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. 2024 Sep 24:12:e55819.
doi: 10.2196/55819.

Evaluating the Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Systematic Review

Chiyembekezo Kachimanga  1 , Haules Robbins Zaniku  2   3 , Titus Henry Divala  2 , Johannes C F Ket  4 , Joia S Mukherjee  5 , Daniel Palazuelos  5 , Alexandra V Kulinkina  6   7 , Ibukun-Oluwa Omolade Abejirinde  8   9 , Thomas van den Akker  1   10
Affiliations

Evaluating the Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Systematic Review

Chiyembekezo Kachimanga et al. JMIR Mhealth Uhealth. .

Abstract

Background: Limited information exists on the impact of mobile health (mHealth) use by community health workers (CHWs) on improving the use of maternal health services in sub-Saharan Africa (SSA).

Objective: This systematic review addresses 2 objectives: evaluating the impact of mHealth use by CHWs on antenatal care (ANC) use, facility-based births, and postnatal care (PNC) use in SSA; and identifying facilitators and barriers to mHealth use by CHWs in programs designed to increase ANC use, facility-based births, and PNC use in SSA using a sociotechnical system approach.

Methods: We searched for articles in 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus) from inception up to September 2022, with additional articles identified from Google Scholar. After article selection, 2 independent reviewers performed title and abstract screening, full-text screening, and data extraction using Covidence software (Veritas Health Innovation Ltd). In addition, we manually screened the references lists of the included articles. Finally, we performed a narrative synthesis of the outcomes.

Results: Among the 2594 records retrieved, 10 (0.39%) studies (n=22, 0.85% articles) met the inclusion criteria and underwent data extraction. The studies were published between 2012 and 2022 in 6 countries. Of the studies reporting on ANC outcomes, 43% (3/7) reported that mHealth use by CHWs increased ANC use. Similarly, of the studies reporting on facility-based births, 89% (8/9) demonstrated an increase due to mHealth use by CHWs. In addition, in the PNC studies, 75% (3/4) showed increased PNC use associated with mHealth use by CHWs. Many of the studies reported on the importance of addressing factors related to the social environment of mHealth-enabled CHWs, including the perception of CHWs by the community, trust, relationships, digital literacy, training, mentorship and supervision, skills, CHW program ownership, and the provision of incentives. Very few studies reported on how program goals and culture influenced mHealth use by CHWs. Providing free equipment, accessories, and internet connectivity while addressing ongoing challenges with connectivity, power, the ease of using mHealth software, and equipment maintenance support allowed mHealth-enabled CHW programs to thrive.

Conclusions: mHealth use by CHWs was associated with an increase in ANC use, facility-based births, and PNC use in SSA. Identifying and addressing social and technical barriers to the use of mHealth is essential to ensure the success of mHealth programs.

Trial registration: PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364.

Keywords: antenatal care; facility-based births; mHealth; maternal health; mobile health; mobile phone; narrative synthesis; postnatal care; review; sub-Saharan Africa.

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Conflict of interest statement

Conflicts of Interest: DP also works for Brigham and Women's Hospital and Harvard Medical School and has done short-term contract work with Vanna Health, the World Health Organization, PIVOT, and Last Mile Health. All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Facilitators and barriers mapped according to the sociotechnical system (STS) framework. mHealth: mobile health.
Figure 2
Figure 2
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. ANC: antenatal care; CHW: community health worker; mHealth: mobile health; PNC: postnatal care.
See this image and copyright information in PMC

References

    1. Geller SE, Koch AR, Garland CE, MacDonald EJ, Storey F, Lawton B. A global view of severe maternal morbidity: moving beyond maternal mortality. Reprod Health. 2018 Jun 22;15(Suppl 1):98. doi: 10.1186/s12978-018-0527-2. https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s... 10.1186/s12978-018-0527-2 - DOI - DOI - PMC - PubMed
    1. Lawrence ER, Klein TJ, Beyuo TK. Maternal mortality in low and middle-income countries. Obstet Gynecol Clin North Am. 2022 Dec;49(4):713–33. doi: 10.1016/j.ogc.2022.07.001.S0889-8545(22)00055-9 - DOI - PubMed
    1. Population (sub-Saharan Africa & world) The World Bank Group. 2022. [2022-09-25]. https://data.worldbank.org/indicator/SP.POP.TOTL?end=2021&locations=ZG-1... .
    1. Maternal mortality. World Health Organization. [2024-04-27]. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality .
    1. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. World Health Organization. [2024-04-29]. https://www.who.int/publications/i/item/9789240068759 .

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