Use of SMS text for Maternal and Child Health Surveillance in resource constrain setting

Momin Kazi¹,Murtaza Ali¹,  Anita Zaidi^1
1Aga Khan University, Pakistan

Journal MTM 1:4S:46, 2012
DOI:10.7309/jmtm.67

Abstract

Background: Department of Paediatrics and Child Health, Aga Khan University, Karachi, conducts active demographic surveillance system (DSS) for maternal and child health at a peri urban site of Karachi, covering an area of 8.1 sq. miles and having a population of around 275,000. The maternal mortality rate (MMR) is around 200 per 100,000 live births. There are around 300 neonatal and 150 post neonatal deaths in the study catchment area. We introduced a two way SMS based pregnancy and birth registration system in the surveillance catchment area.

Method: Community health workers (CHWs) visit household on quarterly bases in the study catchment area to identify new pregnancies and follow the pregnant woman until their pregnancy outcome. As soon as CHW identifies a pregnant woman, she sends a SMS message to the server. Based on this registration, system generates follow up details of each pregnant woman; giving priority to third trimester. Once live birth identified CHW sends a SMS to the server which alerts the team to examine the neonate.

Results: This system helps in early identification and monitoring of pregnant woman and newborns. Also by sending unique structure identifier through SMS to the server, our CHWs and study staff can get desired information of the pregnant woman and children less than 5 years of age in the study surveillance area.

Conclusion: Through SMS registration we have an extra layer for identifying maternal death and pregnancy outcome. Identifying a woman / child information through SMS is also quite helpful.

SMS Text Messages to Monitor the Coverage during Polio Supplementary Immunization Activities in Karachi, Pakistan

Momin Kazi¹,Shariq Khoja¹,Murtaza Ali¹,  Asad Ali^1
1Aga Khan University, Pakistan

Journal MTM 1:4S:45, 2012
DOI:10.7309/jmtm.66

Abstract

Background: Karachi is the only major city in the world that has not been able to interrupt wild type polio transmission. Supplementary Immunization Activities (SIAs) are an important tool by which countries have sought to increase polio immunization coverage. However, more than 50 SIAs have so far failed to interrupt the transmission of poliovirus in Karachi. Cell phone use has seen a tremendous rise in Pakistan with more than 110 million subscribers. In this study, we are using the wide network of cell phone to monitor the coverage rates during SIAs in Karachi, Pakistan.

Methods: 3535 children less than 5 years old from all over Karachi and three high risk towns where included in the baseline data.The baseline survey included information on basic demographics, short message service (SMS) language preferences and household’s GPS coordinates on a smart phone. After each SIA, a randomly selected 840 households are contacted via SMS inquiring if the vaccinator came to their house and whether their child received vaccine dose or not. In case there is no reply by SMS, same information is captured by phone call. The study will continue till 2013.

Results: A total of 3562 children consented for the baseline study. Out of 840 SMS sent after the first second and third SIA 62 (7%), 189 (23%) and 158 (19%) respectively replied to the SMS. 561 (67%), 374 (44%) and 394 (47%) respectively replied to phone call and 217 (27%), 277 (33%) and 288 (34%) respectively did not reply to SMS or phone call.

Conclusion: The coverage data obtained through the SMS text and phone call replies matches with the data collected through ground team monitoring and other methods like LQAs. SMS based surveillance can be a way to determine population level coverage of polio immunization in a very short time period and this system can be upgraded to country level.

Results of Communication Enhancement Used in eIMCI Decision Support for the Treatment of Children Under Five in Tanzania

Seneca Perri¹, Bethany Hedt², Thomas Routen³, AmaniShao⁴, Clotilde Rambaud-Althaus⁵, Ndeniria Swai⁶, Marc Mitchell^2
1University of Utah, Salt Lake City, UT, United States, ²Harvard School of Public Health, Boston, MA, United States, ³Thingsprime, Freiburg, Germany, ⁴National Institute of Medical Research, Dar es Salaam, United Republic of Tanzania, ⁵Swiss Tropical and Public Health Institute, Basel, Switzerland, ⁶City Medical Office of Health, Dar es Salaam, United Republic of Tanzania

Journal MTM 1:4S:44, 2012
DOI:10.7309/jmtm.65

Abstract

The use of standardized decision support protocols have been shown to improve the quality of health service delivery in pediatric patients of low-resource populations if appropriately followed. However, even when clinical services are good, low levels of health literacy levels among caretakers of children may compromise the fulfillment of treatment plans. This study examines whether the use of mobile technology can improve the impact of counseling of children’s caretakers and result in better understanding of what needs to be done at home after the clinical visit and whether this results in better care of the child.

Utilizing mobile technology, we attempted to address the gap in communication during pediatric health care visits by incorporating specific, customized communication prompts into an eIMCI mobile decision support protocol. We utilized a randomized cluster design to include 310 participants from six municipal clinics in Dar es Salaam, Tanzania. The test arm of the study (electronic arm) included a 25-second video formatted for the mobile phone aimed at educating caretakers on relevant health information, embedded prompts within the protocol containing important messages for caretakers, and a customized summary screen compiling the results of the clinical encounter. The control arm (paper arm) provided equivalent information to the electronic counseling messages in written text as part of the protocol. The counseling delivered by health workers and resulting caretaker knowledge were evaluated by an observer and a short questionnaire of the caretakers after the clinic visit. Our research demonstrated that clinicians provided significantly more counseling to caretakers when using the electronic mobile protocol and caretakers were overall better able to recall what they were supposed to do when they returned home. We believe these results are highly valuable to the greater mHealth community seeking to improve the chain of health service delivery for low-resource populations.

Prescribe Wellness Automated Digital Intervention (ADI) Effectiveness to Increase Medication Adherence

Terry Olson^1
1Prescribe Wellness

Journal MTM 1:4S:43, 2012
DOI:10.7309/jmtm.64

Abstract

Medication non-adherence is pervasive within all areas of the U.S. health care system. Non-adherence has been estimated to range between 17 and 80%: involving 38% of patients on short-term treatment, 43% of patients on long-term treatment, and 75% of patients instructed to make a lifestyle change (DiMatteo, 1994). Approximately 133 million Americans, almost half of the country’s population, live with at least one chronic disease (CDC, 2010). It is estimated that by 2020, 164 million people will be diagnosed with a chronic disease, and 24% of all Americans will have two or more chronic conditions (CDC, 2010). Improving medication adherence can have a great potential to contribute to effective chronic disease state management and overall better health outcomes.

Prescribe Wellness, LLC partnered with leading local pharmacies in the Greater Los Angeles area to create a supplemental Automated Digital Intervention (ADI) to be used with patient-centered Medication Therapy Management (MTM) sessions. This proprietary first generation ADI template, aimed to increase medication adherence through the pharmacy’s intervention process, sends out appropriate motivational, behavioral, and educational messages through timely and relevant communications using the Voice of Authority (VOA).

The purpose of this quantitative study was to determine whether a relationship exists between the PrescribeWellness’ ADI and patient medication adherence. The relationship between variables was examined by implementing descriptive statistics and Chi-squared analysis. Pharmacy patients (n=12) were taken through a standard MTM session followed by ADI voice messaging during the subsequent 90-day period. Results showed there was an association between PrescribeWellness’ ADI and patient medication adherence, as medication adherence rates increased from 66.7% to 85.7%. Additional findings showed there was an increase in adherence rates for those patients with chronic conditions of hyperlipidemia (60% to 93.3%), hypertension (76.2% to 90.5%) and diabetes (47.6% to 57.1%).