Digital health and telemedicine in Pakistan: Improving maternal healthcare

Bilal, Wajeeha; Qamar, Khulud; Siddiqui, Amna; Kumar, Prince; Essar, Mohammad Yasir

doi:10.1016/j.amsu.2022.104425

Cited by 13 publications

(9 citation statements)

References 13 publications

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“…Another beneficial aspect of this telemedicine intervention in Bangladesh was that, by using midwives deployed through the national health system and relying on existing telephone technology rather than attempting to roll out a new telehealth platform, it was low-cost. This made it more sustainable than similar remote maternity care interventions implemented in South Asia [ 34 , 35 ]. Cost is a major factor in maternal health care.…”

Section: Discussionmentioning

confidence: 99%

Midwife-led pandemic telemedicine services for maternal health and gender-based violence screening in Bangladesh: an implementation research case study

Islam,

Begum,

Williams

et al. 2023

Reprod Health

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Background The COVID-19 pandemic disrupted maternal and newborn health services in Bangladesh, exacerbating the large gaps in service utilization that existed prior to the pandemic. As part of its response, Bangladesh initiated remote antenatal and postnatal care telemedicine services led by midwives in 36 sub-district hospitals across five of Bangladesh’s 64 districts. Gender-based violence screening and referral were integrated into the service to address a reported rise in violence following the country’s pandemic lockdown. Methods Mixed-methods implementation research was used to develop an intrinsic case study describing the design and implementation of the telemedicine program. Qualitative analysis comprised document review, key informant interviews, and focus group discussions. Quantitative analysis employed an interrupted time series analysis with segmented multi-variate regression to compare maternity care service use trends before and after implementation. Poisson regression analysis was used to examine the trend in number of gender-based violence remote screenings, sessions held, and cases identified. Results A statistically significant change in trend for onsite antenatal and postpartum care as well as women seeking care at the hospital as a result of postpartum hemorrhage arising in the community was observed following the introduction of telemedicine. Facility births and cases of eclampsia appropriately identified and managed also had significant increases. In addition, over 6917 women were screened for GBV, 223 received counseling and 34 referrals were made, showing a statistically significant increase in frequency over time following the implementation of the telemedicine program. Challenges included that not all midwives adopted GBV screening, some women were reluctant to discuss GBV, there was an unanticipated need to introduce a patient visit scheduling system in all intervention hospitals, and many women were not reachable by phone due to lack of access or network coverage. Conclusions Maternal health and gender-based violence telemedicine led by midwives was an effective, low-cost intervention in Bangladesh for addressing pandemic and pre-pandemic gaps in service use. Other low and middle-income countries planning to implement remote maternal health interventions via midwives should consider whether a patient visit scheduling system needs to be introduced, as well as limitations around mobile phone access and connectivity. Future research should include care quality oversight and improvement, and a more well-informed strategy for facilitating effective GBV screening.

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Section: Discussionmentioning

confidence: 99%

Midwife-led pandemic telemedicine services for maternal health and gender-based violence screening in Bangladesh: an implementation research case study

Islam,

Begum,

Williams

et al. 2023

Reprod Health

View full text Add to dashboard Cite

show abstract

“…Another bene cial aspect of this telemedicine intervention in Bangladesh was that, by using midwives deployed through the national health system and relying on existing technology rather than attempting to roll out a new telehealth platform, it was low-cost. This made it more sustainable than similar remote maternity care interventions implemented in South Asia [14,15]. Cost is a major factor in maternal health care.…”

Section: Discussionmentioning

confidence: 99%

Midwife-led Pandemic Telemedicine Services for Maternal Health and Gender-Based Violence Screening in Bangladesh: An Implementation Research Case Study

Islam¹,

Begum²,

Williams³

et al. 2023

Preprint

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Background The COVID-19 pandemic disrupted maternal and newborn health services in Bangladesh, increasing the large gaps in service utilization that existed prior to the pandemic. As part of its response, Bangladesh initiated remote antenatal and postnatal care telemedicine services led by midwives in 36 sub-district hospitals across five of Bangladesh’s 64 districts. Gender-based violence screening and referral were integrated into the service to address a reported rise in violence following the country’s pandemic lockdown. Methods Mixed-methods implementation research was used to develop a case study describing the design and implementation of the telemedicine program. Qualitative analysis comprised document review, key informant interviews, and focus group discussions. Quantitative analysis employed descriptive statistics to compare service use trends before and after implementation. Results Challenges included the unanticipated need to introduce a scheduling system in all intervention hospitals and that many women were not reachable by phone due to lack of access or network coverage. Some women were also reluctant to discuss gender-based violence. However, maternity care service use increased, with 19%-31% more women receiving skilled maternal and newborn care than otherwise would have. In addition, there was a doubling of cases of postpartum hemorrhage and eclampsia that were identified and effectively responded to. Conclusions Maternal health and gender-based violence telemedicine led by midwives was an effective, low-cost intervention in Bangladesh for addressing pandemic and pre-pandemic gaps in service use. Other low and middle-income countries planning to implement remote maternal health interventions via midwives should consider whether a scheduling system needs to be introduced, as well as limitations around mobile phone access and connectivity. Future research should include care quality oversight and improvement.

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“…Organizational factors may be perilous elements of the success of a telemedicine program. Advances in telemedicine technology need to be harmonized with innovations in organizational structure and communication [ 26 , 27 ]. Moreover, workplace support is very important in the proper implementation of telehealth agendas [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Perception and Attitude of Pakistani Doctors Toward the Use of Telemedicine Technology

Zahid¹,

Ali²,

Gul³

et al. 2022

Cureus

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Background: Healthcare providers may improve healthcare delivery and make it available to more people by combining advanced technologies with high-quality network services. In this regard, telemedicine has improved healthcare providers' ability to provide services for a large number of individuals without their physical presence. Pakistan's healthcare system is a mix of government infrastructure, parastatal healthcare, the private sector, civil society, and charitable contributions. However, unawareness, poor education, lack of skills, lack of resources, and technical issues including internet connectivity, and load shedding have limited the accessibility of the Pakistani population towards advancement in the healthcare industry.Methodology: It was a cross-sectional study conducted at a private tertiary care hospital from April to June 2022 in Karachi. To recruit the study participants, a purposive sampling technique was used. Practicing doctors (n=100), who were aware of telemedicine technology and agreed to participate in the study, were included as study participants. A self-developed proforma was administered to doctors to assess the study's objectives.Results: Out of 100, 64% (n=64) of the participants have no experience working in telemedicine while only 36% have worked with telemedicine for at least one year. When asked about the application of telemedicine technology only 46% of the doctors knew the technology used. While only 42% of the doctors were familiar with the telemedicine tools, including a virtual stethoscope, pulse oximeter, etc. views regarding continue using telemedicine, 26% of the participants having no experience with telemedicine agreed that they would like to use telemedicine, 35% agreed to use telemedicine with improvement whereas 3% of them do not want to use the telemedicine technology. Conclusion:The participants of the current study were aware of telemedicine technology and its advantages. However, despite their agreement, the majority of the doctors emphasized the improvement of the system to deliver better services by using this technology.

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Digital health and telemedicine in Pakistan: Improving maternal healthcare

Cited by 13 publications

References 13 publications

Midwife-led pandemic telemedicine services for maternal health and gender-based violence screening in Bangladesh: an implementation research case study

Midwife-led pandemic telemedicine services for maternal health and gender-based violence screening in Bangladesh: an implementation research case study

Midwife-led Pandemic Telemedicine Services for Maternal Health and Gender-Based Violence Screening in Bangladesh: An Implementation Research Case Study

Perception and Attitude of Pakistani Doctors Toward the Use of Telemedicine Technology

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