effectiveness of an innovative mHealth intervention to improve coverage of proven maternal and

newborn health (MNH) interventions in rural India: A quasi-experimental

study

Dr Dhiren Modi

SEWA RURAL, Jhagadia

Gujarat

Date: 10-11-16

Study Design

Quasi Experimental Study

Methods• This study was conducted among all 32 intervention (population:

28,000) and 51 control villages (population: 30,000) in tribal areas of Gujarat, India using quasi-experimental study design in May, 2014 after completing one year of implementation.

• The mHealth intervention is a mobile-phone application in form of a job-aid to village-level frontline workers called ASHAs.

• Primary outcome of interest was coverage of proven MNH interventions.

• A household survey was done by interviewing all women who recently delivered using a structured, pre-tested questionnaire.

• Data analysis was done using STATA IC 10.

“ImTeCHO”(3 COMPONENTS)

Mobile phone as

job aid to….

ASHAs for ensuring her

routine MCH services

Mobile phone as

a job aid to…..

ASHAs/FHWs/

Helpline for better

morbidity management

Web interface at…

PHC level toprovide timely and

accurate information

for better

Support to ASHAs

ImTeCHO = I am support

Daily Login in Morning

Main MenuProvider work planning and scheduling

Data Collection And Reporting

Electronic Decision Support

( Information, Protocols, Algorithm, Checklist)

Electronic Decision Support

( Information, Protocols, Algorithm, Checklist)

Client Education & Behaviour Change Communication ( BCC)

List of videos

1. Mamta Divas

2. Antenatal Complication

3. Birth preparedness and complication Readiness

4. Breast Feeding

5. Early New Born Care

6. New Born Complications

7. Malnutrition Part One

8. Malnutrition Part Two

9. Immunizations

High risk tracking and Follow up

Financial transaction & Incentives

Supply Chain Management

Results

During pregnancy Intervention

Frequency (%)

N=50

Control

Frequency (%)

N=49

Unadjusted

Odds ratio

(95%

Confidence

interval)

Early registration of pregnancy within first three

months 41 (82) 28 (57)

3.42

(1.37-8.55)

At least four ANC examinations by an ANM or doctor

48 (96) 45 (91)

2.13

(0.37-12.22)

Visited at home by an ASHA at least 3 times during last

pregnancy 45 (90) 28 (57)

6.75

(2.28-19.94)

Received satisfactory counseling for antenatal care from

an ASHA during home visit 43 (86) 18 (36)

10.58

(3.94-28.41)

Respondent able to state at least 3 danger signs of

pregnancy 34 (68) 28 (57)

1.59

(0.70-3.62)

Respondent took more than 100 tablets of iron-folic

acid during pregnancy 25 (50) 21 (42)

1.33

(0.60-2.94)

During delivery and postpartum period Intervention

Frequency (%)

Control

Frequency (%)

Unadjusted

Odds ratio

(95%

Confidence

interval)

Hospital delivery 38 (76) 35 (71) 1.27

(0.52-3.11)

Early initiation of breast feeding 45 (90) 36 (73) 3.25 (1.06-9.97)

ASHA visited at home within 24 hours of delivery (in

case of home delivery) or within 24 hours of return to

home from hospital in case of hospital delivery

42 (84) 34 (69) 2.32

(0.89-6.11)

At least 2 home visits by an ASHA within the first week

of delivery

41 (82) 25 (51) 4.37

(1.75-10.90)

At least 5 home visits by an ASHA within the first

month of delivery & 2 home visits within the first week

28 (56) 5 (10) 11.2

(3.80-32.99)

Received satisfactory counseling for postnatal care

from an ASHA during home visit

34 (68) 9 (18) 9.45

(3.70-24.08)

Mother able to state at least 3 danger signs of newborn 45 (90) 36 (73) 3.25

(1.06-9.97)

Care seeking for complications

Intervention

Frequency (%)

Control

Frequency (%)

Unadjusted

Odds ratio

(95%

Confidence

interval)

Sought help from ASHA for antenatal maternal

complication

24 out of 31

cases (77)

19 out of 33

cases (57)

2.53

(0.85-7.51)

Sought help from ASHA for postnatal maternal

complication

8 out of 13

cases (61)

1 out of 11

cases (9)

16.0

(1.54-166.05)

Sought help from ASHA for neonatal

complication

15 out of 19

cases (78)

5 out of 18

cases (27)

9.75

(2.15-44.14)

Child 6 to 9 MonthsIntervention

Frequency (%)

N=95

Control

Frequency

(%)

N=92

Unadjusted Odds Ratio

(Confidence interval)

Exclusive breast feeding during first

six months

42 (44) 22 (23) 2.5 (1.29-4.98)

Child was fed solid, semisolid or

soft food at least once within last 24

hours

73 (74) 71 (79) 0.77 (0.37-1.62)

Mother knew status of child on WHO

growth chart

28 (29) 5 (5) 7.20 (2.56-25.17)

Mother obtained ORS from ASHA for

child’s diarrhea

6 out of 44

cases (14%)

2 out of 32

cases (6%)

2.3 (0.38-25)

Mother sought help from ASHA for

child’s pneumonia/fever

45 out of 111

cases (41%)

21 out of 89

cases (24%)

2.2 (1.14-4.33)

Conclusion

MHealth interventions can help ASHAs significantly improve coverage of MNH interventions along continuum of care in hard to reach areas. Scaling up mHealth interventions in other tribal areas might be considered.

What next….

Cluster Randomized Trial is going on with the technical and financial help from ICMR: Delhi, WHO: Geneva , Mac Arthur Foundation: USA

Acknowledgements

• ASHAs and PHC staff of the two PHCs in Jhagadia..

• Jamsetji Tata Trust , Mumbai for financial support of this project. Allsupervisors and employees at SEWA Rural for training, mentoring,and providing support and motivation to all ASHAs. Department ofHealth and Family Welfare for facilitating implementation ofImTeCHO.

• IT team Argusoft India Ltd. for tirelessly working closely with SEWARural to develop and improvise the ImTeCHO application.

Thanks…