mHealth and Mobile Ultrasound for Mothers in Myanmar (mMUMM)

项目摘要 缅甸西部钦邦的少数民族妇女是孕产妇死亡率最高的国家之一 亚洲2例（每10万活产357例）。目前，只有不到10%的分娩是在医疗机构进行的。 3因为大多数妇女必须步行两天或两天以上，穿过山区才能到达一个。缺乏 产前检查和产科超声波意味着高危条件，包括臀位和 5多胞胎，往往没有确定之前，妇女在劳动提出。我们的双重目标 6个拟议的"为缅甸母亲提供移动保健和移动的超声波"（mMUMM）阶梯楔形集群 7项随机试验旨在评估：（1）使用移动的健康（mHealth）应用程序收集 8人口监测数据，和（2）使用便携式超声设备，以改善 9.助产率和高危孕妇成功转院率。mMUMM试验 10直接响应缅甸健康与希望（HHM）的优先事项， 11在中国提供医疗保健。在过去的10年里，HHM建立了全面的健康， 缅甸西部的12个农业和教育方案，包括培训834名社区卫生工作者和166名 13个传统助产士HHM目前正在将其重点扩大到基于mHealth的人口健康 在电信基础设施投资数百万美元后， 缅甸政府和国际机构在缅甸各地，包括钦邦，共15个。在R21阶段，我们 16将1）评估使用移动健康人群健康监测应用程序收集的数据的质量 17（调查123），优化质量，2）评估数据质量和收集的可行性， 18名当地助产士解读超声波图像。在R33阶段，我们将随机抽取55个村庄， 19移动健康人口监测和移动健康人口监测加超声波对死亡率的影响 20个被照顾或转移的婴儿。我们的中心假设是， 21.监测和超声波检查将增加助产率的综合结果， 22例高危孕妇成功转院通过早期识别，助产士可以计划 23名妇女在那些村庄参加低风险分娩，并将高风险分娩的妇女转移到医院（远在 24提前出生），可以进行外科手术，包括剖腹产。远景目标 该研究计划的25项内容是提高人口健康监测的质量和及时性， 26改善缅甸西部这个偏远、资源匮乏地区的孕产妇和儿童成果。

PROJECT SUMMARY 1 Women in the ethnic minority, Chin state of western Myanmar have one of the highest maternal mortality rates 2 in Asia (357 per 100,000 live births). Currently, less than 10% of births take place in a healthcare facility 3 because most women have to travel two or more days on foot through mountainous regions to reach one. Lack 4 of prenatal care and obstetric ultrasound means that high-risk conditions, including breech position and 5 multiple births, are often not identified prior to the woman presenting in labor. The dual objectives of our 6 proposed “mHealth and Mobile Ultrasound for Mothers in Myanmar” (mMUMM) stepped-wedge cluster 7 randomized trial are to evaluate: (1) the utility of using a mobile health (mHealth) application to collect 8 population surveillance data, and (2) the effectiveness of using a portable ultrasound device to improve the 9 rates of attended births and successful transfers for high-risk pregnancies to a hospital. The mMUMM trial 10 responds directly to the priorities of Health and Hope Myanmar (HHM), the only nonprofit organization 11 providing healthcare in the Chin state. Over the last 10 years, HHM has built comprehensive health, 12 agriculture, and education programs in western Myanmar, including the training of 834 CHWs and 166 13 traditional birth attendants. HHM is currently expanding its focus to mHealth-based population health 14 surveillance data collection following millions of dollars of investment in telecommunications infrastructure 15 across Myanmar, including the Chin state, by the government and international agencies. In the R21 phase we 16 will 1) evaluate the quality of data collected using a mHealth population health surveillance application 17 (Survey123), refine to optimize quality, and 2) assess data quality and the feasibility of collecting and 18 interpreting ultrasound images by local midwives. In the R33 phase we will randomize 55 villages, evaluate the 19 effectiveness of mHealth population surveillance and mHealth population surveillance plus ultrasound on rates 20 of attended or transferred births. Our central hypothesis is that the combination of both mHealth 21 surveillance and ultrasound will increase the composite outcome of prevalence of attended births and 22 successful transfers for high-risk pregnancies to a hospital. Through earlier recognition, midwives can plan to 23 attend low-risk births in the villages and transfer women with high-risk presentations to a hospital (far in 24 advance of the birth) that can conduct surgical procedures, including a cesarean section. The long-term goals 25 of this program of research are to improve the quality and timeliness of population health surveillance, and 26 improve maternal and child outcomes in this remote, low-resource region of Western Myanmar.