Effectiveness of mHealth interventions for maternal, newborn and child health in low– and middle–income countries: Systematic review and meta–analysis

Lee, Siew Hwa; Nurmatov, Ulugbek; Nwaru, Bright I.; Mukherjee, Mome; Grant, Liz; Pagliari, Claudia

doi:10.7189/jogh.06.010401

Cited by 364 publications

(355 citation statements)

References 39 publications

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“…11,12 However, most of the studies in this area are of poor methodologic quality, and few have evaluated the effects on client health outcomes. 12,13 This cluster-randomized clinical trial sought to determine the effect of an mHealth training tool for birth attendants in lowincome countries, the safe delivery app (SDA), on the knowledge and skills of health care workers in neonatal resuscitation and perinatal mortality.…”

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confidence: 99%

Association Between the Safe Delivery App and Quality of Care and Perinatal Survival in Ethiopia

et al. 2016

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IMPORTANCE Health apps in low-income countries are emerging tools with the potential to improve quality of health care services, but few apps undergo rigorous scientific evaluation.OBJECTIVE To determine the effects of the safe delivery app (SDA) on perinatal survival and on health care workers' knowledge and skills in neonatal resuscitation. DESIGN, SETTING, AND PARTICIPANTSIn a cluster-randomized clinical trial in 5 rural districts of Ethiopia, 73 health care facilities were randomized to the mobile phone intervention or to standard care (control). From September 1, 2013, to February 1, 2015, 3601 women in active labor were included at admission and followed up until 7 days after delivery to record perinatal mortality. Knowledge and skills in neonatal resuscitation were assessed at baseline and at 6 and 12 months after the intervention among 176 health care workers at the included facilities. Analyses were performed based on the intention-to-treat principle.INTERVENTIONS Health care workers in intervention facilities received a smartphone with the SDA. The SDA is a training tool in emergency obstetric and neonatal care that uses visual guidance in animated videos with clinical instructions for management. MAIN OUTCOMES AND MEASURESThe primary outcome was perinatal death. Secondary outcomes included the knowledge and clinical management of neonatal resuscitation (skills) of health care workers before the intervention and after 6 and 12 months. RESULTSThe analysis included 3601 women and 176 health care workers. Use of the SDA was associated with a nonsignificant lower perinatal mortality of 14 per 1000 births in intervention clusters compared with 23 per 1000 births in control clusters (odds ratio, 0.76; 95% CI, 0.32-1.81). The skill scores of intervention health care workers increased significantly compared with those of controls at 6 months (mean difference, 6.04; 95% CI, 4.26-7.82) and 12 months (mean difference, 8.79; 95% CI, 7.14-10.45) from baseline, corresponding to 80% and 107%, respectively, above the control level. Knowledge scores also significantly improved in the intervention compared with the control group at 6 months (mean difference, 1.67; 95% CI, 1.02-2.32) and at 12 months (mean difference, 1.54; 95% CI, 0.98-2.09), corresponding to 39% and 38%, respectively, above the control level. CONCLUSIONS AND RELEVANCEThe SDA was an effective method to improve and sustain the health care workers' knowledge and skills in neonatal resuscitation as long as 12 months after introduction. Perinatal mortality was nonsignificantly reduced after the intervention. The results are highly relevant in low-income countries, where quality of care is challenged by a lack of continuing education. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01945931

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Association Between the Safe Delivery App and Quality of Care and Perinatal Survival in Ethiopia

et al. 2016

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“…These authors concluded that the emerging focus on strong experimental research designs, combined with government involvement and integration of mHealth interventions into the healthcare system, was a positive development, and augured well for the field, a marked departure from the conclusion of Lee et al [21]. …”

Section: Literature Reviewmentioning

confidence: 99%

Thinking about the environment and theorising change: how could Life History Strategy Theory inform mHealth interventions in low- and middle-income countries?

Morgan

Hunt

Tomlinson

2017

Global Health Action

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Background: There is a growing body of literature outlining the promise of mobile information and communication technologies to improve healthcare in resource-constrained contexts.Methods: We reviewed the literature related to mobile information and communication technologies which aim to improve healthcare in resource-constrained contexts, in order to glean general observations regarding the state of mHealth in high-income countries (HIC) and low- and middle-income countries (LMIC).Results: mHealth interventions in LMIC often differ substantively from those in HIC, with the former being simpler, delivered through a single digital component (an SMS as opposed to a mobile phone application, or ‘app’), and, as a result, targeting only one of the many factors which impact on the activation (or deactivation) of the target behaviour. Almost as a rule, LMIC mHealth interventions lack an explicit theory of change.Conclusion: We highlight the necessity, when designing mHealth interventions, of having a theory of change that encompasses multiple salient perspectives pertaining to human behaviour. To address this need, we explore whether the concept of Life History Strategy could provide the mHealth field with a useful theory of change. Life History Strategy Theory may be particularly useful in understanding some of the problems, paradoxes, and limitations of mHealth interventions found in LMIC. Specifically, this theory illuminates questions regarding ‘light-weight’ programmes which solely provide information, reminders, and other virtual ‘nudges’ that may have limited impact on behaviours governed by extrinsic structural factors.

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“…Since the establishment of the Millennium Development Goals (MDG) in 2,000 and the Sustainability Development Goals (SDG) in more recent times the healthcare sector in developing countries has witnessed the introduction of various mHealth technologies [8,9]. Numerous mHealth technologies were introduced (cf.…”

Section: Mobile Health (Mhealth) In Developing Countriesmentioning

confidence: 99%

Starting with small health data opportunities for Mhealth in Africa

Heavin¹,

Connor²

2016

Int. J. DNE

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The need to obtain data to understand effective and available child mortality-reducing control measures in rural areas of developing countries is great. Evidence shows that this challenge can potentially be overcome with the increased availability of Information and Communication Technology (ICT) to support the data/information/ knowledge needs of healthcare delivery services in low resource settings. Recognising the benefits of ICT and the need for improvements in the Nigerian health sector, this paper outlines the plans for the technical feasibility assessment of the IMPACT (usIng Mobile Phones for Assessing, Classifying and Treating sick children) smartphone application to capture, store and analyse of child health assessment data. IMPACT is a secure, scalable, user friendly mobile health (mHealth) innovation that is being developed to support 'small data' capabilities within the context of healthcare in the community in Enugu State, Nigeria, Africa. Notwithstanding the heightened focus on 'big data' in health, this research is interested in investigating the opportunities associated with doing 'small healthcare data' well, with the long term view of building to the big data scenario for healthcare in the community in Enugu. This paper outlines the plan for the IMPACT project considering the implications for health data, knowledge management in healthcare and the big data opportunities to support disease surveillance, healthcare delivery and resourcing and healthcare practitioner education.

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Effectiveness of mHealth interventions for maternal, newborn and child health in low– and middle–income countries: Systematic review and meta–analysis

Cited by 364 publications

References 39 publications

Association Between the Safe Delivery App and Quality of Care and Perinatal Survival in Ethiopia

Association Between the Safe Delivery App and Quality of Care and Perinatal Survival in Ethiopia

Thinking about the environment and theorising change: how could Life History Strategy Theory inform mHealth interventions in low- and middle-income countries?

Starting with small health data opportunities for Mhealth in Africa

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