BackgroundMaternal and neonatal mortality figures remain unacceptably high worldwide and new approaches are required to address this problem. This paper evaluates the impact on maternal and neonatal mortality of a pregnancy care package for rural areas of developing countries with portable ultrasound and blood/urine tests.MethodsAn observational study was conducted, with intervention and control groups not randomly assigned. Setting: Rural areas of the districts of Senahu, Campur and Carcha, in Alta Verapaz Department (Guatemala). The control group is composed by 747 pregnant women attended by the community facilitator, which is the common practice in rural Guatemala. The intervention group is composed by 762 pregnant women attended under the innovative Healthy Pregnancy project. That project strengthens the local prenatal care program, providing local nurses training, portable ultrasound equipment and blood and urine tests. The information of each pregnancy is registered in a medical exchange tool, and is later reviewed by a gynecology specialist to ensure a correct diagnosis and improve nurses training.ResultsNo maternal deaths were reported within the intervention group, versus five cases in the control group. Regarding neonatal deaths, official data revealed a 64 % reduction for neonatal mortality. A 37 % prevalence of anemia was detected. Non-urgent referral was recommended to 70 pregnancies, being fetal malpresentation the main reported cause.ConclusionImpact data on maternal mortality (reduction to zero) and neonatal mortality (NMR was reduced to 36 %) are encouraging, although we are aware of the limitations of the study related to possible biasing and the small sample size.The major reduction of maternal and neonatal mortality provides promising prospects for these low-cost diagnostic procedures, which allow to provide high quality prenatal care in isolated rural communities of developing countries.Trial registrationThis research was not registered because it is an observational study where the assignment of the medical intervention was not at the discretion of the investigators.

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Rural areas in developing countries are characterized by lack of resources, low population density, and scarcity of communications infrastructure. These circumstances make it difficult to provide appropriate health-care services. This paper explains research results achieved by Enlace Hispano Americano de Salud – Hispano American Health Link (EHAS) and how they have contributed to improve healthcare in isolated areas of developing countries through the use of information and communication technologies (ICT). As the first step, EHAS always collaborates with public health systems to identify its communication and information needs. Based on the analysis of needs, EHAS does research on appropriate technologies to provide communication in each context and on information systems suited to needs of health personnel. In parallel, EHAS has worked to provide applications that, making use of the communications services installed, could improve the health-care services in these remote areas. In this line, solutions to improve epidemiological surveillance or to provide telemedicine services (like a digital stethoscope or a tele-microscopy system) have been developed. EHAS has also performed several researches trying to ensure the sustainability of their solutions and has summarized them in a Management Framework for Sustainable e-Healthcare Provision. Finally, the effort to spread acquired knowledge has crystallized in a book that details all the technologies and procedures previously mentioned.

SummaryThe Guatemalan NGO (Non-Governmental Organization) TulaSalud has implemented an m-health project in the Department of Alta Verapaz. This Department has 1.2 million inhabitants (78% living in rural areas and 89% from indigenous communities) and in 2012, had a maternal mortality rate of 273 for every 100,000 live births. This m-health initiative is based on the provision of a cell phone to community facilitators (CFs). The CFs are volunteers in rural communities who perform health prevention, promotion and care. Thanks to the cell phone, the CFs have become tele-CFs who able to carry out consultations when they have questions; send full epidemiological and clinical information related to the cases they attend to; receive continuous training; and perform activities for the prevention and promotion of community health through distance learning sessions in the Q’eqchí and/or Poqomchi’ languages. In this study, rural populations served by tele-CFs were selected as the intervention group while the control group was composed of the rural population served by CFs without Information and Communication Technology (ICT) tools. As well as the achievement of important process results (116,275 medical consultations, monitoring of 6,783 pregnant women, and coordination of 2,014 emergency transfers), the project has demonstrated a statistically significant decrease in maternal mortality (p < 0.05) and in child mortality (p = 0.054) in the intervention group compared with rates in the control group. As a result of the telemedicine initiative, the intervention areas, which were selected for their high maternal and infant mortality rates, currently show maternal and child mortality indicators that are not only lower than the indicators in the control area, but also lower than the provincial average (which includes urban areas).

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