Nowhere are global inequalities more starkly evident than in maternal, newborn and child health. The WHO/UNICEF Interagency report for 2013 details that in high income countries there are only 16 maternal deaths per 100,000 births compared to around 240 maternal death per 100,00 births in low income countries, while a child in born in a low income country is approximately 18 times more like to die before the age of 5. More than 95% of these deaths occur in sub-Saharan Africa and Southern Asia, which has prompted the UN into listing “Reduce Child Mortality” and “Improving Maternal Health” as the 4th and 5th Millennium Development Goals.
As 2015 draws near, the prospect of achieving these goals appears bleak, with some countries experiencing an increase, rather than a decrease in maternal and child mortality. Healthcare workers are therefore turning to new technologies to respond to these challenges, and the ubiquity and increased penetration of mobile phones to all parts of the globe represent a unique opportunity. In Africa alone there are more than 600 million mobile phone users, and thus applying mobile phones in healthcare (mHealth) is becoming an increasingly popular tool to strengthen limited healthcare systems.
mHealth is particularly attractive in Maternal and Child Health as it offers a way to cover the three stages of continuum of care for maternal, newborn and child health (MNCH) as defined by the WHO, and covers the comprehensive trajectory of heath needs for women and children over this period. The technology has been increasingly adopted and developed by small scale, donor-funded programs such as MAMA, but there is currently a shift for the development of overarching policy and management frameworks at the national level. This requires evidence of its potential value and impact on maternal and child care which is still lacking. There are signs, however, that the evidence is starting to grow and one such example is the Wired Mothers project in Tanzania.
A Wired Mother (from Lund et al, 2014)
The Wired Mothers mobile phone intervention was designed with the aim to link pregnant women to their primary health care provider throughout their pregnancy, childbirth, and postpartum period. The intervention was developed in Tanzania using simple technology and at low cost. The program consisted of two components: an automated short message service (SMS) system providing wired mothers with unidirectional text messaging and a mobile phone voucher system providing the possibility of direct two-way communication between wired mothers and their primary health care providers. In order to evaluate the association between mobile phone intervention and antenatal care in this resource-limited setting, the researchers carried out a cluster randomized control trial in clinics on the island of Zanzibar. This study has produced seminal evidence for a positive effect of mHeath on 3 different outcomes of maternal and child health:
1) The Wired Mothers intervention significantly increased the proportion of women receiving the recommended four antenatal care visits during their pregnancy (Lund et al, 2014a)
2) The mobile phone intervention significantly increased skilled delivery attendance amongst women in urban environments (Lund et al, 2014b).
Photo from GlobalHealthCheck.org
3) The mobile phone intervention was associated with a significant reduction in perinatal mortality at 42 days (Lund et al, 2014c).
Photo Credit: © 2012 FELM/organization, Courtesy of Photoshare
This study is one of the few examples using a randomized design which is considered the “gold-standard” for evidence-based data. But as data is being generated all the time, the eHealth Research Group at the University of Edinburgh Medical School is undertaking a systematic review and meta-analysis of all data on the effectiveness of mHealth interventions for maternal, newborn and child health in low- and middle-income countries. This analysis of all publications between 1990 and 2014, in addition to assessment of on-going, unpublished studies will help to generate the evidence-base that is required to respond to the policy implications of the findings of smaller individual studies, and guide the development of appropriate national and international strategies in this field.