142nd APHA Annual Meeting and Exposition

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Can an Integrated mHealth System Increase Utilization of Antenatal care services and Promote Safe Delivery?

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Neelu Singh, MPH, MSW , Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Alain Labrique, PhD, MHS, MS , Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Sucheta Mehra, MSC , Center for Human Nutrition - Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Hasmot Ali, MBBS, MPH , Johns Hopkins University Bangladesh, Dhaka, Bangladesh
Parul Christian, DrPH , International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Keith West Jr., DrPH , Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Background:In JiVitA population research site in Northern Bangladesh, 85% of births occur at home & 18.5% of pregnant women receive antenatal care (ANC). We developed a comprehensive mHealth system called mCARE, facilitating digital pregnancy surveillance & registration that successfully enrolled 30,000 rural women; women were visited every 5 weeks to identify incident pregnancies, of which 1600 were enrolled in the study.

Methods: Community health workers (CHWs) used mCARE to enroll 1600 pregnant women & determine gestational age based on date of last menstrual period (LMP). Based on LMP, a server algorithm automatically scheduled upto 4 ANC visits for each woman in the mobile system group. SMS reminders to access timely ANC during were sent to 800 women with phones in the mobile group and to CHWs responsible for their well-being, creating both demand and supply-side drivers.

Results: All 1600 women were interviewed to document patterns of ANC utilization, type of ANC facility used & specific services received. Women not seeking ANC were asked to identify whether lack of time, transport, financial constraints, no permission from family to access ANC & intention to seek/receive ANC services in future contributed to poor utilization. Responses will help determine whether community mobilization through text-messaging (to both client & provider) is associated with differential care seeking and safe-delivery behavior.

Conclusion: The study is still in progress and we expect to have all of the data analyzed by April 2014. This research is among the first such data to be systematically collected in South Asia.

Learning Areas:

Communication and informatics
Program planning
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Assess increase in utilization of antenatal care services by pregnant women who received up to 4 scheduled SMS reminders based on gestational age to receive timely ANC as compared to pregnant women who did not receive any reminders to access antenatal care.

Keyword(s): Health Systems Transformation, Practice-Based Research

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the author of this paper and lead scientist on the project, overseeing its daily implementation and progress in the field.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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