Abstract
BackgroundThe World Health Organization has recommended at least four antenatal care (ANC) visits and skilled attendants at birth. Most pregnant women in rural communities in low-income countries do not achieve the minimum recommended visits and deliver without skilled attendants. With the aim of increasing number of ANC visits, reducing home deliveries, and supplementing care given by ANC clinics, a proposed system based on low-cost mobile phones and portable ultrasound scan machines was piloted.MethodsA sample of 323 pregnant women from four rural communities in the Central Region of Ghana were followed within a 11-month project. In each community, at least one health worker was trained and equipped with a mobile phone to promote ANC and hospital deliveries in her own community. If women cannot attend ANC, technicians acquired scans by using portable ultrasound machines in her community directly and sent them almost in real time to be analyzed by a gynecologist in an urban hospital. A preliminary survey to assess ANC status preceding the pilot study was conducted. During this, one hundred women who had had pregnancies within five years prior to the study were interviewed.ResultsThe preliminary survey showed that women who attended ANC were less likely to have a miscarriage and more likely to have delivery at hospital or clinic than those who did not, and women who attained at least four ANC visits were less likely to practice self-medication. Among the women involved in the project, 40 gave birth during the period of observation. The proposed prenatal care approach showed that 62.5 % of pregnant women who gave birth during the observation period included in the project (n=40) had their labor attended in clinics or hospitals as against 37.5 % among the cases reported in the pre-survey. One case of ectopic and two cases of breech pregnancies were detected during the pilot through the proposed approach, and appropriate medical interventions were sought.ConclusionOur results show that the proposed prenatal care approach can make quality ANC accessible in rural communities where pregnant women have not been able to access proper ANC.
Highlights
The World Health Organization has recommended at least four antenatal care (ANC) visits and skilled attendants at birth
Low-income countries account for 99 % of these deaths, with the sub-Saharan Africa region alone accounting for 62 % [1]
This section comprises the results of the survey to assess the initial baseline level, and the results obtained from the pilot study
Summary
The World Health Organization has recommended at least four antenatal care (ANC) visits and skilled attendants at birth. Most pregnant women in rural communities in low-income countries do not achieve the minimum recommended visits and deliver without skilled attendants. Low-income countries account for 99 % of these deaths, with the sub-Saharan Africa region alone accounting for 62 % [1]. Most maternal deaths are due to obstetric complications which can be prevented or detected and managed if pregnant women get early access to available intervention programs. The attendance of birth by skilled health professionals presents opportunities for preventing some maternal and child deaths as it ensures clean and safe delivery practices. Skilled attendants ensure effective handling of labor, delivery and postpartum complications such as obstructed labor, breech birth, postpartum hemorrhage, retained placenta, and other emergencies [5]. Ultrasound-based analysis is the most accurate method to assess breech pregnancies [6], and the key to diagnose ectopic pregnancies and other dangerous pathologies [7]
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