TulaSalud: An m-health system for maternal and infant mortality reduction in Guatemala

Martínez-Fernández, Andrés; Lobos-Medina, Isabel; Díaz-Molina, Cesar Augusto; Chen-Cruz, Moisés Faraón; Prieto-Egido, Ignacio

doi:10.1177/1357633x15575830

Cited by 32 publications

(19 citation statements)

References 14 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For example, in a study conducted in rural Pakistan by Jokhio et al [30], training TBAs to recognize maternal and perinatal complications, alongside efforts made to better integrate them into the formal health system, resulted in increased referral rates to facility-care for emergency obstetrical care. Similarly, a recent study in rural Guatemala connecting community health workers – with higher levels of clinical training and literacy than the TBAs in our study – to medical specialists via cell-phones [31], showed a promising trend toward reductions in maternal mortality.…”

Section: Discussionsupporting

confidence: 67%

mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial

et al. 2018

View full text Add to dashboard Cite

Background/objectiveGuatemala’s indigenous Maya population has one of the highest perinatal and maternal mortality rates in Latin America. In this population most births are delivered at home by traditional birth attendants (TBAs), who have limited support and linkages to public hospitals. The goal of this study was to characterize the detection of maternal and perinatal complications and rates of facility-level referral by TBAs, and to evaluate the impact of a mHealth decision support system on these rates.MethodsA pragmatic one-year feasibility trial of an mHealth decisions support system was conducted in rural Maya communities in collaboration with TBAs. TBAs were individually randomized in an unblinded fashion to either early-access or later-access to the mHealth system. TBAs in the early-access arm used the mHealth system throughout the study. TBAs in the later-access arm provided usual care until crossing over uni-directionally to the mHealth system at the study midpoint. The primary study outcome was the monthly rate of referral to facility-level care, adjusted for birth volume.ResultsForty-four TBAs were randomized, 23 to the early-access arm and 21 to the later-access arm. Outcomes were analyzed for 799 pregnancies (early-access 425, later-access 374). Monthly referral rates to facility-level care were significantly higher among the early-access arm (median 33 referrals per 100 births, IQR 22–58) compared to the later-access arm (median 20 per 100, IQR 0–30) (p = 0.03). At the study midpoint, the later-access arm began using the mHealth platform and its referral rates increased (median 34 referrals per 100 births, IQR 5–50) with no significant difference from the early-access arm (p = 0.58). Rates of complications were similar in both arms, except for hypertensive disorders of pregnancy, which were significantly higher among TBAs in the early-access arm (RR 3.3, 95% CI 1.10–9.86).ConclusionsReferral rates were higher when TBAs had access to the mHealth platform. The introduction of mHealth supportive technologies for TBAs is feasible and can improve detection of complications and timely referral to facility-care within challenging healthcare delivery contexts.Trial registrationClinicaltrials.gov NCT02348840.

show abstract

Section: Discussionsupporting

confidence: 67%

mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial

et al. 2018

View full text Add to dashboard Cite

show abstract

“…8,9 Despite the advance of e-health technologies through electronic devices, there are relatively few studies that have evaluated the management of high risk pregnant women. 5,6 There may be an increased demand for bidirectional e-health selfcare telemedicine using a smartphone app in high risk pregnant women.…”

Section: Discussionmentioning

confidence: 99%

“…However, to the best of our knowledge, through literature reviews, there is limited information regarding the utility of ICTbased maternity data collection and a comprehensive home-based model of care for high risk pregnant women who want to identify obstetric problems earlier and increasing demand for their need and care, implemented through an e-healthcare software. 5,6 We have developed a new model for maternity e-healthcare devices using a tablet-based application that provides a bidirectional communication through e-mails and mobile text messages between pregnant women and trained coordinators/ obstetricians and offers medical advice. The objectives of this study were 1) to determine the usability, feasibility, preliminary efficacy and safety of a tablet-based real-time bidirectional telecommunication of self-reported maternal condition such as body weight, blood pressure and daily symptom questionnaire for 30 days in normal and high risk pregnant women, and 2) to evaluate the effect of a bidirectional and multi-group telemedicine system on satisfaction in these pregnant women.…”

Section: Introductionmentioning

confidence: 99%

Development and Feasibility of a Tablet-based Self-monitoring and Management System in Pregnant Women

Kobayashi¹,

Osanai²,

Sado³

et al. 2017

JournalMTM

View full text Add to dashboard Cite

Objectives: Many health telemedicine applications (apps) have been released in the clinical-care setting. There is limited information regarding the utility of ICT-based maternity data collection and a comprehensive home-based model of care for high risk pregnant women. The aim of our study was to assess the feasibility of a tablet-based real-time bidirectional telecommunication of self-reported maternal condition in normal and high risk pregnant women. Methods:The study included eighteen pregnant women (13 normal pregnant women [the Cohort 1 study] and 5 high risk pregnant women [the Cohort 2 study]) who expressed their interest in participating in the study. Participants were supplied with a tablet computer installed with the ''MaternityCare'' service program. Each user recorded physical information (body weight and blood pressure) and answered the multiple questions on obstetrical symptoms daily for 30 days. Results:The median value of individual compliance with practice (individual patient-level reporting rates) was 76.7% in the Cohort 1 study and 100% in the Cohort 2 study. Self-reporting data were transmitted on 65.8% for the Cohort 1 study, and 218.9% for the Cohort 2 study of subject days (subject day =1 subject ) 1 day). 66.7% (10/15) of participants affirmed applications' ease of use, and 60% (9/ 15) desired to implement the app into practice after the study.Discussion: In conclusion, high risk pregnant women had a positive attitude about home-based selfmonitoring and expressed a strong desire to receive this app. A dynamic, real-time, bidirectional and interactive mobile maternity health system with a tablet app may support information sharing, quick consultation and initiation of the prophylaxis and treatment at the patient, pre-hospital healthcare provider and physician levels.

show abstract

“…They observed that 168 of 273 patients who received the intervention via text messaging responded significantly better when compared to 132 of 265 patients who received face to face care. In Guatemala, Martínez-Fernández et al [27] studied the development of an online health system via text messaging and mobile phones in indigenous rural areas, observing a statistically significant reduction of maternal and infant mortality amongst 6783 pregnant women.…”

Section: Mobile Phones and Social Workmentioning

confidence: 99%

Mobile Phones and Psychosocial Therapies with Vulnerable People: a First State of the Art

et al. 2016

View full text Add to dashboard Cite

Mobile phones are becoming a communication tool commonly used by people all over the world; and they are started to be adopted in psychosocial therapies involving vulnerable people. We are herein presenting the results of an academic literature review. We identified scientific papers published between 2006 and 2015 resorting to academic databases available on the Internet, applying a systematic selection method based on quality criteria. Secondly, we analysed contents, highlighting the scarcity of research involving vulnerable people. The available literature specialized in psychosocial therapies offers investigation results which involve mobile phones and patients in general, focusing particularly on the clinical psychology field and, to a lesser extent, on the social work field. Particularly significant are the investigation works developed in the United States. In the present paper we introduce a first “state of the art”, identifying opportunities and also the limitations surrounding the use of mobile phones in psychosocial therapies targeting the vulnerable. Issues concerning privacy and data confidentiality, and the access of vulnerable people to mobile phones and how they use them, pose significant challenges; but they offer the opportunity to reach isolated or impoverished populations, or even to facilitate access to social and healthcare services. We close this paper formulating possible orientations, hypotheses and goals to design new investigation works involving vulnerable populations.

show abstract

TulaSalud: An m-health system for maternal and infant mortality reduction in Guatemala

Cited by 32 publications

References 14 publications

mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial

mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial

Development and Feasibility of a Tablet-based Self-monitoring and Management System in Pregnant Women

Mobile Phones and Psychosocial Therapies with Vulnerable People: a First State of the Art

Contact Info

Product

Resources

About