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. 2012:13:31.
Epub 2012 Oct 14.

Designing and Implementing an Innovative SMS-based alert system (RapidSMS-MCH) to monitor pregnancy and reduce maternal and child deaths in Rwanda

Fidele Ngabo  1 , Judith Nguimfack, Friday Nwaigwe, Catherine Mugeni, Denis Muhoza, David R Wilson, John Kalach, Richard Gakuba, Corrine Karema, Agnes Binagwaho
Affiliations

Designing and Implementing an Innovative SMS-based alert system (RapidSMS-MCH) to monitor pregnancy and reduce maternal and child deaths in Rwanda

Fidele Ngabo et al. Pan Afr Med J. 2012.

Abstract

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.

Keywords: Maternal and Child Health; RapidSMS; SMS; eHealth; mHealth.

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Figures

Figure 1
Figure 1
Maternal health care configuration at sector level. Former configuration consisted of patient and CHWs in the communities on one side and the facility on the other side. Emergency obstetric care was lacking especially for those patient located at a long distance from hospital. The newly implemented RapidSMS-MCH system offers a linkage between the patient in the community and the appropriate level of care.
Figure 2
Figure 2
RapidSMS-MCH system information flow
Figure 3
Figure 3
Web user interface
Figure 4
Figure 4
Trend in facility and home deliveries in Musanze District, January 2009 - May 2011
See this image and copyright information in PMC

References

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