Azzah Nofly Said

Wired Mothers Use of mobile phones to improve skilled delivery attendance in Zanzibar Presented by Azzah Nofly, AMO, MIH Ministry of Health, Zanzibar, Tanzania Principal Investigator Stine Lund, MD, PhD stud Institute of International Health, University of Copenhagen mHealth summit 5th -7th December 2011 99% attend one time ANC 51% institutional delivery MMR [2006]: 528 / 100,000 IMR: 61 / 1,000 Targets 2015 80% - SBA MMR – 130 /100.000 Wired Mothers Maternal Health in Zanzibar Sources: TDHS 2004/05, Lund et al. Facility Based Maternal Mortality in Zanzibar 2005-2007 Documentation Continuous monitoring Audits Misoprostol Training Coordination Job aids Research Wired Mothers Strategic Initiative 2008 to date To link pregnant women to the health care system through mobile phones To improve attendance to antenatal and postnatal care To improve attendance to skilled delivery attendance To improve access to emergency obstetric care Wired Mothers Objectives Wired Mothers Intervention Community •Pregnant Women Health Center •Midwife Hospital •Doctor •Nurse •Ambulance Person Person Person Person Text Messages Health Education Wired Mothers Intervention SMS text messages Automatically generates and sends text reminders for appointments Health educational messages sent on a monthly basis Frequency and content varies depending on gestational age 9587 messages sent Wired Mothers Intervention Cell phone vouchers Direct communication link between the women and midwife Directly communication link between midwife and referral institutions Wired Mothers Methodology Prospective multisite cohort study 24 health facilities - 2550 women Randomization at facility level Clusters based on districts Participants - women attending 1st ANC visit Followed until 42 days after delivery Jina - a wired mother Skilled delivery attendance Wired Mothers Results 0% 10% 20% 30% 40% 50% 60% Skilled delivery attendance 60% 47% Intervention Control Skilled delivery attendance Association with intervention Wired Mothers Antenatal Care Visits Wired Mothers Voice calls • Bleedings before and after delivery • Eclampsia • Obstructed labor • Abortion • Abdominal pain • In labour • Medicines • PV discharge • When to come to clinic 39% called their midwife • Significant difference in women delivering with skilled attendance • Urban women more than 4 times likely to delivery with SBA in intervention group • Did not reach significance amongst rural women • Positive outcomes linked to intervention communication system • Intervention widely accepted amongst health workers and women Wired Mothers Conclusions Zanzibar MOH considering scaling wired mothers to national scale Mobile phone solutions may contribute to saving women’s and newborn lives and towards achievement of MDG 5 mHealth solutions should be considered by maternal health policy makers in developing countries Wired Mothers Policy Implications Wired Mothers��Use of mobile phones to improve skilled delivery attendance in Zanzibar� Wired Mothers Slide Number 3 Slide Number 4 Slide Number 5 Slide Number 6 Slide Number 7 Slide Number 8 Jina - a wired mother Wired Mothers Results Skilled delivery attendance Wired Mothers Wired Mothers Slide Number 14 Slide Number 15 Slide Number 16