Assessment of the Quality of Antenatal Care Services Provided by Health Workers Using a Mobile Phone Decision Support Application in Northern Nigeria: A Pre/Post-Intervention Study

Abstract

BackgroundGiven the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs) are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre.MethodsUsing the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care.ResultsOverall, the quality score increased from 13.3 at baseline to 17.2 at endline (p<0.0001), out of a total possible score of 25, with the most significant improvements related to health counseling, technical services provided, and quality of health education.ConclusionThese study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.

Mobile Health Application in Implementation of Maternity Nursing Care: Literature Review

“…The results shows that the use of this application improves the quality of antenatal care in various aspects of service. These results were consistent with respondents' satisfaction which showed a statistically significant increase after using m4Change (Mcnabb et al, 2015).…”

“…Almost all of the study show that mobile health application help mother and father to enhance health status on her pregnancy especially for working mom (Chaves et al, 2017;Premji, 2014;Jennings et al, 2016;Obasola, Mabawonku, & Lagunju, 2015;Felicie et al, 2016;Ledford et al, 2016;Mcnabb et al, 2015, Waring et al, 2014Spiby et al, 2014, Asiodu et al, 2015Rhyne & Borawski, 2014;Guerra-reyes et al, 2017;Smith) . Inline with previous study from Western countries, the 7 studies from non-Western countries including Africa, India, Bangladesh, Australia found that mobile health can give positive impact for pregnant mom Balakrishnan et al, 2016;Forti, Stapleton, & Kildea, 2013;Huq, Azmi, Quaiyum, & Hossain, 2014;Khatun et al, 2015;Lupton & Pedersen, 2016;Khatun et al, 2017).…”

Trends, Findings, and Opportunities: An Archival Review of Health Information Systems Research in Nigeria

“…These studies provide some evidence for same. For example, McNabb et al (2015) developed a mobile application to collect patient antenatal data and provide primary healthcare workers with assisted guidance when treating patients, which resulted in improvements in the service provided by workers. Other organizational challenges include corruption in the Nigerian government, resistance to adoption among end users (Benson, 2011a), and the role of culture.…”

“…For example, it is argued that electronic medical records have the potential to transform health data collection in Nigeria at a low cost (Thompson et al, 2010). Further more recent research purports their mobile health intervention provides a low cost means of collecting patient data and assisting primary health workers in delivering high quality care (McNabb et al, 2015). Financing remains a key issue on a practical level in Nigeria.…”

“…Some studies developed and tested new HIS interventions. For example, one study tested the effectiveness of mobile health interventions for improving antenatal care services (McNabb et al, 2015) and another explored the potential of electronic medical records for collecting data in a family clinic (Thompson et al, 2010). This illustrates the variety of applications of technology within healthcare in Nigeria.…”