Implementation of an international standardized set of outcome indicators in pregnancy and childbirth in Kenya: Utilizing mobile technology to collect patient-reported outcomes


Autoři: Ishtar Al-Shammari aff001;  Lina Roa aff002;  Rachel R. Yorlets aff004;  Christina Akerman aff001;  Annelies Dekker aff005;  Thomas Kelley aff001;  Ramona Koech aff005;  Judy Mutuku aff006;  Robert Nyarango aff006;  Doriane Nzorubara aff005;  Nicole Spieker aff005;  Manasi Vaidya aff005;  John G. Meara aff002;  David Ljungman aff002
Působiště autorů: International Consortium for Health Outcomes Measurement (ICHOM), Boston, Massachusetts, United States of America aff001;  Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America aff002;  Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Canada aff003;  Department of Plastic & Oral Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America aff004;  PharmAccess (PAI), Amsterdam, The Netherlands aff005;  Gertrude’s Children’s Hospital, Nairobi, Kenya aff006;  Department of Surgery, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden aff007
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222978

Souhrn

Background

Limited data exist on health outcomes during pregnancy and childbirth in low- and middle-income countries. This is a pilot of an innovative data collection tool using mobile technology to collect patient-reported outcome measures (PROMs) selected from the International Consortium of Health Outcomes Measurement (ICHOM) Pregnancy and Childbirth Standard Set in Nairobi, Kenya.

Methods

Pregnant women in the third trimester were recruited at three primary care facilities in Nairobi and followed prospectively throughout delivery and until six weeks postpartum. PROMs were collected via mobile surveys at three antenatal and two postnatal time points. Outcomes included incontinence, dyspareunia, mental health, breastfeeding and satisfaction with care. Hospitals reported morbidity and mortality. Descriptive statistics on maternal and child outcomes, survey completion and follow-up rates were calculated.

Results

In six months, 204 women were recruited: 50% of women returned for a second ante-natal care visit, 50% delivered at referral hospitals and 51% completed the postnatal visit. The completion rates for the five PROM surveys were highest at the first antenatal care visit (92%) and lowest in the postnatal care visit (38%). Data on depression, dyspareunia, fecal and urinary incontinence were successfully collected during the antenatal and postnatal period. At six weeks postpartum, 86% of women breastfeed exclusively. Most women that completed the survey were very satisfied with antenatal care (66%), delivery care (51%), and post-natal care (60%).

Conclusion

We have demonstrated that it is feasible to use mobile technology to follow women throughout pregnancy, track their attendance to pre-natal and post-natal care visits and obtain data on PROM. This study demonstrates the potential of mobile technology to collect PROM in a low-resource setting. The data provide insight into the quality of maternal care services provided and will be used to identify and address gaps in access and provision of high quality care to pregnant women.

Klíčová slova:

Antenatal care – Finance – Incontinence – Kenya – Labor and delivery – Mental health and psychiatry – Pregnancy – Surveys


Zdroje

1. Sustainable Development Knowledge Platform. United Nations 2018 [Available from: https://sustainabledevelopment.un.org/.

2. Filippi V, Ronsmans C, Campbell OM, Graham WJ, Mills A, Borghi J, et al. Maternal health in poor countries: the broader context and a call for action. Lancet (London, England). 2006;368(9546):1535–41.

3. Austin A, Langer A, Salam RA, Lassi ZS, Das JK, Bhutta ZA. Approaches to improve the quality of maternal and newborn health care: an overview of the evidence. Reproductive health. 2014;11 Suppl 2:S1.

4. Liskin LS. Maternal morbidity in developing countries: a review and comments. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 1992;37(2):77–87.

5. Zafar S, Jean-Baptiste R, Rahman A, Neilson JP, van den Broek NR. Non-Life Threatening Maternal Morbidity: Cross Sectional Surveys from Malawi and Pakistan. PloS one. 2015;10(9):e0138026. doi: 10.1371/journal.pone.0138026 26390124

6. McCauley M, Madaj B, White SA, Dickinson F, Bar-Zev S, Aminu M, et al. Burden of physical, psychological and social ill-health during and after pregnancy among women in India, Pakistan, Kenya and Malawi. BMJ global health. 2018;3(3):e000625. doi: 10.1136/bmjgh-2017-000625 29736274

7. Kruk ME, Mbaruku G, McCord CW, Moran M, Rockers PC, Galea S. Bypassing primary care facilities for childbirth: a population-based study in rural Tanzania. Health policy and planning. 2009;24(4):279–88. doi: 10.1093/heapol/czp011 19304785

8. Mselle LT, Moland KM, Mvungi A, Evjen-Olsen B, Kohi TW. Why give birth in health facility? Users' and providers' accounts of poor quality of birth care in Tanzania. BMC health services research. 2013;13:174. doi: 10.1186/1472-6963-13-174 23663299

9. Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet (London, England). 2006;368(9543):1284–99.

10. Wall SN, Lee AC, Carlo W, Goldenberg R, Niermeyer S, Darmstadt GL, et al. Reducing intrapartum-related neonatal deaths in low- and middle-income countries-what works? Seminars in perinatology. 2010;34(6):395–407. doi: 10.1053/j.semperi.2010.09.009 21094414

11. McGlynn EA. Six challenges in measuring the quality of health care. Health affairs (Project Hope). 1997;16(3):7–21.

12. Donabedian A. The Definition of Quality and Approaches to its management: Ann Arbor: Health Administration Press; 1980. 163 p.

13. van den Broek NR, Graham WJ. Quality of care for maternal and newborn health: the neglected agenda. BJOG: an international journal of obstetrics and gynaecology. 2009;116 Suppl 1:18–21.

14. Knight HE, Self A, Kennedy SH. Why are women dying when they reach hospital on time? A systematic review of the 'third delay'. PloS one. 2013;8(5):e63846. doi: 10.1371/journal.pone.0063846 23704943

15. Say L, Souza JP, Pattinson RC. Maternal near miss—towards a standard tool for monitoring quality of maternal health care. Best practice & research Clinical obstetrics & gynaecology. 2009;23(3):287–96.

16. Souza JP, Cecatti JG, Haddad SM, Parpinelli MA, Costa ML, Katz L, et al. The WHO maternal near-miss approach and the maternal severity index model (MSI): tools for assessing the management of severe maternal morbidity. PloS one. 2012;7(8):e44129. doi: 10.1371/journal.pone.0044129 22952897

17. Baltussen RM, Ye Y, Haddad S, Sauerborn RS. Perceived quality of care of primary health care services in Burkina Faso. Health policy and planning. 2002;17(1):42–8. doi: 10.1093/heapol/17.1.42 11861585

18. Anwar I. Perceptions of quality of care for serious illness at different levels of facilities in a rural area of Bangladesh. Journal of health, population, and nutrition. 2009;27(3):396–405.

19. Kruk ME, Leslie HH, Verguet S, Mbaruku GM, Adanu RMK, Langer A. Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys. The Lancet Global health. 2016;4(11):e845–e55. doi: 10.1016/S2214-109X(16)30180-2 27670090

20. Marchant T, Bryce J, Victora C, Moran AC, Claeson M, Requejo J, et al. Improved measurement for mothers, newborns and children in the era of the Sustainable Development Goals. Journal of global health. 2016;6(1):010506. doi: 10.7189/jogh.06.010506 27418960

21. Nguhiu PK, Barasa EW, Chuma J. Determining the effective coverage of maternal and child health services in Kenya, using demographic and health survey data sets: tracking progress towards universal health coverage. Tropical medicine & international health: TM & IH. 2017;22(4):442–53.

22. Porter ME. What is value in health care? The New England journal of medicine. 2010;363(26):2477–81. doi: 10.1056/NEJMp1011024 21142528

23. The International Consortium for Health Outcomes Measurement (ICHOM) [Available from: http://www.ichom.org/.

24. Trends in Maternal Mortality: 1990–2015 [Internet]. World Health Organization. 2015. Available from: https://data.worldbank.org/indicator/.

25. Transforming our world: The 2030 Agenda for Sustainable Development United Nations 2015.

26. Implementing free maternal health care in Kenya: challenges,strategies, and recommendations. In: Health KMo, editor. Nairobi2015.

27. Pyone T, Smith H, van den Broek N. Implementation of the free maternity services policy and its implications for health system governance in Kenya. BMJ global health. 2017;2(4):e000249. doi: 10.1136/bmjgh-2016-000249 29177098

28. Sharma J, Leslie HH, Kundu F, Kruk ME. Poor Quality for Poor Women? Inequities in the Quality of Antenatal and Delivery Care in Kenya. PloS one. 2017;12(1):e0171236. doi: 10.1371/journal.pone.0171236 28141840

29. Ng M, Fullman N, Dieleman JL, Flaxman AD, Murray CJ, Lim SS. Effective coverage: a metric for monitoring Universal Health Coverage. PLoS medicine. 2014;11(9):e1001730. doi: 10.1371/journal.pmed.1001730 25243780

30. Demombynes G TA. Kenya’s mobile revolution and the promise of mobile savings. World Bank Policy Research Working Paper. 2012.

31. Kenya National e-Health Strategy 2011–2017. In: Ministry of Medical Services MoPHaS, editor. Nairobi2011.

32. Silva BM, Rodrigues JJ, de la Torre Diez I, Lopez-Coronado M, Saleem K. Mobile-health: A review of current state in 2015. Journal of biomedical informatics. 2015;56:265–72. doi: 10.1016/j.jbi.2015.06.003 26071682

33. Ronen K, Unger JA, Drake AL, Perrier T, Akinyi P, Osborn L, et al. SMS messaging to improve ART adherence: perspectives of pregnant HIV-infected women in Kenya on HIV-related message content. AIDS care. 2018;30(4):500–5. doi: 10.1080/09540121.2017.1417971 29254362

34. Bardosh KL, Murray M, Khaemba AM, Smillie K, Lester R. Operationalizing mHealth to improve patient care: a qualitative implementation science evaluation of the WelTel texting intervention in Canada and Kenya. Globalization and health. 2017;13(1):87. doi: 10.1186/s12992-017-0311-z 29208026

35. World Health Statistics 2015. Geneva: World Health Organization; 2015.

36. Demographic Kenya and Survey Health 2014. Nairobi: Kenya National Bureau of Statistics; 2015.

37. Leslie HH, Fink G, Nsona H, Kruk ME. Obstetric Facility Quality and Newborn Mortality in Malawi: A Cross-Sectional Study. PLoS medicine. 2016;13(10):e1002151. doi: 10.1371/journal.pmed.1002151 27755547

38. Larson E, Hermosilla S, Kimweri A, Mbaruku GM, Kruk ME. Determinants of perceived quality of obstetric care in rural Tanzania: a cross-sectional study. BMC health services research. 2014;14:483. doi: 10.1186/1472-6963-14-483 25326007

39. Alkire BC, Peters AW, Shrime MG, Meara JG. The Economic Consequences Of Mortality Amenable To High-Quality Health Care In Low- And Middle-Income Countries. Health affairs (Project Hope). 2018;37(6):988–96.

40. Souza JP, Gulmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet (London, England). 2013;381(9879):1747–55.

41. Aguiar C, Jennings L. Impact of Male Partner Antenatal Accompaniment on Perinatal Health Outcomes in Developing Countries: A Systematic Literature Review. Maternal and child health journal. 2015;19(9):2012–9. doi: 10.1007/s10995-015-1713-2 25656727

42. Weeks F, Pantoja L, Ortiz J, Foster J, Cavada G, Binfa L. Labor and Birth Care Satisfaction Associated With Medical Interventions and Accompaniment During Labor Among Chilean Women. Journal of midwifery & women's health. 2017;62(2):196–203.

43. Third Quarter Sector Statistics Report for the Financial Year 2017/2018. In: Ra Statistics, editor. Nairobi: Communications Authority of Kenya; 2018.

44. Nations United. Every Woman, Every Child: Global Strategy. New York: United Nations; 2015.

45. Firoz T, Chou D, von Dadelszen P, Agrawal P, Vanderkruik R, Tuncalp O, et al. Measuring maternal health: focus on maternal morbidity. Bulletin of the World Health Organization. 2013;91(10):794–6. doi: 10.2471/BLT.13.117564 24115804

46. Vanderkruik RC, Tuncalp O, Chou D, Say L. Framing maternal morbidity: WHO scoping exercise. BMC pregnancy and childbirth. 2013;13:213. doi: 10.1186/1471-2393-13-213 24252359


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2019 Číslo 10