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      Using the BELT Framework to Implement an mHealth Pilot Project for Preventative Screening and Monitoring of Pregnant Women in Rural Burkina Faso, Africa

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          Abstract

          Introducing mHealth in resource-poor communities is not without technical, financial, and infrastructural challenges. Even today, little is known about the process of implementing sustainable mHealth services in these regions. The Broadband/Bandwidth, Education/Environment, Leadership, & Technology (BELT) framework helps guide stakeholders in identifying the core contextual elements that ensure successful implementation and organizational readiness. Hence, this paper describes challenges experienced when implementing the Strengthening Relationships and Enhancing Access to Maternal Services (STREAMS) project using this framework, in a rural community in Burkina Faso, Africa.

          Methods and Findings

          A focused ethnography using participant observation documented implementing the STREAMS process through the use of descriptive field notes. Despite having a champion who drove implementation, challenges that arose were mainly due to problems of Internet connectivity and a lack of participants’ baseline computer skills, which had negative consequences on the initial training sessions and subsequent service delivery.

          Conclusions

          Availability of limited information on the rural context/demographics and similar mHealth projects in Burkina Faso led to a misfit between the initial plan and the contextual reality. Having access to this type of background information is especially important to the success of mHealth initiatives providing humanitarian aid.

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          Mobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: a cluster-randomised controlled trial.

          To examine the association between a mobile phone intervention and skilled delivery attendance in a resource-limited setting. Pragmatic cluster-randomised controlled trial with primary healthcare facilities as the unit of randomisation. Primary healthcare facilities in Zanzibar. Two thousand, five hundred and fifty pregnant women (1311 interventions and 1239 controls) who attended antenatal care at one of the selected primary healthcare facilities were included at their first antenatal care visit and followed until 42 days after delivery. All pregnant women were eligible for study participation. Twenty-four primary healthcare facilities in six districts in Zanzibar were allocated by simple randomisation to either mobile phone intervention (n = 12) or standard care (n = 12). The intervention consisted of a short messaging service (SMS) and mobile phone voucher component. Skilled delivery attendance. The mobile phone intervention was associated with an increase in skilled delivery attendance: 60% of the women in the intervention group versus 47% in the control group delivered with skilled attendance. The intervention produced a significant increase in skilled delivery attendance amongst urban women (odds ratio, 5.73; 95% confidence interval, 1.51-21.81), but did not reach rural women. The mobile phone intervention significantly increased skilled delivery attendance amongst women of urban residence. Mobile phone solutions may contribute to the saving of lives of women and their newborns and the achievement of Millennium Development Goals 4 and 5, and should be considered by maternal and child health policy makers in developing countries. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.
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            Designing and Implementing an Innovative SMS-based alert system (RapidSMS-MCH) to monitor pregnancy and reduce maternal and child deaths in Rwanda

            Introduction With the continuous growth of mobile network coverage and unprecedented penetration of mobile devices in the developing world, several mHealth initiatives are being implemented in developing countries. This paper aims to describe requirements for designing and implementing a mobile phone-based communication system aiming at monitoring pregnancy and reducing bottlenecks in communication associated with maternal and newborn deaths; and document challenges and lessons learned. Methods An SMS-based system was developed to improve maternal and child health (MCH) using RapidSMS®, a free and open-sourced software development framework. To achieve the expected results, the RapidSMS-MCH system was customized to allow interactive communication between a community health worker (CHW)following mother-infant pairs in their community, a national centralized database, the health facility and in case of an emergency alert, the ambulance driver. The RapidSMS-MCH system was piloted in Musanze district, Nothern province of Rwanda over a 12-month period. Results A total of 432 CHW were trained and equipped with mobile phones. A total of 35,734 SMS were sent by 432 CHW from May 2010 to April 2011. A total of 11,502 pregnancies were monitored. A total of 362 SMS alerts for urgent and life threatening events were registered. We registered a 27% increase in facility based delivery from 72% twelve months before to 92% at the end of the twelve months pilot phase. Major challenges were telephone maintenance and replacement. Disctrict heath team capacity to manage and supervise the system was strengthened by the end of pilot phase. Highly committed CHWs and effective coordination by the District health team were critical enablers. Conclusion We successully designed and implemented a mobile phone SMS-based system to track pregnancy and maternal and child outcomes in limited resources setting. Implementation of mobile-phone systems at community level could contribute to improving emergency obstetric and neonatal care, yet it requires a well-organized community health structure in limited resource settings.
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              Mobile Phone-Based mHealth Approaches for Public Health Surveillance in Sub-Saharan Africa: A Systematic Review

              Whereas mobile phone-based surveillance has the potential to provide real-time validated data for disease clustering and prompt respond and investigation, little evidence is available on current practice in sub-Sahara Africa. The objective of this review was to examine mobile phone-based mHealth interventions for Public Health surveillance in the region. We conducted electronic search in MEDLINE, EMBASE, IEE Xplore, African Index Medicus (AIM), BioMed Central, PubMed Central (PMC), the Public Library of Science (PLoS) and IRIS for publications used in the review. In all, a total of nine studies were included which focused on infectious disease surveillance of malaria (n = 3), tuberculosis (n = 1) and influenza-like illnesses (n = 1) as well as on non-infectious disease surveillance of child malnutrition (n = 2), maternal health (n = 1) and routine surveillance of various diseases and symptoms (n = 1). Our review revealed that mobile phone-based surveillance projects in the sub-Saharan African countries are on small scale, fragmented and not well documented. We conclude by advocating for a strong drive for more research in the applied field as well as a better reporting of lessons learned in order to create an epistemic community to help build a more evidence-based field of practice in mHealth surveillance in the region.
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                Author and article information

                Journal
                TMT
                Telehealth and Medicine Today
                Partners in Digital Health
                2471-6960
                25 July 2019
                2019
                : 4
                : 10.30953/tmt.v4.100
                Affiliations
                McGill University, Montreal, Canada; Institut de Formation et de Recherche Interdisciplinaire en Sciences de la Santé et de l’Education (IFRISSE), Burkina Faso, Africa
                Author notes
                Corresponding Author: Antonia Arnaert, N, MPH, MPA, PhD, Associate Professor, McGill University, Ingram School of Nursing, 680 Sherbrooke West, Office 1906, Montreal, Quebec, Canada H3A 2N7, Email: antonia.arnaert@ 123456mcgill.ca
                Article
                100
                10.30953/tmt.v4.100
                f55fd984-eee9-4833-92a6-3e6ea873dea6
                © 2019 Antonia Arnaert

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, adapt, enhance this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Categories
                Methodologies

                Social & Information networks,General medicine,General life sciences,Health & Social care,Public health,Hardware architecture
                Burkina Faso,Framework,Pregnancy,BELT,Postpartum Monitoring,Africa,mHealth,UN-Sustainable Development Goal #3,Internet Connectivity,Community Health,STREAMS,Antenatal Care

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