Empowered by this success, Labrique’s team will launch a new project this year called mCARE that takes these previous studies to a whole new level. Working closely with the Bangladeshi Ministry of Health and Family Welfare, complementing the government’s vision of a “Digital Bangladesh,” supported by the UBS Optimus Foundation, the researchers will be supplying cell phones to the community health workers who visit women periodically to get those who are pregnant into prenatal care as soon as possible. The phone is an in-expensive Chinese-made Android model—an operating system well suited to mHealth applications because its open-source nature makes it highly customizable to users’ needs.
On their regular pregnancy surveillance visits, these workers can use these phones to register their clients, possibly even snapping a quick picture so supervisors can verify who they’re talking with in subsequent visits. Guided by a customized app on the phone, the workers will then ask a series of questions incorporating lunar calendars and local events, to sort out when the woman’s last menstrual period took place. If it was more than five weeks ago, the app notifies the worker that this client is potentially pregnant.
That pivotal revelation will automatically trigger a series of other events. Based on the woman’s expected due date, the app schedules several prenatal appointments. It will send her reminders on her own phone, if she owns one, and to the community health worker, who will stop by a couple of days before appointments to emphasize the importance of each visit to the woman and her family. As with the previous study, each woman and her family will be encouraged to notify the study by text when they go into labor and if they need help, spurring a mobile health care team into action to attend the birth or facilitate a referral to clinical care. If labor appears premature according to the system’s records, it then signals a special alert to the health care team that they may be dealing with a preterm baby that may have more intense medical needs. Another text when the baby is born will trigger another series of visits one, three and five days later, to make sure that mother and baby are doing well.
When they were about to give birth, the pregnant Bangladeshi women texted a central number. A nurse-midwife team was quickly dispatched.
“Each action here stimulates a reaction,” Labrique explains. “Rather than waiting for a crisis to happen, we’re using mobile technology to respond to potential problems before they occur.”
The study’s impact on mortality is yet to be measured, but based on the pilot work with labor and birth notification systems and emergency dispatches of nurse-midwife teams, Labrique expects these efforts will pay off through better prenatal care for mothers, more attended births and targeted care for infants (especially high-risk, preterm babies)—ultimately saving the lives of mothers and their infants.
“The groundwork has been done to demonstrate that these systems can work in this challenging, resource-limited, remote context,” he says.
A Game Changer?
As Labrique and his astute colleagues noticed, cell phones are an ideal solution to connecting with low-resource populations. But mHealth isn’t just for the developing world, according to Betty Jordan, an assistant professor in the Johns Hopkins School of Nursing.
In 2009, when Jordan was serving on the board of directors at the National Healthy Mothers, Healthy Babies Coalition, she heard of a project that would send text messages with health advice to pregnant women three times a week. Then, once they gave birth, it would switch to health advice for newborns, all based on the due date that enrollees provide when they sign up for the service.
While many low-income women may not have computers or pregnancy books, the coalition reasoned, many of them do have phones—providing a way to deliver information that could have enormous impact on their health knowledge and behavior and the health of their babies.
“I thought it was a fabulous idea,” Jordan recalls. “A 16-year-old inner city pregnant teen may not be going to the library to read a pregnancy website or be able to afford childbirth classes, but she might be willing to read the message that comes across her phone."
Alain Labrique shows off a trove of low-cost technological treasures that support research from Kenya to Bangladesh.
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