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effectiveness of an innovative
mHealth intervention to improve
coverage of proven maternal and
newborn health (MNH) interv...
Study Design
Quasi Experimental Study
Methods
• This study was conducted among all 32 intervention (population:
28,000) and 51 control villages (population: 30,...
“ImTeCHO”
(3 COMPONENTS)
Mobile phone as
job aid to….
ASHAs
for ensuring her
routine MCH services
Mobile phone as
a job ai...
Daily Login in Morning
Main Menu
Provider work planning and
scheduling
Data Collection And Reporting
Electronic Decision Support
( Information, Protocols, Algorithm, Checklist)
Electronic Decision Support
( Information, Protocols, Algorithm, Checklist)
Client Education & Behaviour
Change Communication ( BCC)
List of videos
1. Mamta Divas
2. Antenatal Complication
3. Birth ...
High risk tracking and Follow up
Financial transaction & Incentives
Supply Chain Management
Results
During pregnancy Intervention
Frequency (%)
N=50
Control
Frequency (%)
N=49
Unadjusted
Odds ratio
(95%
Confidence
interval...
During delivery and postpartum period Intervention
Frequency (%)
Control
Frequency (%)
Unadjusted
Odds ratio
(95%
Confiden...
Care seeking for complications
Intervention
Frequency (%)
Control
Frequency (%)
Unadjusted
Odds ratio
(95%
Confidence
inte...
Child 6 to 9 Months
Intervention
Frequency (%)
N=95
Control
Frequency
(%)
N=92
Unadjusted Odds Ratio
(Confidence interval)...
Conclusion
MHealth interventions can help ASHAs significantly
improve coverage of MNH interventions along
continuum of car...
What next….
Cluster Randomized Trial is going on with the
technical and financial help from ICMR: Delhi,
WHO: Geneva , Mac...
Acknowledgements
• ASHAs and PHC staff of the two PHCs in Jhagadia..
• Jamsetji Tata Trust , Mumbai for financial support ...
Thanks…
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Effectiveness of an innovative mHealth intervention to improve coverage of proven maternal and new born health (MNH) interventions in rural India: A quasiexperimental study

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This presentation was made by Dr. Dhiren Modi (SEWA - Rural) in the session on ‘Taking it to the frontline: Improving frontline worker motivation, performance and convergence in health and nutrition’ at the POSHAN Conference "Delivering for Nutrition in India Learnings from Implementation Research", November 9–10, 2016, New Delhi.
For more information about the conference visit our website: www.poshan.ifpri.info

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Effectiveness of an innovative mHealth intervention to improve coverage of proven maternal and new born health (MNH) interventions in rural India: A quasiexperimental study

  1. 1. effectiveness of an innovative mHealth intervention to improve coverage of proven maternal and newborn health (MNH) interventions in rural India: A quasi-experimental study Dr Dhiren Modi SEWA RURAL, Jhagadia Gujarat Date: 10-11-16
  2. 2. Study Design Quasi Experimental Study
  3. 3. Methods • This study was conducted among all 32 intervention (population: 28,000) and 51 control villages (population: 30,000) in tribal areas of Gujarat, India using quasi-experimental study design in May, 2014 after completing one year of implementation. • The mHealth intervention is a mobile-phone application in form of a job-aid to village-level frontline workers called ASHAs. • Primary outcome of interest was coverage of proven MNH interventions. • A household survey was done by interviewing all women who recently delivered using a structured, pre-tested questionnaire. • Data analysis was done using STATA IC 10.
  4. 4. “ImTeCHO” (3 COMPONENTS) Mobile phone as job aid to…. ASHAs for ensuring her routine MCH services Mobile phone as a job aid to….. ASHAs/FHWs/ Helpline for better morbidity management Web interface at… PHC level to provide timely and accurate information for better Support to ASHAs ImTeCHO = I am support
  5. 5. Daily Login in Morning
  6. 6. Main Menu Provider work planning and scheduling
  7. 7. Data Collection And Reporting
  8. 8. Electronic Decision Support ( Information, Protocols, Algorithm, Checklist)
  9. 9. Electronic Decision Support ( Information, Protocols, Algorithm, Checklist)
  10. 10. Client Education & Behaviour Change Communication ( BCC) List of videos 1. Mamta Divas 2. Antenatal Complication 3. Birth preparedness and complication Readiness 4. Breast Feeding 5. Early New Born Care 6. New Born Complications 7. Malnutrition Part One 8. Malnutrition Part Two 9. Immunizations
  11. 11. High risk tracking and Follow up
  12. 12. Financial transaction & Incentives
  13. 13. Supply Chain Management
  14. 14. Results
  15. 15. During pregnancy Intervention Frequency (%) N=50 Control Frequency (%) N=49 Unadjusted Odds ratio (95% Confidence interval) Early registration of pregnancy within first three months 41 (82) 28 (57) 3.42 (1.37-8.55) At least four ANC examinations by an ANM or doctor 48 (96) 45 (91) 2.13 (0.37-12.22) Visited at home by an ASHA at least 3 times during last pregnancy 45 (90) 28 (57) 6.75 (2.28-19.94) Received satisfactory counseling for antenatal care from an ASHA during home visit 43 (86) 18 (36) 10.58 (3.94-28.41) Respondent able to state at least 3 danger signs of pregnancy 34 (68) 28 (57) 1.59 (0.70-3.62) Respondent took more than 100 tablets of iron-folic acid during pregnancy 25 (50) 21 (42) 1.33 (0.60-2.94)
  16. 16. During delivery and postpartum period Intervention Frequency (%) Control Frequency (%) Unadjusted Odds ratio (95% Confidence interval) Hospital delivery 38 (76) 35 (71) 1.27 (0.52-3.11) Early initiation of breast feeding 45 (90) 36 (73) 3.25 (1.06-9.97) ASHA visited at home within 24 hours of delivery (in case of home delivery) or within 24 hours of return to home from hospital in case of hospital delivery 42 (84) 34 (69) 2.32 (0.89-6.11) At least 2 home visits by an ASHA within the first week of delivery 41 (82) 25 (51) 4.37 (1.75-10.90) At least 5 home visits by an ASHA within the first month of delivery & 2 home visits within the first week 28 (56) 5 (10) 11.2 (3.80-32.99) Received satisfactory counseling for postnatal care from an ASHA during home visit 34 (68) 9 (18) 9.45 (3.70-24.08) Mother able to state at least 3 danger signs of newborn 45 (90) 36 (73) 3.25 (1.06-9.97)
  17. 17. Care seeking for complications Intervention Frequency (%) Control Frequency (%) Unadjusted Odds ratio (95% Confidence interval) Sought help from ASHA for antenatal maternal complication 24 out of 31 cases (77) 19 out of 33 cases (57) 2.53 (0.85-7.51) Sought help from ASHA for postnatal maternal complication 8 out of 13 cases (61) 1 out of 11 cases (9) 16.0 (1.54-166.05) Sought help from ASHA for neonatal complication 15 out of 19 cases (78) 5 out of 18 cases (27) 9.75 (2.15-44.14)
  18. 18. Child 6 to 9 Months Intervention Frequency (%) N=95 Control Frequency (%) N=92 Unadjusted Odds Ratio (Confidence interval) Exclusive breast feeding during first six months 42 (44) 22 (23) 2.5 (1.29-4.98) Child was fed solid, semisolid or soft food at least once within last 24 hours 73 (74) 71 (79) 0.77 (0.37-1.62) Mother knew status of child on WHO growth chart 28 (29) 5 (5) 7.20 (2.56-25.17) Mother obtained ORS from ASHA for child’s diarrhea 6 out of 44 cases (14%) 2 out of 32 cases (6%) 2.3 (0.38-25) Mother sought help from ASHA for child’s pneumonia/fever 45 out of 111 cases (41%) 21 out of 89 cases (24%) 2.2 (1.14-4.33)
  19. 19. Conclusion MHealth interventions can help ASHAs significantly improve coverage of MNH interventions along continuum of care in hard to reach areas. Scaling up mHealth interventions in other tribal areas might be considered.
  20. 20. What next…. Cluster Randomized Trial is going on with the technical and financial help from ICMR: Delhi, WHO: Geneva , Mac Arthur Foundation: USA
  21. 21. Acknowledgements • ASHAs and PHC staff of the two PHCs in Jhagadia.. • Jamsetji Tata Trust , Mumbai for financial support of this project. All supervisors and employees at SEWA Rural for training, mentoring, and providing support and motivation to all ASHAs. Department of Health and Family Welfare for facilitating implementation of ImTeCHO. • IT team Argusoft India Ltd. for tirelessly working closely with SEWA Rural to develop and improvise the ImTeCHO application.
  22. 22. Thanks…

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