developed application was distributed to all health extension workers (HEWs) to both intervention woredas who filled maternal, child and stock related forms and submitted to the central server which in turn sends reminder about the scheduled date of ANC visit, expected date of delivery, PNC, immunization schedule and vaccine and contraceptive stock status. Moreover, in Abeshge, the voluntary health workers (vCHW) and HEW supervisors in both intervention woreda were given a phone to facilitate communication with the HEW. No mobile was offered to the control woreda.Pre [2012] and post [2013] intervention community based survey on mothers who have under 5 and under 1 year old child was done to assess the effect of the mobile intervention on selected MCH process indicators. Structured and pretested questionnaire was used to collect data and SPSS v16 statistical software was used for analysis.RESULTS: Three thousand two hundred and forty mothers, 1,080 from each, were surveyed in the three woredas. The study revealed that the proportion of mothers receiving more than four ANC visits increased significantly in both intervention woredas. Besides, the rate of ANC delivered by HEWs improved in Ezha woreda (T1) (19.01% to 28.27%), proportions of deliveries attended by skilled health workers increased and home delivery decreased in all woredas; most pronounced increases in referrals from health post to health center by HEWs, reported in Ezha and Abeshge. The intervention also led to a significant reduction in stock-outs of preferred contraceptive products in Ezha (T1) from 16.96% to 8.24% but no change was observed in both contraceptive prevalence and immunization rates in the control and the other intervention woreda.CONCLUSIONS: The study confirmed the positive contribution of SMS based mobile phone intervention in most of the selected MCH service indicators, like improvement in the percent of recommended number of ANC visit, percentage of delivery attended by health workers and facilitating the work processes of the health workers in rural Ethiopia.