Mobile Technology May Alter Estimates of Maternal and Infant Mortality

Maria Sgambati, MD

November 10, 2010

November 10, 2010 (Washington, DC) — In the next 90 minutes, 1500 children and 60 women will die in childbirth, mostly from preventable causes. Such were the sobering statistics that Daisy Mafubelu, former assistant director-general of the World Health Organization, quoted to attendees of "Global Strategies for Saving Lives Through Innovation," a session being held here as part of the 2010 mHealth Summit.

Even those numbers could be an underestimate, according to Linda Wright, MD, director of the Global Network for Women's and Children's Health Research at the National institutes of Health in Bethesda, Maryland. She pointed out that 1 critical problem is the lack of data on which to base maternal–child health programs and policy .

"Less than 2% of babies around the globe have their births and deaths recorded in registries," Dr. Wright told Medscape Medical News. "And stillbirths are very rarely recorded or reported in the developing world."

One study that the Global Network carried out is helping to improve this situation. "In Kenya, we had trouble finding all the births and deaths," said Dr. Wright. "So we gave mobile phones to the chiefs and asked them to text us a notification of every pregnant women."

With this technology, the early registry of pregnancies and for prenatal care skyrocketed suddenly and dramatically, but the number of neonatal deaths also rose because there were pregnancies — and therefore deaths — that had previously gone unrecorded.

"Registries are really the low-hanging fruit in terms of impact we can make with mobile technology," Dr. Wright observed.

"One really big challenge has been counting maternal, newborn, and child deaths, which really have been estimates," Ms. Mafubelu told Medscape Medical News. "Mobile phones are being used in innovative ways to get more accurate numbers. But this technology is also letting us get a better idea of the cause of these deaths, whether it is peripartum sepsis or bleeding or eclampsia." Knowing the causes may help improve delivery of care, she noted.

Data like this will assist healthcare providers, researchers, private companies, the technology industry, and policy makers in better understanding how to use innovative technologies to help meet the 2015 United Nations Millennium Development Goals. Two of the 8 goals focus on reducing child mortality and improving maternal health. Despite progress towards these goals, cited in a September 2010 UN report, newborn, child, and maternal deaths remain high and are far from reaching the two-thirds and three-quarters reductions in morality goals, respectively, laid out in the original signing of the Millennium Development Goals in 2000.

Other panelists confirmed that accurate data are part of the problem. Hamish Fraser, MB ChB, MSc, director of informatics and telemedicine, Partners in Health, Boston, Massachusetts, cited a study that also showed underestimates of pregnancy. "In one study carried out by Martin Were in Kenya, healthcare workers went house to house to collect data using [personal digital assistant]/[global positioning system] technology," Dr. Fraser said. "We found that we only knew about 45% of the pregnant women in the area we studied." In some regions of the world, using the interface of mobile technology combined with old technology — going door to door to collect data — may prove to be the most effective and accurate approach to gathering data.

However, better data keeping is only part of the approach to improving maternal and child health outcomes with innovative technology.

"We have to have affordable technology," stressed Andrew Dunnett, director of the Vodafone Foundation and a member of the panel. To help make this a reality, Vodafone developed a $15.00 mobile phone that is an integral part of a health delivery project in Dar Es Saalam, Tanzania.

"We decided to focus on several surgical problems in the country, including cleft palate and vesicovaginal fistulas," noted Mr. Dunnett. Vesicovaginal fistulas, which are often a complication of prolonged labor during childbirth, create significant adverse effects on a woman's physical and emotional well-being. One key problem in fixing these 2 conditions was identifying patients in remote areas and scheduling them for surgery in the city hospital.

To overcome this hurdle, charity workers, nurses, and physicians in villages identified patients in need of these surgeries, and used Vodafone's M-PESA service to send a text message to the hospital. Within 3 hours, the hospital wired money back to the village for the bus fare — which is often the significant access issue for patients. When patients arrive at the hospital, they show their bus ticket, which is linked to the hospital scheduling plan. "For want of a $3.50 bus ticket, women and children have been living with these conditions without any hope of relief," Mr. Dunnett said. "With this simple cell phone technology, we are overcoming that hurdle."

"This new technology really presents a great opportunity to address some of the big issues we are still trying to find solutions to in terms of maternal, newborn, and child health," Ms. Mafubelu told Medscape Medical News. "Some of the challenges we are experiencing with this new technology are lots of pilot studies and duplication — and not as many evaluation studies, in terms of effectiveness," she said. "So we all need to work together better to reduce the duplication and share results. Also, there is just no way that government alone, particularly in developing countries, can do all of this. We need public–private partnerships to help make this happen."

Although the session focused on the innovative technology to improve maternal and infant health issues in developing countries where the need is most critical, at the same meeting, Johnson and Johnson announced a major expansion of their US program called "Text4Baby."

Launched in spring 2010, Text4Baby allows women to sign up to receive free weekly SMS text messages timed to the birth of their baby or delivery date. Messages, which can be sent in either English or Spanish, offer practical information for new or expecting mothers. Since its launch, Text4Baby has reached about 100,000 subscribers. The expansion hopes to reach more than 1 million subscribers, with increased interactivity. The US Department of Defense and Departments of Health and Human Services are both conducting formal evaluations of the service. Among industrialized nations, the US infant mortality rate is one of the highest.

The speakers have disclosed no relevant financial relationships.

2010 mHealth Summit: Plenary session. Presented November 8, 2010.

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