Boosting antenatal care attendance and number of hospital deliveries among pregnant women in rural communities: a community initiative in Ghana based on mobile phones applications and portable ultrasound scans

Abstract

BackgroundThe World Health Organization has recommended at least four antenatal care (ANC) visits and skilled attendants at birth. Most pregnant women in rural communities in low-income countries do not achieve the minimum recommended visits and deliver without skilled attendants. With the aim of increasing number of ANC visits, reducing home deliveries, and supplementing care given by ANC clinics, a proposed system based on low-cost mobile phones and portable ultrasound scan machines was piloted.MethodsA sample of 323 pregnant women from four rural communities in the Central Region of Ghana were followed within a 11-month project. In each community, at least one health worker was trained and equipped with a mobile phone to promote ANC and hospital deliveries in her own community. If women cannot attend ANC, technicians acquired scans by using portable ultrasound machines in her community directly and sent them almost in real time to be analyzed by a gynecologist in an urban hospital. A preliminary survey to assess ANC status preceding the pilot study was conducted. During this, one hundred women who had had pregnancies within five years prior to the study were interviewed.ResultsThe preliminary survey showed that women who attended ANC were less likely to have a miscarriage and more likely to have delivery at hospital or clinic than those who did not, and women who attained at least four ANC visits were less likely to practice self-medication. Among the women involved in the project, 40 gave birth during the period of observation. The proposed prenatal care approach showed that 62.5 % of pregnant women who gave birth during the observation period included in the project (n=40) had their labor attended in clinics or hospitals as against 37.5 % among the cases reported in the pre-survey. One case of ectopic and two cases of breech pregnancies were detected during the pilot through the proposed approach, and appropriate medical interventions were sought.ConclusionOur results show that the proposed prenatal care approach can make quality ANC accessible in rural communities where pregnant women have not been able to access proper ANC.

Exploring the availability and impact of antenatal point‐of‐care ultrasound services in rural and remote communities: A scoping review

“…Majority of the results were observational studies, with 7 prospective cohort studies, 3 cross‐sectional studies and 1 retrospective data analysis . Other study designs included a non‐blinded clustered randomised control trial, a pre‐post survey, a randomised control trial, a blinded investigational study, a field action report and a survey followed by a pilot project …”

“…Africa was the region with the largest volume of literature, with 11 studies identified . Common themes explored included the utilisation of ANC, clinical knowledge and skills and patient outcomes.…”

“…Four observational studies reporting on the utilisation of ANC demonstrated the association between the implementation of PoCUS services and ANC attendance . These studies used variable measures of outcome such as ANC attendance, service utilisation or the number of ANC interventions administered.…”

“…Amoah et al . used a pilot test to evaluate the implementation of low‐cost mobile phones and PoCUS in four rural Ghana communities.…”

Mobilising faith-based and lay leaders to address antenatal care outcomes in northern Ghana

“…The interaction term, programme area*round of data collection, indicated the effect of the CoC in the context of the EPPICS standard activities. Covariates, including maternal age, education, parity, employment status, ethnicity, and distance from nearest health facility, were selected based on the literature (Ahmed et al 2010;Amoah et al 2016;Asundep et al 2013;Pell et al 2013;Simkhada et al 2008), and were included in all models. To examine the relationship between programme area and round of data collection, the interaction was plotted using the margins command in Stata 13.0.…”