Boosting antenatal care attendance and number of hospital deliveries among pregnant women in rural communities: a community initiative in Ghana based on mobile phones applications and portable ultrasound scans

BMC Pregnancy and Childbirth, Jun 2016

Background The World Health Organization has recommended at least four antenatal care (ANC) visits and skilled attendants at birth. Most pregnant women in rural communities in low-income countries do not achieve the minimum recommended visits and deliver without skilled attendants. With the aim of increasing number of ANC visits, reducing home deliveries, and supplementing care given by ANC clinics, a proposed system based on low-cost mobile phones and portable ultrasound scan machines was piloted. Methods A sample of 323 pregnant women from four rural communities in the Central Region of Ghana were followed within a 11-month project. In each community, at least one health worker was trained and equipped with a mobile phone to promote ANC and hospital deliveries in her own community. If women cannot attend ANC, technicians acquired scans by using portable ultrasound machines in her community directly and sent them almost in real time to be analyzed by a gynecologist in an urban hospital. A preliminary survey to assess ANC status preceding the pilot study was conducted. During this, one hundred women who had had pregnancies within five years prior to the study were interviewed. Results The preliminary survey showed that women who attended ANC were less likely to have a miscarriage and more likely to have delivery at hospital or clinic than those who did not, and women who attained at least four ANC visits were less likely to practice self-medication. Among the women involved in the project, 40 gave birth during the period of observation. The proposed prenatal care approach showed that 62.5 % of pregnant women who gave birth during the observation period included in the project (n=40) had their labor attended in clinics or hospitals as against 37.5 % among the cases reported in the pre-survey. One case of ectopic and two cases of breech pregnancies were detected during the pilot through the proposed approach, and appropriate medical interventions were sought. Conclusion Our results show that the proposed prenatal care approach can make quality ANC accessible in rural communities where pregnant women have not been able to access proper ANC.

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Boosting antenatal care attendance and number of hospital deliveries among pregnant women in rural communities: a community initiative in Ghana based on mobile phones applications and portable ultrasound scans

Amoah et al. BMC Pregnancy and Childbirth Boosting antenatal care attendance and number of hospital deliveries among pregnant women in rural communities: a community initiative in Ghana based on mobile phones applications and portable ultrasound scans Benjamin Amoah 0 1 Evelyn A. Anto 0 1 Prince K. Osei 0 3 Kojo Pieterson 4 Alessandro Crimi 0 1 2 0 African Institute for Mathematical Sciences , P.O. Box DL 676, Cape Coast , Ghana 1 ETH Zurich , Zurich , Switzerland 2 Istituto Italiano di Tecnologia , Genoa , Italy 3 University of Ghana , Accra , Ghana 4 Korle Bu Teaching Hospital , Accra , Ghana Background: The World Health Organization has recommended at least four antenatal care (ANC) visits and skilled attendants at birth. Most pregnant women in rural communities in low-income countries do not achieve the minimum recommended visits and deliver without skilled attendants. With the aim of increasing number of ANC visits, reducing home deliveries, and supplementing care given by ANC clinics, a proposed system based on low-cost mobile phones and portable ultrasound scan machines was piloted. Methods: A sample of 323 pregnant women from four rural communities in the Central Region of Ghana were followed within a 11-month project. In each community, at least one health worker was trained and equipped with a mobile phone to promote ANC and hospital deliveries in her own community. If women cannot attend ANC, technicians acquired scans by using portable ultrasound machines in her community directly and sent them almost in real time to be analyzed by a gynecologist in an urban hospital. A preliminary survey to assess ANC status preceding the pilot study was conducted. During this, one hundred women who had had pregnancies within five years prior to the study were interviewed. Results: The preliminary survey showed that women who attended ANC were less likely to have a miscarriage and more likely to have delivery at hospital or clinic than those who did not, and women who attained at least four ANC visits were less likely to practice self-medication. Among the women involved in the project, 40 gave birth during the period of observation. The proposed prenatal care approach showed that 62.5 % of pregnant women who gave birth during the observation period included in the project (n=40) had their labor attended in clinics or hospitals as against 37.5 % among the cases reported in the pre-survey. One case of ectopic and two cases of breech pregnancies were detected during the pilot through the proposed approach, and appropriate medical interventions were sought. Conclusion: Our results show that the proposed prenatal care approach can make quality ANC accessible in rural communities where pregnant women have not been able to access proper ANC. Ghana; Antenatal care; Pregnancy; Mobile phones; Portable ultrasound; Skilled attendants Background In 2013, globally, an estimated 800 women died from pregnancy and childbirth-related complications each day. Low-income countries account for 99 % of these deaths, with the sub-Saharan Africa region alone accounting for 62 % [ 1 ]. The adult lifetime risk of maternal mortality in women from sub-Saharan Africa was 1 in 38, in sharp contrast to 1 in 3700 among women in high income countries [ 1 ]. Maternal mortality in Ghana in 2013 was estimated at 380 (per 100,000 live births), a figure which is far above the 185 targeted in Millennium Development Goal (MDG) Five [ 1, 2 ]. Despite the progresses made, Ghana did not achieve the MDG Five, especially in rural isolated communities. Most maternal deaths are due to obstetric complications which can be prevented or detected and managed if pregnant women get early access to available intervention programs. Infections, malaria, anemia, and antepartum hemorrhage among other causes of maternal death can be treated, whereas other causes such as pre-eclampsia and eclampsia can be managed during ANC [ 3 ]. The attendance of birth by skilled health professionals presents opportunities for preventing some maternal and child deaths as it ensures clean and safe delivery practices. Clean deliveries prevent puerperal sepsis, a major cause of maternal deaths [ 4 ]. Skilled attendants also ensure effective handling of labor, delivery and postpartum complications such as obstructed labor, breech birth, postpartum hemorrhage, retained placenta, and other emergencies [ 5 ]. Ultrasound-based analysis is the most accurate method to assess breech pregnancies [ 6 ], and the key to diagnose ectopic pregnancies and other dangerous pathologies [ 7 ]. Due to the shortage in medical staff, facility and equipment in rural communities, women living in rural and poorer communities are more likely to die from pregnancy and childbirth complications than those who live in urban communities [ 8 ]. In rural areas the distance to modern ANC providers can be considerable. One out of nine women have to travel more than 15 km to reach medical care, th (...truncated)


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Benjamin Amoah, Evelyn Anto, Prince Osei, Kojo Pieterson, Alessandro Crimi. Boosting antenatal care attendance and number of hospital deliveries among pregnant women in rural communities: a community initiative in Ghana based on mobile phones applications and portable ultrasound scans, BMC Pregnancy and Childbirth, 2016, pp. 141, 16, DOI: 10.1186/s12884-016-0888-x