Impact of Mobile Health (mHealth) Use by Community Health Workers on the Utilization of Maternity Care in Rural Malawi: A Time Series Analysis.

IF 2.6 4区医学 Q2 OBSTETRICS & GYNECOLOGY International Journal of Women's Health Pub Date : 2025-01-31 eCollection Date: 2025-01-01 DOI:10.2147/IJWH.S497100

Chiyembekezo Kachimanga, Wingston Felix Ng'ambi, Doctor Kazinga, Enoch Ndarama, Mercy Ambogo Amulele, Fabien Munyaneza, Ibukun-Oluwa O Abejirinde, Thomas van den Akker, Alexandra V Kulinkina

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Abstract

Purpose: Maternal mortality in Malawi is high, with low coverage of maternity care being a contributing factor. To improve maternal health coverage, an Android-based, integrated mobile health (mHealth) app called YendaNafe was introduced to community health workers (CHWs) in the Neno district, rural Malawi. This study evaluates the impact of this app on the uptake of antenatal care (ANC), facility-based births, and postnatal care (PNC), compared to a reference period where CHWs provided the same services without mHealth, using the interrupted time series analysis.

Patients and methods: Using aggregated monthly data and segmented quasi-Poisson regression models, we compared the effects of mHealth on selected maternal health outcomes. The models were adjusted for the COVID-19 pandemic, the occurrence of cyclones, and a cholera epidemic. We analyzed data from six eligible health facilities and their respective catchment areas in which CHWs were using YendaNafe, and compared 12 months before and 12 months after its introduction.

Results: The use of YendaNafe was associated with a 22% immediate increase in facility-based births (aIRR 1.22, 95% CI 1.12-1.33, p<0.001) but not an immediate increase in new ANC visits (aIRR 1.02,95% CI 0.90-1.14, p=0.77), ANC in the first trimester (aIRR 1.17, 95% CI 0.95-1.45 p=0.13), or PNC visits (aIRR 1.03, 95% CI 0.79-1.36, p=0.81). For long-term effect, YendaNafe was associated with an increase in new ANC visits (aIRR 1.04, 95% CI 1.01-1.07, p <0.01) and ANC in the first trimester (aIRR 1.03,95% CI 1.00-1.07 p=0.046), but not facility-based births (aIRR 1.01, 95% CI 0.99-1.03, p=0.46) or PNC (aIRR 0.97 95% CI 0.93-1.01, p=0.14).

Conclusion: mHealth shows potential of increasing utilization of new ANC visits, ANC in the first trimester and facility-based births. Further research is needed to understand why mHealth did not have an effect on PNC.

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社区卫生工作者使用移动医疗（mHealth）对马拉维农村地区孕产妇护理利用率的影响：时间序列分析

目的：马拉维的产妇死亡率很高，产妇保健覆盖率低是一个促成因素。为了提高孕产妇健康覆盖率，一款名为YendaNafe的基于android的综合移动健康（mHealth）应用程序被引入了马拉维农村Neno区的社区卫生工作者（chw）。本研究评估了该应用程序对产前护理（ANC）、基于设施的分娩和产后护理（PNC）的吸收的影响，与chw提供相同服务的参考时期相比，使用中断时间序列分析。患者和方法：使用汇总的月度数据和分段准泊松回归模型，我们比较了移动医疗对选定的孕产妇健康结果的影响。这些模型针对COVID-19大流行、飓风的发生和霍乱疫情进行了调整。我们分析了来自六个符合条件的卫生机构及其各自集水区的数据，这些卫生工作者使用YendaNafe，并比较了引入该服务之前和之后的12个月。结果：使用YendaNafe与医院分娩立即增加22%相关（aIRR 1.22, 95% CI 1.12-1.33, p）。结论：移动健康显示了增加新ANC就诊、妊娠早期ANC和医院分娩利用率的潜力。需要进一步的研究来理解为什么移动医疗对PNC没有影响。

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来源期刊

International Journal of Women's Health OBSTETRICS & GYNECOLOGY-

CiteScore

3.70

自引率

0.00%

发文量

194

审稿时长

16 weeks

期刊介绍： International Journal of Women''s Health is an international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews and commentaries on all aspects of women''s healthcare including gynecology, obstetrics, and breast cancer. Subject areas include: Chronic conditions including cancers of various organs specific and not specific to women Migraine, headaches, arthritis, osteoporosis Endocrine and autoimmune syndromes - asthma, multiple sclerosis, lupus, diabetes Sexual and reproductive health including fertility patterns and emerging technologies to address infertility Infectious disease with chronic sequelae including HIV/AIDS, HPV, PID, and other STDs Psychological and psychosocial conditions - depression across the life span, substance abuse, domestic violence Health maintenance among aging females - factors affecting the quality of life including physical, social and mental issues Avenues for health promotion and disease prevention across the life span Male vs female incidence comparisons for conditions that affect both genders.