Impact of a Smartphone Intervention on Tanzanian Women's Childbirth Location

Obstetric Complication Clinical Trial

— SUSTAIN1  

Official title:

Evaluation of an mHealth Intervention to Improve Women's Access to Maternal Health Services in Rural Tanzania

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03161184
• Other study ID #: 28832
• Status: Completed
• Phase: N/A
• First received: May 1, 2017
• Last updated: May 18, 2017
• Start date: July 23, 2013
• Est. completion date: June 25, 2014

Study information

• Verified date: May 2017
• Source: University of Toronto
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study investigates whether training Community Health Workers (CHW) to use a smartphone-based prenatal counseling application as a "job aid" instead of the existing paper based standard is associated with increased women's use of maternal health services in Singida region, Tanzania.

Description:

In low-income countries, frontline community health workers (CHWs) have potential to improve women's access to maternal health services through prenatal counseling and referral. However, CHW performance can often be enhanced with sufficient training, incentives, supportive supervision and job aids. Smartphone-based applications designed to assist CHWs with referrals, health education and client counseling may improve the quality of care delivered during household visits. There is a need for rigorous scientific studies on the impact of such interventions.

This study investigates whether CHWs' use of a smartphone-based application increases women's use of maternal health services in Singida region, Tanzania. It is hypothesized that smartphone-assisted counselling by CHWs can increase use of health facility-based delivery services compared to a control group of CHWs using standard paper-based protocols. This study is conducted within the context of larger project - SUSTAIN-MNCH Project (Supporting Systems to Improve Nutrition, Maternal, Newborn and Child Health), implemented by World Vision through multiple partners.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 572
• Est. completion date: June 25, 2014
• Est. primary completion date: June 25, 2014
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Female
• Age group: 16 Years to 49 Years

Eligibility

Inclusion Criteria:

• client of one of the CHWs enrolled in the mHealth study

• visited at least once by a CHW following intervention (baseline training for CHWs) and during their most recent pregnancy

• most recent delivery was a live birth and the child is still living

Exclusion Criteria:

Related Conditions & MeSH terms

• Birth Injuries
• Delivery Complication
• Delivery Problem for Fetus
• Delivery; Injury, Maternal
• Dystocia
• Maternal Death
• Maternal Death Affecting Fetus or Newborn
• Obstetric Complication
• Wounds and Injuries

Intervention

Behavioral:
• SUSTAIN Smartphone training of CHW (SP+)
Intervention (Smart phone assisted): During prenatal household visits, the smart phone based application guides CHW through electronic "decision tree" protocols, directing them to specific health/nutrition counseling topics and messages based on each woman's gestational age, and her answers to a specific series of diagnostic questions. Based on the client's gestational age, the tool directs CHW to lessons in an accompanying photo book, and reminds them to counsel on the importance of accessing timed and targeted maternal health services at health facilities. The application also assists CHW to identify danger signs during pregnancy, flags clients who require immediate referral to health facilities, and reminds CHW to follow-up with clients who were previously referred to clinics.
• SUSTAIN Paperbased training of CHW (SOC)
SUSTAIN Paperbased training of CHW (SOC): During prenatal household visits, the CHW asks a specific series of diagnostic questions based on the client's gestational age, offers counsel on the importance of accessing appropriate maternal health services at health facilities and uses lessons in an accompanying photo book to deliver messages on a variety of maternal and newborn health and nutrition topics. CHW are trained to identify danger signs during pregnancy, flag clients who require immediate referral to health facilities, and follow-up with clients who were previously referred to clinics.

Locations

Country	Name	City	State
n/a

Sponsors (3)

Lead Sponsor	Collaborator
University of Toronto	Muhimbili University of Health and Allied Sciences, World Vision

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Delivery in a facility	Participant delivered at or on the way to a health facility, measured by retrospective report at time of interview, after delivery	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Primary	Antenatal care attendance	Whether participant attended 4 ANC visits or more during their most recent pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	Gestational age at first contact/ANC	Number of months into pregnancy the participant had first ANC visit	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	Iron supplementation during pregnancy	Whether participant received 100 IFA tablets during pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	HIV screening HIV Screening	Whether the participant was screened for HIV during pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	De-worming treatment during pregnancy	Whether the participant reported during interview taking any listed de-worming medication during pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	Bednet use	Whether the participant slept under an insecticide treated bed net during pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	Malaria prophylaxis during pregnancy	Whether the participant reported during interview receiving two doses of IPTp during pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	Tetanus Toxoid Vaccination	Whether the participant received two TT vaccinations during pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	Referrals	Whether the participant was referred to a clinic during pregnancy by a CHW	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	Referral uptake	Whether a referred participant went to the facility during pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	Presence of partner at ANC	Whether the participant's husband/spouse accompanied her to at least one ANC visit	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	Birth plan	Whether the participant developed a birth plan during pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	Early initiation of breastfeeding	Whether the participant initiated breastfeeding within 1 hour after birth	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	Exclusive breastfeeding at 7 days	Whether the participant breastfed exclusively for the first week after birth	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	BCG vaccination	Whether the participant's child received BCG vaccination within the first week of life	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)
Secondary	Maternal knowledge of danger signs during pregnancy	Number of pregnancy danger signs listed by participant	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)