Tracking of antenatal services and outcomes using community health information system in a slum population of North India

Abstract

Background: Despite of improvement of public health service, the reach of these services has remained low in urban slums due to various socio cultural and environmental factors.Methods: An information and communication technology (ICT) based community health information system was installed in a urban primary health centre catering to urban slum populations in North India. The system was used to track all the antenatal cases registered over a period of one and half years for antenatal services, risk factors and antenatal outcome. The system allowed for tracking of antenatal cases for antenatal care (ANC) visits, investigations, high risk factors, delivery and perinatal care. Real-time monitoring of antenatal cases was made possible through dynamic dashboard with indicators.Results: Among 614 women tracked for ANC and outcome, majority were below 30 years of age (78.3%), belonged to lower caste (85.7%) and many were illiterate (42.8%). Out of all antenatal cases 68% got registered in 1st trimester and only 47% completed 4 ANC visit. Majority delivered in government hospitals (95.4%) with 22.8% delivered through caesarean section. Illiteracy was found to have significant association with higher gravida (>2) (p<0.001). The high risk factors were present in 29.5% of antenatal cases and it was found to be significantly associated with increasing age (p=0.02) and preterm deliveries (p<0.001). Twin pregnancy was also found to be significantly associated with increasing age (p<0.001).Conclusions: An ICT based community health information system can be an effective tool for real-time monitoring of health services, identifying the gaps and tracking of antennal cases especially in difficult to reach slum population.