The effect of mobile Health (mHealth) on family planning in Southern Ethiopia: a cluster randomized controlled trial
Funding Area: Critical shared infrastructure / Infraestructura compartida critica
Problem Statement: Over the last two decades, there have been substantial efforts to improve maternal and child health around the globe. However, some areas such as the African countries have only benefited minimally from these efforts due to many unforeseen challenges. According to the WHO, 62% of maternal deaths occur in the Sub-Saharan region. One in 11 children born in the Sub-Saharan region face death before five years and one in forty15-year-old girls die due to pregnancy-related causes. The major challenge is women's lack of awareness and access to health information, resulting in unnecessary death and sub-par maternal and child health. One of the potential solutions is increasing the accessibility to mobile phones and applying technologies such as mobile health (mHealth) to provide health information to mothers. However, most mothers are poor and have no mobile phones to take the service through mHealth, and health institutions need computers to coordinate the messaging system. The main objective of this study is to assess postpartum family planning. Secondary objectives include timing of complementary feeding, percentage of prelacteal feeding, percentage of exclusive breastfeeding (EBF), and the number of children who completed the one-year childhood vaccination. Infrastructures like computer installation, training health professionals, and mobile phones and computers are the main tasks of the project implementation strategies.
Proposed Activities: Software customization: To create a messaging service tailored to this study, we will modify customizable messaging software, FrontlineSMS, and will assimilate it into the mobile phone scheme and the central server at Arba Minch University. Subscription will be done for short-code system and general service mobile (GSM) modem through Ethio-Telecom. The Ethio-telecom endpoint will be connected with the local network at the point of the mHealth management system. The software will enable us to know whether the woman reads the message or not. For not responding women, We make phone calls if do not read messages. Recruitment: The screening to show no difference between intervention and control groups regarding maternal and health service uptalking will be confirmed ahead of individual recruitment. These will include socioeconomic factors, location or place of residence, and ANC-using status. Thus, 1. There are 102 functional health facilities (HF) in the selected Gamo and Gofa zones 2. We pick 20 HF (10 controls and 10 interventions) from the two zones using two people randomly invited outside the research team for this procedure. 3. From the folded pieces of paper containing names of HF inside an opaque basket, one person picks intervention and the other picks the controls 4. Individual women in a given HF are included in the study using Simple Random Sampling (SRS) from the ANC registration book unit number. The ANC registers have unique (unit) numbers, dates of appointment, and women's contact addresses. The health extension/community health worker/ family folder or field book is available to recruit mothers outside health centers. The field book contains information registered during home-to-home visits. The family folder contains the overall family profile including health Cards, Integrated Antenatal, delivery, postnatal and newborn cards. It enables us to find pregnant women who are not in the hospital’s or health center’s ANC registration books. 5. We randomize women with declared third-trimester gestational age (GA) into controls and intervention. 6. Mothers are blinded to the final aim of the trial while health professionals are blinded to who is in or out of the trial. 7. We register women and collect biodata. 8. At this stage, the initial data collection or interview with women will take place. Follow-up: We will send text messages every two weeks and an additional text message within 24 hours of the appointment date through their mobile phone registered during recruitment. The mothers will receive messages at 7:00 p.m. In addition to the data collected during the recruitment, the project holds four data collection periods, after birth. Stool examination: The assessment will include a stool examination to support the mothers’ reports. Mothers may report not starting complementary feeding before the standard time (6 months), but the presence of intestinal parasites will confirm whether the child took additional food at this age.
Openness: The primary clearance for the study was obtained from the Institutional Review Board of Arba Minch University (AMU-IRB Ref. No 1326/2022). This is because the study will be conducted in Southern Ethiopia in the AMU research catchment area with the full attention of AMU. The University of Maastricht provides support for the candidate. We will collect permission letters from respective Zonal and Woreda/district Health Departments in research areas to conduct the data collection. Written consent will be obtained to participate in the study. Participants will be guaranteed all rights to decide on their participation. Client-identifying information remains confidential throughout. The protocol for this study is under peer review for publication and every scientific method is openly available for comments. The data collected during the project will be available to the scientific community within six months of completion of the project. All the procurement activities infrastructures like mobile phones, laptop computers, and desktop computers will be carried out through the formal Arba Minch University channel and evidence will be available for internal and external audits.
Challenges: Inflation: Ethiopia is currently one of the severely affected countries by inflation. Although could report an inflation rate of 36%, the fact on ground is different. The cost of laptop computer is 20000 Ethiopian birr last year but is 60000 this year. A mobile phone is being bought by the maximum 10000 ETB and is 20-30000 this year. The condition is still uncertain and what will happen next is not known. However, depending on the current stability situation, the possibilities of getting into more inflation is high. Staff turnover: When we install computers at health institutions for sending messages for mothers to take service, we will train at least one staff regarding manipulating messaging system. However, that person leave the institution, it might be difficult to manage the system. Thus, making the included institutions part of Arba Minch University community service and mentorship program wight help in this situation. This will ensure continues follow up the program. Power fluctuation: Health institutions may face power fluctuation throughout the program implementation. This is the genuine problem of most institutions in the country. However, for the sake of vaccine preservation, health institutions have backup generators. Additionally, we will procure backup batteries for computers.
Neglectedness: Arba Minch University provides the fund for data collection only ($5,000). The amount is scanty and cannot buy any device to implement this program/project, In the absence of any external funding, we can only send messages from our computers. However, this has got many challenges such as the bias of including only those who have mobiles, missing a larger proportion of the rural mothers, and poor externalization of the findings. We are preparing many documents to try to apply for small grants in the next one-year time to support or vision but have no funding currently and are not sure where it will come from.
Success: Community service is a continuous activity at Arba Minch University. Staff promotion and competitions for positions are dependent on community service certificates. This project activity is specifically an important community service activity for the public health department, which is currently willing to take on more topics to serve the community. This may help us to make the current project one of the community service activities for the university. Maternal and child health is a hot issue in Ethiopia, thus, the project may be supported to become one of the routine community service activities. Supportive supervision, mentorship, and technical support on mHealth equipment may be among the activities that the University may provide to health institutions. . At the end of the third year from the start, there will be a three-year report, which may show how it fits the community. Activity modification might be necessary to make it close to the community. At the end of one year of sustainability, the Arba Minch University community would accept the project as regular community service and a full report presentation at the annual University conference start. Arba Minch University Community Service Directorate would assume the responsibility of strengthening its continuity. Thus, the project would establish itself as a regular community service activity. The health informatics department then started developing data centers and preparing datasets for research.
Total Budget: $25,000
Budget File: pdf
Affiliations: Maastricht university
LMIE Carveout: Maastricht university
Team Skills: The project applicants had many previous successes in project leadership and implementations. Girma Gilano completed computerizing (digitalization) of chronic care data handling at Arba Minch General Hospital (2018-2022). Gilano is also completed “Improving Health Management Information System (HMIS) data quality and information use” at Arba Minch Zuria Woreda health institutions, in Southern Ethiopia (2020-2022). Additionally, two reviews (the effect of mHealth on child feeding practice in Africa: systematic review and meta-analysis and the effect of mHealth on childhood vaccination in Africa: a systematic and meta-analysis) completed by Gilano under the current project. Gilano is an assistant professor in Public Health Informatics inclined to research activities and has published 27 articles mostly related to maternal and child health. He is striving to achieve the main aim of researching in and outside Ethiopia to solve community health problems. He started the current project to be an activity that is continually modified until all necessary resources are fulfilled and its acceptance as part of routine child and maternal health service. The previous successes might be key to the success of the current project. Professor Dekker and Dr. Fijten are both experts in the interaction between technology and health.
TLDR: Maternal and child health
Submission Number: 10
Loading