https://orcid.org/0000-0002-5431-1811
Abstract
Background
The estimated burden of maternal morbidities in lower-income countries, such as Madagascar, is high. However, there is still a lack of data on maternal morbidities, in part due to an absence of standardized assessment tools. This cross-sectional study aims to report maternal morbidities among 1015 women in the district of Ambanja, Madagascar, and to describe the advantages and limitations of a mHealth system.
Methods
Data were collected using the PANDA (pregnancy and newborn diagnosis assessment) system, an mHealth device that incorporates the WHO recommendations for antenatal care (ANC). Data, including personal and medical information, but also clinical data such as hypertension, anemia or HIV were collected from more than 1000 women attending ANC.
Results
A total of 1015 pregnant women were recruited from January 2015 to August 2018. The average age was 24.6 years old, and most women were married (82.3%). The majority lived in urban areas and were unemployed. Prevalence of hypertension and gestational diabetes was relatively low (4% vs 2.2%). Malaria infection was diagnosed in 2.2% and HIV was diagnosed in 1.2% of pregnant women. The most common morbidity was anemia (68.4%) and the only significant factor associated was being single compared to being married (OR 1.68, 95% CI 1.05–2.70, p-value 0.032).
Discussion
The prevalence of anemia in our study population was much higher than previously reported in Sub-Saharan Africa. This finding highlights the need for regular iron supplementation during pregnancy, especially in vulnerable (eg, single) women. The PANDA mHealth system provides unique opportunities due to its standardization of ANC and creation of a digital database accessible from a distance. However, one of the main challenges was that even a mHealth system such as the PANDA remains dependent on the local procurement chain. Therefore, future studies need to access opportunities of mHealth systems to support health service delivery.
Trial Registration
Registered on ISRCTN on 14th October 2015, number ISRCTN18270380. Retrospectively registered.
Abbreviations
ANC, antenatal care; CI, confidence intervals; CMC, Centre Médico Chirurgical; mHealth, mobile health; OR, odds ratio; PANDA, Pregnancy And New-born Diagnostic-Assessment; WHO, World Health Organization.
Data Sharing Statement
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Ethical Approval and Informed Consent
The local health authorities in Ambanja, Madagascar and the Ethical Cantonal Board of Geneva, Switzerland (CER 14-217; project number CCER PB_2017-00641_Amend n°1) approved the study. All women included in the study gave their informed consent to participate.
Acknowledgments
The authors would like to acknowledge the health-care providers and staff of the Centre Saint Damien for their support, interest and collaboration throughout the duration of the study. We would especially like to thank Adelia, Rossina and Lucie for their assistance in recruiting and conducting the ANC visits. The authors would also like to thank Giovanna Stancanelli and the PANDA team for the opportunity to analyze the data collected in the mHealth intervention.
Author Contributions
All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content, gave final approval of the version to be published; and agree to be accountable of all aspects of the work.
Disclosure
Nicole C Schmidt reports grants from Swiss Society of Gynecology and Obstetrics (GRSSGO), during the conduct of the study. The authors declare that they have no other potential competing interests for this work.