Detection of Potential Arbovirus Infections and Pregnancy Complications in Pregnant Women in Jamaica Using a Smartphone App (ZIKApp): Pilot Evaluation Study

Abstract

Background There is growing evidence of the benefits of mobile health technology, which include symptom tracking apps for research, surveillance, and prevention. No study has yet addressed arbovirus symptom tracking in pregnancy. Objective This study aimed to evaluate the use of a smartphone app (ZIKApp) to self-report arbovirus symptoms and pregnancy complications and to assess compliance with daily symptom diaries during pregnancy in a cohort of women in an arbovirus-endemic, subtropical, middle-income country (Jamaica). Methods Pregnant women aged ≥16 years, having a smartphone, and planning on giving birth at the recruiting center were enrolled between February 2020 and July 2020. ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arbovirus infection and pregnancy complications. Sociodemographic, epidemiological, and obstetric information was collected at enrollment, with additional review of medical records, and users’ perception was collected through an exit survey. Descriptive analyses and logistic regression analysis of possible factors associated with diary adherence were performed. Results Of the 173 women enrolled, 157 (90.8%) used ZIKApp for a median duration of 155 (IQR 127-173) days until pregnancy end, 6 (3.5%) used the app for <7 days, and 10 (5.8%) exited the study early. For each successive 30-day period from enrollment up to 150 days after enrollment, of these 157 women, 121 (77.1%) to 129 (82.2%) completed their daily symptom diary; 50 (31.8%) to 56 (35.7%) did so on the same day. Overall, 31.8% (50/157) of the women had good adherence to diary reporting (ie, they completed the task on the same day or 2 to 3 days later for ≥80% of the days enrolled). There were 3-fold higher odds of good adherence for participants aged >34 years versus those aged 25 to 29 years (adjusted odds ratio 3.14, 95% CI 1.10-8.98) and 2-fold higher odds for women with tertiary versus secondary education (adjusted odds ratio 2.26, 95% CI 1.06-4.83). Of the 161 women who ever made a diary entry, 5454 individual symptom reports were made (median 17 per woman; IQR 4-42; range 0-278); 9 (5.6%) women reported symptom combinations triggering a potential arbovirus episode (none had an adverse pregnancy outcome) and 55 (34.2%) reported painful uterine contractions or vaginal bleeding, mainly in the month before delivery. Overall, 51.8% (71/137) of the women rated the app as an excellent experience and were less likely to be poor diary adherers (P=.04) and 99.3% (138/139) reported that the app was easy to understand and use. Conclusions This pilot found a high adherence to ZIKApp. It demonstrated the feasibility and usability of the app in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arbovirus infections in pregnancy and to optimize maternal care.

Arboviruses and pregnancy: are the threats visible or hidden?

“…Artificial intelligence can utilize environmental and climate data to predict disease outbreaks. The use of a smartphone app in an arbovirus-endemic region can contribute to surveillance and diagnosis of arbovirus infections in pregnancy [ 121 ].…”

Dengue, chikungunya and zika arbovirus infections in Caribbean children

“…In Grenada, a controlled neurodevelopment stimulation intervention for ZIKV-exposed children who were born with normal head circumference and who were older than 2 years, showed subsequent improved language development and positive behaviors in preparation for school readiness [ 71 ▪▪ ]. Jamaica has documented the usefulness of and adherence to a ZIKApp in pregnancy to identify arbovirus symptoms early in pregnancy to thereby facilitate early diagnosis of infections and maximize maternal care [ 72 ▪▪ ]. The ZIKAction research initiative continues to elucidate these arboviruses in pregnant women, infants and children in Jamaica and Haiti [ 16 , 18 ▪▪ , 19 , 31 ▪▪ , 32 , 43 , 48 , 49 , 57 , 58 , 61 – 65 , 72 ▪▪ ].…”

“…Jamaica has documented the usefulness of and adherence to a ZIKApp in pregnancy to identify arbovirus symptoms early in pregnancy to thereby facilitate early diagnosis of infections and maximize maternal care [ 72 ▪▪ ]. The ZIKAction research initiative continues to elucidate these arboviruses in pregnant women, infants and children in Jamaica and Haiti [ 16 , 18 ▪▪ , 19 , 31 ▪▪ , 32 , 43 , 48 , 49 , 57 , 58 , 61 – 65 , 72 ▪▪ ].…”