Using mobile health to support clinical decision-making to improve maternal and neonatal health outcomes in Ghana: Insights of frontline health worker information needs
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Date
2019-05-24
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of Medical Internet Research
Abstract
Background: Developing and maintaining resilient health systems in low-resource settings like Ghana requires innovative
approaches that adapt technology to context to improve health outcomes. One such innovation was a mobile health (mHealth)
clinical decision-making support system (mCDMSS) that utilized text messaging (short message service, SMS) of standard
emergency maternal and neonatal protocols via an unstructured supplementary service data (USSD) on request of the health care
providers. This mCDMSS was implemented in a cluster randomized controlled trial (CRCT) in the Eastern Region of Ghana.
Objective: This study aimed to analyze the pattern of requests made to the USSD by health workers (HWs). We assessed the
relationship between requests made to the USSD and types of maternal and neonatal morbidities reported in health facilities
(HFs).
Methods: For clusters in the intervention arm of the CRCT, all requests to the USSD during the 18-month intervention period
were extracted from a remote server, and maternal and neonatal health outcomes of interest were obtained from the District Health
Information System of Ghana. Chi-square and Fisher exact tests were used to compare the proportion and type of requests made
to the USSD by cluster, facility type, and location; whether phones accessing the intervention were shared facility phones or
individual-use phones (type-of-phone); or whether protocols were accessed during the day or at night (time-of-day). Trends in
requests made were analyzed over 3 6-month periods. The relationship between requests made and the number of cases reported
in HFs was assessed using Spearman correlation.
Results: In total, 5329 requests from 72 (97%) participating HFs were made to the intervention. The average number of requests
made per cluster was 667. Requests declined from the first to the third 6-month period (44.96% [2396/5329], 39.82% [2122/5329],and 15.22% [811/5329], respectively). Maternal conditions accounted for the majority of requests made (66.35% [3536/5329]).
The most frequently accessed maternal conditions were postpartum hemorrhage (25.23% [892/3536]), other conditions (17.82%
[630/3536]), and hypertension (16.49% [583/3536]), whereas the most frequently accessed neonatal conditions were prematurity
(20.08% [360/1793]), sepsis (15.45% [277/1793]), and resuscitation (13.78% [247/1793]). Requests made to the mCDMSS varied
significantly by cluster, type of request (maternal or neonatal), facility type and its location, type-of-phone, and time-of-day at
6-month interval (P<.001 for each variable). Trends in maternal and neonatal requests showed varying significance over each
6-month interval. Only asphyxia and sepsis cases showed significant correlations with the number of requests made (r=0.44 and
r=0.79; P<.001 and P=.03, respectively).
Conclusions: There were variations in the pattern of requests made to the mCDMSS over time. Detailed information regarding
the use of the mCDMSS provides insight into the information needs of HWs for decision-making and an opportunity to focus
support for HW training and ultimately improved maternal and neonatal health.
Description
Research Article
Keywords
mHealth, maternal health, neonatal health, health care systems, developing countries, decision-making, information retrieval systems