Using technology to promote safe maternal health practices in Nigeria

_{By Oluwaseun Obasola, Nigerian Information Scientist}

Summary

In sub-Saharan Africa, especially Nigeria, maternal and infant mortality remains a persistent and serious health challenge. Information and Communication Technology (ICT) interventions offer an effective approach to alleviate this challenge and improve health outcomes. From the experiences of health workers, this study found that using ICT to care for women during and after pregnancy increased the demand for health services and had a positive effect on maternal-infant deaths. It reaffirms that ICT tools (mobile phones, the Internet, television/digital video disk (DVD) and radio) are important for appointment reminders, communication of health tips and referrals of emergencies. Findings indicate that it is imperative to subsidise the cost of access, repackage messages in a language and style to suit mothers, and harmonise and integrate existing ICT-based projects for nationwide implementation in order to expand access and improve the care of women during and after pregnancy.

Background

The United Nations’ Sustainable Development Goal 3 (SDG 3) specifies the need to ensure healthy lives and promote well-being for all ages. Target 3.1 of the SDG specifically underscores the need to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 from the 533 deaths per 100000 live births currently experienced in Sub-Saharan Africa. To realize this target, both improving access to health care and the use of Information Communication Technology (ICT) to communicate maternal health information have been found to be vital to place health information within reach of this vulnerable group, and therefore save lives. ICT has already proven efficient and valuable for disseminating information and delivering care services to patients in underprivileged groups. To maximize the gains of ICT for maternal and child health care (MCH), an in-depth understanding of the value of ICT tools, especially mobile phones, is imperative to improve practicability, acceptability and evaluation of such interventions. 

Description of study

Having personally suffered a miscarriage and experienced complications at delivery, as well as watched mothers, gasp for breath in childbirth, the pain and misery of mother and infant death is deeply relatable and has inspired this field of inquiry.

The study identified and interviewed health care providers in nine clinics with ICT-based interventions for maternal and child health care in four Nigerian states (Ondo, Imo, Gombe and Kaduna.) The ICT-based interventions or projects for maternal and child health utilize ICT tools (like mobile phones , IPAD, computers) by health care providers to care for pregnant women and nursing mothers with their infants. Data collected were analysed using Nvivo (software program) to identify themes relevant to the objective of the study. The study was initiated in December 2018 and completed in August 2020.

This work is unique because previous Nigerian studies on ICT-based interventions for maternal and child health (MCH) explored the use of ICT mostly from the patient's perspective. The views and experiences of health care providers in ICT-based projects for MCH add an important perspective of the value of ICT for MCH care; these multiple perspectives will be valuable to scale up existing health care models for ICT-based interventions targeted at pregnant women and mothers with infants.

 This research is based on a solid foundation of literature from field practitioners on the use of ICT to reduce the mortality of mothers and their infants in Nigeria. The imperative to tackle this public health challenge is even more urgent in the pandemic and post-pandemic era, because ICT-enabled remote consultation, information dissemination and education enable less frequent visits to antenatal clinics, thus limiting exposure to infection and ensuring compliance with COVID-19 protocols. The use of ICT has been accelerated by COVID-19 in other sectors, including government, academia and business, to transact business, communicate, counsel, hold meetings and deliver lectures. Perhaps a silver lining of the pandemic may be increased investment in ICT by the government, the private sector and NGOs to accelerate the establishment of a robust ICT infrastructure and to strengthen the capacity of health workers to serve expectant mothers and their babies remotely. 

 Study outcomes

The average age of the participants was 45.6yrs. Participants reported using mobile phones, the Internet, television/digital video disk (DVD), and radio to provide maternal health care. Other tools such as laptops/projectors for PowerPoint slides and public address systems were used during antenatal classes for maternal health education. The same ICT tools were also used for appointment reminders, communicating health tips, and referrals during emergencies. Participants reported challenges such as unreliable power supply, the cost of using ICT and irrelevant calls. Using ICT to care for women during and after pregnancy increased the demand for health services and a decrease in infant mortality In one clinic the turnout increased from 10 to 60 women going for antenatal service in a day which is attributed to an increase in awareness of health information and services provided at the clinic.

Participants (health care providers) report that the use of ICT tools made their jobs more interesting because of the association of ICT tools for patient care with advanced clinics. The health care providers also reported enhanced ability to promptly refer pregnant women and infants during emergencies - for example, one of the respondents highlighted a reduction in infant death within the first week of life noting that after the Safe Motherhood mhealth project was launched, the death of newborns within the first seven days of life had reduced.  Using ICT tools for MCH care also encourages maternal health practices including the uptake of immunization and health facility utilisation.

The study synthesizes information from published literature and field practitioners to provide health care providers, designers of ICT-based interventions for MCH and policymakers data to inform design and formulate policies to expand and improve access to and delivery of care that can save the lives of mothers and infants. 

Lessons 

The major lesson from this study is that it is important to go beyond the perspective of patients to also capture the perspective of health services providers to design, implement, introduce, and evaluate ICT-based interventions.  Harmonised and integrated ICT-based projects must be replicated nationwide to optimise ICT in order to improve maternal and child health outcomes.

 Impact 

This study provides valuable information to formulate policy and fortify ICT use for maternal and child health care in low resource settings. It also promotes the adoption of healthy practices among pregnant women. The study has also led to my new research project, on communication design (styles, formats and languages) in maternal health for poor, illiterate mothers who often are excluded from e-health interventions for maternal health. Adaptation of e-health strategies for maternal and child health care must account for local context, addressing the views, needs and challenges of all stakeholders.

About Oluwaseun Obasola

Oluwaseun is a Nigerian Information Scientist at the University of Ibadan and a Postdoctoral Fellow of the Consortium for Advanced Research in Africa (CARTA) and a beneficiary of their PhD fellowship. Her research interests include health information behaviour of different target groups, ICT use in the provision of health information, use of online health information resources, and library digitization. CARTA is one of the eleven Developing Excellence, Leadership and Training in Science in Africa (DELTAS Africa) programmes. DELTAS Africa funds Africa-based scientists to amplify the development of world-class research and scientific leadership on the continent while strengthening African institutions. It is implemented through the Alliance for Accelerating Excellence in Science in Africa (AESA) platform, funding, agenda-setting, programme management initiative founded by 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. DELTAS Africa is supported by Wellcome and the United Kingdom Foreign, Commonwealth and Development Office (FCDO, formerly DFID).