mHealth and Mobile Ultrasound for Mothers in Myanmar (mMUMM)

项目总结 1缅甸西部钦邦少数民族妇女是孕产妇死亡率最高的地区之一 2在亚洲(每10万名活产儿中有357名)。目前，只有不到10%的新生儿在医疗机构出生 3因为大多数女性必须步行两天或更长时间才能到达山区。缺欠 4产前护理和产科超声意味着高危状况，包括臀位和 5多胞胎，通常在产妇临产前不能确定。我们的双重目标 6建议的“缅甸母亲的移动健康和移动超声波”(MMUMM)阶梯式楔形群组 7项随机试验旨在评估：(1)使用移动健康(MHealth)应用程序收集 8人口监测数据，以及(2)使用便携式超声设备改善 9高危妊娠的接生率和转院成功率。MUMM审判 10直接响应缅甸健康与希望组织(HHM)的优先事项，这是唯一的非营利性组织 11在钦邦提供医疗保健。在过去的10年里，HHM建立了全面的健康， 12个缅甸西部的农业和教育方案，包括培训834名社区妇女和166名妇女 13名传统助产士。HHM目前正在将其重点扩展到基于mHealth的人口健康 14在对电信基础设施进行数百万美元投资后收集监控数据 15缅甸各地，包括钦邦，由政府和国际机构提供。在R21阶段，我们 16将1)评估使用移动健康人口健康监测应用程序收集的数据的质量 17(Survey123)，细化以优化质量，以及2)评估数据质量和收集和 18由当地助产士翻译超声图像。在R33阶段，我们将随机选择55个村庄，评估 19移动健康人口监测和移动健康人口监测加超声波对发病率的影响 20%的陪产或转产。我们的中心假设是mHealth和mHealth的结合 21监测和超声检查将增加住院分娩患病率和 22成功将高危妊娠转移到医院。通过更早的识别，助产士可以计划 23在乡村参加低风险分娩，并将高危分娩的妇女转移到医院(远在#年 24可以进行外科手术，包括剖腹产。长期目标 这项研究计划中的25项是为了提高人口健康监测的质量和及时性，以及 26改善缅甸西部这一资源匮乏的偏远地区的孕产妇和儿童状况。

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.