Usability and feasibility of a mobile health system to provide comprehensive antenatal care in low-income countries: PANDA mHealth pilot study in Madagascar

Benski, Anne Caroline; Stancanelli, G.; Scaringella, Stefano; Herinainasolo, Josea Léa; Jinoro, Jeromine; Vassilakos, Pierre; Petignat, Patrick; Schmidt, Nicole

doi:10.1177/1357633x16653540

Cited by 28 publications

(28 citation statements)

References 9 publications

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“…The PANDA mHealth system was first implemented in 2015 in a pilot study to assess the system’s feasibility and usability in Madagascar [ 22 ]. The program was designed to support health care providers who received training on using a smartphone app and on conducting a standardized ANC visit.…”

Section: Methodsmentioning

confidence: 99%

“…All pregnant women, regardless of age or stage of pregnancy, were eligible to participate in the study. The only exclusion criterion was the inability to understand or act as described in a previous publication explaining the acceptability and feasibility of the PANDA mHealth device [ 22 ]. As ANC with the PANDA mHealth system was offered to all women receiving routine ANC, the sample is considered to be representative.…”

Section: Methodsmentioning

confidence: 99%

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Improving the Quality of Antenatal Care Using Mobile Health in Madagascar: Five-Year Cross-Sectional Study

Benski¹,

Schmidt

Viviano³

et al. 2020

JMIR Mhealth Uhealth

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Background Despite many efforts, maternal mortality remains a major burden in most developing countries. Mobile health (mHealth) has the potential to improve access to obstetric care through apps that help patients and providers. Objective This study aimed to use mHealth to provide antenatal care (ANC) to 1446 pregnant women in a rural area in Madagascar and evaluate the quality of ANC provided by an mHealth system designed to change the behaviors of providers and patients. Methods We included 1446 women who attended ANC visits in rural Madagascar from 2015 to 2019 using an mHealth system called Pregnancy and Newborn Diagnostic Assessment (PANDA). This cross-sectional study used data from different participants, with information collected over several years, to analyze the outputs related to the quality of ANC over time. Specifically, we examined the timing of the first ANC visit, the relationship between the visit duration and the risk factors among pregnant women, and the number of ANC visits per woman. Results Following the implementation of the mHealth system in 2015, we observed that women started to come earlier for their first ANC visit; more women attended their first ANC visit in the second trimester of pregnancy in 2019 than in the previous years (P<.001). In 2019, fewer women attended their first ANC visit in the third trimester (57/277, 20.6%) than in 2015 (147/343, 42.9%). There were statistically significant associations between the ANC visit durations and the risk factors, including age (>35 years; 25.0 min, 95% CI 24.0-25.9), educational level (longer visit for women with lower than primary education and for women who attended university and shorter for women with primary school–level education; 40.7 min, 95% CI 30.2-51.3 and 25.3 min, 95% CI 24.4-26.3 vs 23.3 min, 95% CI 22.9-23.8; P=.001), experience of domestic violence during pregnancy, gravidity, parity, infectious diseases (HIV, malaria, and syphilis), and level of anemia. Statistically significant associations were observed for all quality indicator variables. We observed a statistically significant increase in the number of ANC visits per woman over time from 2015 to 2017; the number of ANC visits per woman then became stable after the third year of implementing the PANDA mHealth system. Conclusions This study shows the potential of an mHealth system to improve the quality of ANC, change provider behavior by standardizing ANC visits, and change patient behavior by increasing the willingness to return for subsequent visits and encouraging ANC attendance early in pregnancy. As this is an exploratory study, further studies are necessary to better understand how mHealth can change behavior and identify the conditions required for behavioral changes to persist over time.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Improving the Quality of Antenatal Care Using Mobile Health in Madagascar: Five-Year Cross-Sectional Study

Benski¹,

Schmidt

Viviano³

et al. 2020

JMIR Mhealth Uhealth

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“…The only exclusion criteria were inability to understand or act, as described in a previous publication explaining the acceptability and feasibility of the PANDA mHealth device. 11 As the ANC using the PANDA mHealth system was offered to all women consulting for the routine ANC care, the sample is considered to be representative. More than 98% of invited women accepted to participate in the ANC using the PANDA mHealth device.…”

Section: Recruitment Of Study Participantsmentioning

confidence: 99%

“…Standardized mHealth systems support less skilled health personal or health professionals from other health disciplines. 11,26 Second, the system allows recording and creating an electronic record for each patient, facilitating follow-up visits. Furthermore, large-scale databases are generated, giving the opportunity to follow-up maternal morbidities not only on the individual but also on the population level.…”

Section: Advantages and Limitations Of An Mhealth System To Collect Mmentioning

confidence: 99%

<p>Description of Maternal Morbidities Amongst 1000 Women During Pregnancy in Ambanja, Madagascar – Opportunities and Challenges of Using an mHealth System</p>

Vilaplana¹,

Petignat²,

Benski³

et al. 2020

IJWH

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Background: The estimated burden of maternal morbidities in lower-income countries, such as Madagascar, is high. However, there is still a lack of data on maternal morbidities, in part due to an absence of standardized assessment tools. This cross-sectional study aims to report maternal morbidities among 1015 women in the district of Ambanja, Madagascar, and to describe the advantages and limitations of a mHealth system. Methods: Data were collected using the PANDA (pregnancy and newborn diagnosis assessment) system, an mHealth device that incorporates the WHO recommendations for antenatal care (ANC). Data, including personal and medical information, but also clinical data such as hypertension, anemia or HIV were collected from more than 1000 women attending ANC. Results: A total of 1015 pregnant women were recruited from January 2015 to August 2018. The average age was 24.6 years old, and most women were married (82.3%). The majority lived in urban areas and were unemployed. Prevalence of hypertension and gestational diabetes was relatively low (4% vs 2.2%). Malaria infection was diagnosed in 2.2% and HIV was diagnosed in 1.2% of pregnant women. The most common morbidity was anemia (68.4%) and the only significant factor associated was being single compared to being married (OR 1.68, 95% CI 1.05-2.70, p-value 0.032). Discussion: The prevalence of anemia in our study population was much higher than previously reported in Sub-Saharan Africa. This finding highlights the need for regular iron supplementation during pregnancy, especially in vulnerable (eg, single) women. The PANDA mHealth system provides unique opportunities due to its standardization of ANC and creation of a digital database accessible from a distance. However, one of the main challenges was that even a mHealth system such as the PANDA remains dependent on the local procurement chain. Therefore, future studies need to access opportunities of mHealth systems to support health service delivery. Trial Registration: Registered on ISRCTN on 14th October 2015, number ISRCTN18270380. Retrospectively registered.

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“…Indirect causes such as diabetes, malaria or anaemia can worsen the mother’s condition during pregnancy and also lead to maternal death. Most of these maternal deaths could be avoided by providing comprehensive antenatal care, skilled delivery care and access to emergency obstetric care [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Cross-sectional survey of knowledge of obstetric danger signs among women in rural Madagascar

Salem

Lacour

Scaringella³

et al. 2018

BMC Pregnancy Childbirth

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BackgroundAntenatal care (ANC) has the potential to identify and manage obstetric complications, educate women about risks during pregnancy and promote skilled birth attendance during childbirth. The aim of this study was to assess women’s knowledge of obstetric danger signs and factors associated with this knowledge in Ambanja, Madagascar. It also sought to evaluate whether the participation in a mobile health (mHealth) project that aimed to provide comprehensive ANC to pregnant women in remote areas influenced women’s knowledge of obstetric danger signs.MethodsFrom April to October 2015, a non-random, convenience sample of 372 women in their first year postpartum were recruited, including 161 who had participated in the mHealth project. Data were analyzed using bivariate and multivariate logistic regression.ResultsKnowledge of at least one danger sign varied from 80.9% of women knowing danger sign(s) in pregnancy, to 51.9%, 50.8% and 53.2% at delivery, postpartum and in the newborn, respectively. Participation in the mHealth intervention, higher household income, and receipt of information about danger signs during pregnancy were associated with knowledge of danger signs during delivery, in bivariate analysis; only higher household income and mHealth project participation were independently associated. Higher educational attainment and receipt of information about danger signs in antenatal care were associated with significantly higher odds of knowing danger sign(s) for the newborn in both bivariate and multivariate analysis.ConclusionsKnowledge of obstetric danger signs is low. Information provision during pregnancy and with mHealth is promising.Trial registrationThis trial was retrospectively registered at the International Standard Randomized Controlled Trial Register (identifier ISRCTN15798183; August 22, 2015).Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1664-x) contains supplementary material, which is available to authorized users.

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Usability and feasibility of a mobile health system to provide comprehensive antenatal care in low-income countries: PANDA mHealth pilot study in Madagascar

Cited by 28 publications

References 9 publications

Improving the Quality of Antenatal Care Using Mobile Health in Madagascar: Five-Year Cross-Sectional Study

Improving the Quality of Antenatal Care Using Mobile Health in Madagascar: Five-Year Cross-Sectional Study

<p>Description of Maternal Morbidities Amongst 1000 Women During Pregnancy in Ambanja, Madagascar – Opportunities and Challenges of Using an mHealth System</p>

Cross-sectional survey of knowledge of obstetric danger signs among women in rural Madagascar

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