Improving the Quality of Antenatal Care Using Mobile Health in Madagascar: Five-Year Cross-Sectional Study
Improving the Quality of Antenatal Care Using Mobile Health in Madagascar: Five-Year Cross-Sectional Study
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DOI：
10.2196/18543
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发表时间：
2020-07-08
影响因子：
5
通讯作者：
Reich, Michael R.
中科院分区：
文献类型：
--
作者：
Benski, Anne Caroline;Schmidt, Nicole C.;Reich, Michael R.
背景：尽管作出了许多努力，孕产妇死亡率仍然是大多数发展中国家的一个主要负担。移动的健康（mHealth）有可能通过帮助患者和提供者的应用程序来改善产科护理的可及性。目的：本研究旨在使用mHealth为马达加斯加农村地区的1446名孕妇提供产前护理（ANC），并评估旨在改变提供者和患者行为的mHealth系统提供的ANC质量。我们纳入了2015年至2019年在马达加斯加农村参加ANC访问的1446名妇女，使用名为妊娠和新生儿诊断评估（PANDA）的移动健康系统。这项横断面研究使用了来自不同参与者的数据，以及几年来收集的信息，以分析随着时间的推移与ANC质量相关的输出。具体而言，我们检查了首次产前检查的时间，孕妇的访问持续时间和风险因素之间的关系，以及每位妇女的产前检查访问次数。结果：在2015年实施移动医疗系统后，我们观察到妇女开始提前进行首次产前检查; 2019年，在怀孕的第二个三个月参加首次ANC访问的妇女比往年更多（P35岁; 25.0 min，95% CI 24.0-25.9），教育水平（对未受过小学教育的妇女和上过大学的妇女延长就诊时间，对受过小学教育的妇女缩短就诊时间; 40.7 min，95% CI 30.2-51.3和25.3 min，95% CI 24.4-26.3 vs 23.3 min，95% CI 22.9-23.8; P=.001），妊娠期间的家庭暴力经历，妊娠，产次，传染病（HIV，疟疾和梅毒）和贫血水平。所有质量指标变量均观察到统计学显著相关性。我们观察到，从2015年到2017年，每名女性的ANC就诊次数在统计学上显著增加;在实施PANDA mHealth系统的第三年后，每名女性的ANC就诊次数趋于稳定。这项研究显示了移动医疗系统在提高ANC质量，通过标准化ANC访问改变提供者行为，并通过增加患者复诊的意愿和鼓励在妊娠早期进行产前护理来改变患者的行为。由于这是一项探索性研究，因此有必要进行进一步的研究，以更好地了解移动健康如何改变行为，并确定行为变化随时间持续所需的条件。
Background: Despite many efforts, maternal mortality remains a major burden in most developing countries. Mobile health (mHealth) has the potential to improve access to obstetric care through apps that help patients and providers.Objective: This study aimed to use mHealth to provide antenatal care (ANC) to 1446 pregnant women in a rural area in Madagascar and evaluate the quality of ANC provided by an mHealth system designed to change the behaviors of providers and patients.Methods: We included 1446 women who attended ANC visits in rural Madagascar from 2015 to 2019 using an mHealth system called Pregnancy and Newborn Diagnostic Assessment (PANDA). This cross-sectional study used data from different participants, with information collected over several years, to analyze the outputs related to the quality of ANC over time. Specifically, we examined the timing of the first ANC visit, the relationship between the visit duration and the risk factors among pregnant women, and the number of ANC visits per woman.Results: Following the implementation of the mHealth system in 2015, we observed that women started to come earlier for their first ANC visit; more women attended their first ANC visit in the second trimester of pregnancy in 2019 than in the previous years (P35 years; 25.0 min, 95% CI 24.0-25.9), educational level (longer visit for women with lower than primary education and for women who attended university and shorter for women with primary school-level education; 40.7 min, 95% CI 30.2-51.3 and 25.3 min, 95% CI 24.4-26.3 vs 23.3 min, 95% CI 22.9-23.8; P=.001), experience of domestic violence during pregnancy, gravidity, parity, infectious diseases (HIV, malaria, and syphilis), and level of anemia. Statistically significant associations were observed for all quality indicator variables. We observed a statistically significant increase in the number of ANC visits per woman over time from 2015 to 2017; the number of ANC visits per woman then became stable after the third year of implementing the PANDA mHealth system.Conclusions: This study shows the potential of an mHealth system to improve the quality of ANC, change provider behavior by standardizing ANC visits, and change patient behavior by increasing the willingness to return for subsequent visits and encouraging ANC attendance early in pregnancy. As this is an exploratory study, further studies are necessary to better understand how mHealth can change behavior and identify the conditions required for behavioral changes to persist over time.