Our colleague, Araya Abrha (now Dr Araya) has made available the summary of his doctoral thesis “The use of mHealth for Maternal Health Care in Ethiopia”.
Download the title and index
Download the thesis summary
Since one of the papers contained in his thesis is still pending publication, we’re unable to post the whole thesis here, however if you would like a copy then please contact Araya directly (at arayaabrha@yahoo.com)
We have just had a research paper accepted and published on “Meeting community health worker needs for maternal health care service delivery using appropriate mobile technologies in Ethiopia”. The paper describes our approach and the technologies used in our recent project working with health extension workers in Ethiopia using mobile technologies for recording and managing maternal care visits. We anticipate that the results and approach outlined in this paper would be of great interest to others working in the field of mobile health.
The full open-access article can be found on the PlosOne website, and here is the abstract:
Background
Mobile health applications are complex interventions that essentially require changes to the behavior of health care professionals who will use them and changes to systems or processes in delivery of care. Our aim has been to meet the technical needs of Health Extension Workers (HEWs) and midwives for maternal health using appropriate mobile technologies tools.
Methods
We have developed and evaluated a set of appropriate smartphone health applications using open source components, including a local language adapted data collection tool, health worker and manager user-friendly dashboard analytics and maternal-newborn protocols. This is an eighteen month follow-up of an ongoing observational research study in the northern of Ethiopia involving two districts, twenty HEWs, and twelve midwives.
Results
Most health workers rapidly learned how to use and became comfortable with the touch screen devices so only limited technical support was needed. Unrestricted use of smartphones generated a strong sense of ownership and empowerment among the health workers. Ownership of the phones was a strong motivator for the health workers, who recognised the value and usefulness of the devices, so took care to look after them. A low level of smartphones breakage (8.3%,3 from 36) and loss (2.7%) were reported. Each health worker made an average of 160 mins of voice calls and downloaded 27Mb of data per month, however, we found very low usage of short message service (less than 3 per month).
Conclusions
Although it is too early to show a direct link between mobile technologies and health outcomes, mobile technologies allow health managers to more quickly and reliably have access to data which can help identify where there issues in the service delivery. Achieving a strong sense of ownership and empowerment among health workers is a prerequisite for a successful introduction of any mobile health program.
AMREF Ethiopia have just posted up the following vacancy for a Project Officer: http://www.ethiojobs.net/display-job/24608/Project-Officer.html. This role is to work on our mobile learning project, in partnership with AMREF and is to be based in Mekelle, Ethiopia. The closing date is 14th October.
Please send any applications directly to AMREF Ethiopia (to the address in the job advert), rather than to Digital Campus.
Alex has recently presented the OppiaMobile platform and our recent and ongoing projects with health workers in Ethiopia at the DaeSav Ethiopia Conference 2013 in Berlin “Innovation through Cooperation”.
Here is a copy of the presentation on SlideShare and we hope to be able to post soon a link to the video:
It was great to have been invited to speak at the conference and make many more contacts. We hope to be able to tie up our work on OppiaMobile with the work of Ahadoo – a new start up in Ethiopia developing mobile learning tools, currently focused on secondary education.
We’re really pleased to announce that we have just received confirmation of funding for a new project working with mobile learning for Health Extension Workers. The project is funded by UKAid and we’re working with AMREF Ethiopia as the local implementing partners.
Over the coming 3 years we’ll be working with 160 Health Workers who are taking part in their Level 4 upgrade programme (using the HEAT content), supplementing the existing training content with additional videos and quizzes to track their performance, skills and knowledge, especially once they return to their health posts.
The main focus will be on maternal care, but we’ll cover all of the primary care topics in the HEAT content. This will give us an excellent opportuity to develop and extend the OppiaMobile application as well as provide us with some excellent information as to how the health workers get on with using mobile learning and how it may help to improve the services they provide to their communities.
You will be able to track the project progress via the DfID project database at: http://projects.dfid.gov.uk/ – the official project title is: “Improving Health Extension Workers’ training and effectiveness through continuous skills improvement, knowledge assessment and patient management processes for 160 Ethiopian health workers”. We’ll also be making regular updates about the project progress via this blog too.
Mahmud, one of the phd students we’ve been working with the last couple of years, has just had a new research paper published, “Risk factors for intestinal parasitosis, anaemia, and malnutrition among school children in Ethiopia”. The full article can be found here, but here is the abstract:
Research on associated risk factors for intestinal parasitic infections and malnutrition in various geographic regions is needed for the development of appropriate control strategies. The aim of this study was to determine the risk factors associated with intestinal parasitic infections, anaemia, and malnutrition in schoolchildren, living in urban and rural areas of northern Ethiopia. Six hundred school children, aged 6–15 years,were randomly selected in a cross-sectional survey from 12 primary schools. Sociodemographic andanthropometric data were collected. Faecal samples were examined using direct, concentration, and the Kato–Katz methods. Urine specimens were analysed for Schistosoma haematobium ova. Haemoglobinwas measured using a HemoCue spectrometer. The overall prevalence of intestinal parasitosis was 72%(95% confidence interval (CI): 66–76%). The prevalence of anaemia, stunting, and thinness were 11% (95%CI: 8–13%), 35% (95% CI: 31–38%), and 34% (95% CI: 30–38%), respectively. Poor personal hygiene habits were generally associated with anaemia and nutritional deficiency (low body mass index). Multivariate logistic regression models related Schistosoma mansoni infection with boys. Boys were also more likely to be malnourished. Hookworm infection was associated with anaemia and unhygienic fingernails. Access to clean water and latrines, with some hygiene and sanitation communication activities, could improve health of children in Ethiopia. The use of smartphone technology in demographic data collection proved to be successful. The potential advantage offered by this technology for parasitological field surveys merits further investigation.
We’ve recently been collaborating with Escape Computing, an Addis-based company specializing in providing thin client and zero client solutions and services. Over the last 2 weeks, our colleague Edu has been over in Ethiopia, with Simon from Escape Computing, to set up a new thin client lab at the Ethiopian Civil Service University. We anticipate this new lab can be used as a showcase/demonstration to other educational institutions looking to provide scalable, cost-efficient and supported computer access for their students. I’ll post up some more of the technical detail of the new lab set-up in the coming days, but for now, here are a few photos of the new lab:
Here’s a graph of the numbers of patient visit records the HEWs have been submitting over the last year or so (click to view a larger version):
The numbers of visit records submitted have been grouped by week, we’re not yet sure why there seem to be so many peaks & troughs in the numbers submitted each week, although the increase in the last couple of months will be attributable to us now having more HEWs and midwives working with us – in total we now have around 30 HEWs and midwives, it varies quite often as staff go away for further study, move on to other jobs, or go on maternity leave.
Araya has just had his second paper published: “Knowledge and performance of the Ethiopian health extension workers on antenatal and delivery care: a cross-sectional study”. The full paper is available from Human Resources for Health, provisional abstract:
Background
In recognition of the critical shortage of human resources within health services, community health workers have been trained and deployed to provide primary health care in developing countries. However, very few studies have investigated whether these health workers can provide good quality of care. This study investigated the knowledge and performance of health extension workers (HEWs) on antenatal and delivery care. The study also explored the barriers and facilitators for HEWs in the provision of maternal health care.
Methods
In conducting this research, a cross-sectional study was performed. A total of 50 HEWs working in 39 health posts, covering a population of approximately 195,000 people, were interviewed. Descriptive statistics was used and a composite score of knowledge of HEWs was made and interpreted based on the Ethiopian education scoring system.
Results
Almost half of the respondents had at least 5 years of work experience as a HEW. More than half (27 (54%)) of the HEWs had poor knowledge on contents of antenatal care counseling, and the majority (44 (88%)) had poor knowledge on danger symptoms, danger signs, and complications in pregnancy. Health posts, which are the operational units for HEWs, did not have basic infrastructures like water supply, electricity, and waiting rooms for women in labor. On average within 6 months, a HEW assisted in 5.8 births. Only a few births (10%) were assisted at the health posts, the majority (82%) were assisted at home and only 20% of HEWs received professional assistance from midwives.
Conclusion
Considering the poor knowledge of HEWs, poorly equipped health posts, and poor referral systems, it is difficult for HEWs to play a key role in improving health facility deliveries, skilled birth attendance, and on-time referral through early identification of danger signs. Hence, there is an urgent need to design appropriate strategies to improve the performance of HEWs by enhancing their knowledge and competencies, while creating appropriate working conditions.
We’ve just set up a demonstration site of our analytics and mobile site for the patient management tools. Previously if someone wanted to test out the tool for themselves, we could really only give them the mobile application and the protocols to look at, but we didn’t have a demo area for the server side. The only demo was on my laptop, and we can’t give access to the live site as it has real patient cases. I took this opportunity to look at using Amazon Web Services (EC2) for setting up the demo server – it all worked out really well and very easy to use.
You can log into the analytics/scorecard site at:
http://odk-demo.digital-campus.org/scorecard/ (username/password is demo/demo)
and the mobile version is at:
http://odk-demo.digital-campus.org/scorecard/mobile (same username/password)
The demo user has supervisor privileges, so is able to see all the data entered, usually health workers logging in would only get to see the data directly related to their patients.
If you would like to see the whole process, from entering the protocols on the smartphone, all the way through to seeing the cases on the analytics scorecard and mobile site, I also set up a demo ODK Aggregate server for submitting protocols. To set this up:
Please let us know how you get on – especially if I need to add some more info to the instructions above.
