An mHealth monitoring system for traditional birth attendant-led antenatal risk assessment in rural Guatemala

Abstract

Limited funding for medical technology, low levels of education and poor infrastructure for delivering and maintaining technology severely limit medical decision support in low- and middle-income countries. Perinatal and maternal mortality is of particular concern with millions dying every year from potentially treatable conditions. Guatemala has one of the worst maternal mortality ratios, the highest incidence of intra-uterine growth restriction (IUGR), and one of the lowest gross national incomes per capita within Latin America. To address the lack of decision support in rural Guatemala, a smartphone-based system is proposed including peripheral sensors, such as a handheld Doppler for the identification of foetal compromise. Designed for use by illiterate birth attendants, the system uses pictograms, audio guidance, local and cloud processing, SMS alerts and voice calling. The initial prototype was evaluated on 22 women in highland Guatemala. Results were fed back into the refinement of the system, currently undergoing RCT evaluation.

Keywords:

• Intrauterine growth restriction
• mHealth
• perinatal monitoring
• resource constrained healthcare

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding

LS acknowledges the support of the RCUK Digital Economy Programme grant number [10.13039/501100000690] EP/G036861/1 (Oxford Centre for Doctoral Training in Healthcare Innovation) and of the Oxford Centre for Affordable Healthcare Technology. GC, PR and RHC acknowledge the support of the National Institutes of Health, the Fogarty International Centre and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, grant number 1R21HD084114–01 [10.13039/100000071] (“Mobile Health Intervention to Improve Perinatal Continuum of Care in Guatemala”). Generous sponsorship was also received from ARM through the Centre for Affordable Healthcare Technology at Kellogg College, Oxford.

Notes

1 Wuqu’ Kawoq – Maya Health Alliance, 2 calle 5–43 zona 1, Santiago Sacatepquez, Guatemala 03006, Central America. Web URL: www.wuqukawoq.org.

2 Department of Engineering Science, University of Oxford, Oxford, UK and Department of Biomedical Informatics, Emory University, & Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, USA.

3 Maya Health Alliance Wuqu’ Kawoq, Guatemala and Harvard Medical School Boston, USA.

4 Department of Anthropology and Public Health, Agnes Scott College, Atlanta, USA.

5 FrontlineSMS is an open source desktop software that enables two-way communication to mobile handsets. Website URL: http://www.frontlinesms.com.

6 OpenMRS is an open source software platform, which enables the design of customised medical record systems. Website URL: http://openmrs.org.

7 Part of the Amazon Web Services (AWS), Amazon Simple Storage Service (S3) is a web-based data storage service. Website URL: https://aws.amazon.com/s3.

8 Randomisation was constrained to balance both travel time to Wuqu’ Kawoq headquarters and age of traditional birth attendants. Participants were randomised by village to reduce interaction between arms and potential envy.