Solar-Powered tracking bracelets reduces maternal mortality in Kenya

Dahabo Adi Galgallo is an epidemiologist working with Ministry of Health Marsabit County as County Epidemiologist and Founder of Track and Save a Life, a Community Based Organization in Moyale Sub County. She is also an innovator supported by the Grand Challenges Africa (GC Africa) programme. Grand Challenges Africa seeks to promote Africa-led scientific innovations to help countries achieve the Sustainable Development Goals by awarding seed and full grants to the continent’s most impressive solutions. GC Africa is implemented through the AESA Platform. AESA (Alliance for Accelerating Excellence in Science in Africa) is a funding, agenda-setting, programme management initiative of the African Academy of Sciences (AAS), the African Union Development Agency (AUDA-NEPAD), founding and funding global partners, and through a resolution of the summit of African Union Heads of Governments. GC Africa is supported by the Bill & Melinda Gates Foundation.

Summary

Kenya’s high maternal mortality can be partly explained by the low proportion of women delivering in health facilities and attended to by skilled birth attendants. Dahabo and her team developed beaded bracelets with solar-powered GPS to enable health workers to monitor pregnant pastoralist women, preventing maternal and child deaths.

Background

Maternal mortality is unacceptably high. It is estimated that in 2015, roughly 303,000 women –830 each day -- died from pregnancy or childbirth-related complications worldwide. Almost all of these deaths occurred in low-resource settings, and most could have been prevented.

In Kenya and in most developing countries, maternal and infant mortality rates are still very high compared to developed countries. While maternal mortality rate in Kenya stood at 488/100,000, in Marsabit County it is 820/100,000 which is 2 times the National average, 4 times of Global estimate and 8 times the UN Sustainable Development Goals (SDGs) targets. This county alone reported 97 maternal deaths: 30 during pregnancy, 47 during delivery and 20 within two months after delivery, making it the twelfth of 47 counties in Kenya in terms of recorded maternal death. Marsabit County has a doctor-to-population ratio of 1:10,000.

Pastoralist (Nomadic/Mobile community) women are more likely to die from pregnancy and childbirth complications than those who live in urban settings due to the shortage of medical staff and lack of suitable physical infrastructure (facilities, supplies and equipment). In rural areas, the average geographic distance to reach modern antenatal care (ANC) providers is considerable. One way to improve ANC management is to enable access to remote medical expertise via mobile services that go to where the women are. ANC for pregnant pastoralist women is important as it enables clinicians to detect medical obstetric problems early, allowing intervention before the condition progresses further with detrimental effects on maternal and infant morbidity and mortality.

Marsabit County is a community of 80% pastoralists and is among the 10 counties in Kenya with the highest maternal mortality rates. As a result of the adverse effects of climate change, pastoralist communities are constantly on the move with their livestock to reach available pasture and water. Due to this nomadic lifestyle, expectant women are unable to access health care services as per national and international standards. Existing facilities are typically far away; there is also a high illiteracy rate in these communities.

The UN SDGs 3, 4 and 5, as well as Kenya’s “Big Four” agenda, both specify maternal-child health as a priority concern for the national and global community. The President of Kenya identified health as a pillar of his plan for socioeconomic growth and for good quality and accessible mother and childcare.

Description of Study

This research project fits pastoralist expectant women with electronic bracelets to track them. A GPS device is fitted into a culturally accepted embroidered bead bracelet that relays the wearer’s position to health workers via a web- or android-based application. This enables health care workers to pinpoint the wearer, whether or not she is within cellular network coverage.

Upon enrolment, the women were outfitted with the bracelet design of their choice; only women who were pregnant and gave informed consent were enrolled. The project used an initial sample in 10 key areas of Moyale Sub County, all of which have true nomadic populations. Women selected were <16 weeks pregnant, >15 years old, and with no history of adverse pregnancy outcomes. All subjects live a nomadic lifestyle and move with the family’s animals in search of pasture and water. Women enrolled were tracked until six months after the baby’s birth.

In this demonstration phase of the project, the primary outcome was measured by >3 ANC visits per woman; secondary outcomes were increased skilled attendance at delivery, reduced maternal mortality, reduced neonatal mortality, increased uptake of tetanus vaccine  and increased immunization coverage of new-borns.

Outcome of the Study

Over 500 expectant mothers in the study received ANC and laboratory profiling services; 51 of them had been fitted with GPS. Of the expectant mothers fitted with GPS, over 73% had received more than four ANC visits, with 100% successful delivery without maternal or infant death. All children born to these mothers were immunized on time up to nine (9) months (measles). In contrast, only 2% of mothers without GPS received more than four ANC visits, and almost half of them missed post-birth ANC services. Cases of infant death (2%) were noted among this population. In this group, only a third of infants received immunization through to 9 months. In both groups of women (with and without GPS), the majority of deliveries were conducted at home with the assistance of Trained Birth Assistants (TBAs.) Only four women without GPS delivered at health facilities, whereas seven delivered at a health facility when they wore a bracelet, representing an increase of 43% in facility-based births when mothers were tracked. Most deliveries were at home because outreach sites were typically far away from appropriate health facilities and because of a poor referral system.

In addition to providing antenatal service, the Integrated Maternal Mobile Health (IMMH) program, supported through Grand Challenges Africa, together with the County government and Ministry of Health, was able to provide laboratory services (526 tests conducted), treatment to children over 5 years (4,072 beneficiaries), under 5 years (1,027 beneficiaries), nutrition screening to children under 5 years (2,571), immunization to over 200 children under 5 years and health education to over 5,000 people. Because 98% of these mothers are illiterate, we composed two educational songs in the local language to help spread messages of the importance of attending an ANC clinic for women and to encourage male involvement.

Lessons

In this pilot study, expectant mothers were saved, and data collected can be used to justify scaling the project. We consider this to be an improvement on similar efforts, such as the initiative launched by the First Lady of Kenya to reach pastoralist women, BEYOND ZERO. Our project augments BEYOND ZERO by easily tracing pastoralist women so that when they fail to appear for an ANC appointment and/or fail to bring their child for immunization, they can be tracked, and services can be dispatched to wherever they are.

Impact

The GPS gadget was tested and its impact on better health outcomes has proven to be significant. The pilot project indicated that with the use of GPS tracking bracelets, maternal and child death was reduced by approximately 40%, immunization coverage increased 80-85%, the number of women receiving four or more ANC visits increased from 16% to 95%, skilled deliveries increased from 56% to 66%, and the number of  early screenings for other medical conditions increased from 59% to 90%. There was an improvement in most maternal and child health indicators.

The project was closely coordinated with AMREF and registered as a Local Community Based Organization (name: Track and Save a Life.)  The beneficiaries of these products are people in marginalized, poor communities, so support will be sought from the National/County Ministry of Health, Frontier County and the NHIF insurance company for the sustainability phase of the project.