Community based weighing of newborns and use of mobile phones by village elders in rural settings in Kenya: a decentralised approach to health care provision

Abstract

BackgroundIdentifying every pregnancy, regardless of home or health facility delivery, is crucial to accurately estimating maternal and neonatal mortality. Furthermore, obtaining birth weights and other anthropometric measurements in rural settings in resource limited countries is a difficult challenge. Unfortunately for the majority of infants born outside of a health care facility, pregnancies are often not recorded and birth weights are not accurately known. Data from the initial 6 months of the Maternal and Neonatal Health (MNH) Registry Study of the Global Network for Women and Children's Health study area in Kenya revealed that up to 70% of newborns did not have exact weights measured and recorded by the end of the first week of life; nearly all of these infants were born outside health facilities.MethodsTo more completely obtain accurate birth weights for all infants, regardless of delivery site, village elders were engaged to assist in case finding for pregnancies and births. All elders were provided with weighing scales and mobile phones as tools to assist in subject enrollment and data recording. Subjects were instructed to bring the newborn infant to the home of the elder as soon as possible after birth for weight measurement.The proportion of pregnancies identified before delivery and the proportion of births with weights measured were compared before and after provision of weighing scales and mobile phones to village elders. Primary outcomes were the percent of infants with a measured birth weight (recorded within 7 days of birth) and the percent of women enrolled before delivery.ResultsThe recorded birth weight increased from 43 ± 5.7% to 97 ± 1.1. The birth weight distributions between infants born and weighed in a health facility and those born at home and weighed by village elders were similar. In addition, a significant increase in the percent of subjects enrolled before delivery was found.ConclusionsPregnancy case finding and acquisition of birth weight information can be successfully shifted to the community level.

Health Worker mHealth Utilization

“…Health worker acceptability, or the acceptance of using technology to facilitate their work, was generally very high in qualitative surveys 14,20,21,30 . In studies comparing pen-and-paper data collection with mobile device collection, researchers consistently observed improvements in data quality 16,20,38,41 . Some improvements in health outcomes were observed 12,26 , and many increased program enrollment due to better organization and workflow 16,22,33 .…”

“…While several studies documented a high level of interest and acceptability amongst health workers 13,16,18,21–23 , they also documented low actual use and challenges in use, particularly without incentives other than improved work efficiency (e.g., monetary incentives or personal phone-use incentive and no penalty for not using the technology) 14,18,23,24 . As such, there was a high demand and need for training with the mHealth technology, as well as training to reinforce skills and health worker responsibilities 14,17 .…”

“…As such, there was a high demand and need for training with the mHealth technology, as well as training to reinforce skills and health worker responsibilities 14,17 . A study on newborn weights found an increase from 40% to 100% accurate birth weights (recorded within one week of birth) because of the efficiency of a mHealth intervention compared to pen and paper systems 16 .…”

“…Some improvements in health outcomes were observed 12,26 , and many increased program enrollment due to better organization and workflow 16,22,33 . While initial startup costs were high, phone replacement was low, and most studies reported minimal ongoing maintenance costs 15,16,32,39–41 .…”

Knowledge and Skill Retention of a Mobile Phone Data Collection Protocol in Rural Liberia

“…14 Liberia is no exception. Liberia, located in West Africa is a country trying to rebuild in the aftermath of civil and rebel wars that ravaged the country for 14 years.…”