Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Mar 4, 2020
Date Accepted: May 14, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Improving the Quality of Antenatal Care Using Mobile Health in Madagascar: A Cross-sectional Study Over 5 years
ABSTRACT
Background:
: Despite many efforts, maternal mortality remains a major burden in most developing countries. Mobile health has the potential to improve access to obstetric care through applications that help patients and providers.
Objective:
To use mHealth in providing antenatal care (ANC) to 1446 pregnant women in a rural area of Madagascar and evaluate the quality of ANC provided by an mHealth system designed to change the behaviors of providers and patients.
Methods:
We included 1446 women who attended ANC visits using an mHealth system in rural Madagascar from 2015 to 2019. This cross-sectional study used data on different participants, with information collected over several years, to analyze outputs related to ANC quality over time. Specifically, we examined the timing of first ANC visit, the relationship between visit duration and risk factors among pregnant women, and the number of ANC visits per woman.
Results:
The first ANC visit occurred earlier in the pregnancy as time passed after the implementation of the mHealth system in 2015. More women attended their first ANC visit in the second trimester of pregnancy in 2019 than in previous years (P<.001). In 2019 fewer women attended their first ANC visit in the third trimester (57/277, 20.7%) than in 2015 (147/343, 42.9%). There were statistically significant associations between ANC visit duration and risk factors including age (over 35 years, 25.0, 95%CI 24.0-25.9), educational level (longer for women with lower than primary education and for women who attended university than primary-school-level-education 40.7 95% CI 30.2-51.3 and 25.3, 95% CI 24.4-26.3 vs 95% CI 22.9-23.8; P=0.001), experience of domestic violence during pregnancy, gravidity, parity, infectious diseases (HIV, malaria, and syphilis), and level of anemia. Statistically significant associations were observed for all quality indicator variables. We observed a statistically significant increase in the number of ANC visits per woman over time from 2015 to 2017; the number of ANC visits per woman then became stable after the third year following the implementation of the PANDA (Pregnancy and Newborn Diagnostic Assessment) mHealth system.
Conclusions:
This study shows the potential of an mHealth system to improve the quality of ANC, change provider behavior by standardizing ANC visits, and change patient behavior by increasing willingness to return for subsequent visits and encouraging ANC attendance early in the pregnancy. As this is an exploratory study, further studies are necessary to better understand how mHealth can change behavior and to identify the conditions required for behavior changes to persist over time. Clinical Trial: ISRCTN18270380
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