Effectiveness of an Integrated Community and Hospital Digital Health Information System in Improving Maternal and Newborn Health Access in Northern Kenya

Abstract

Background: Poor access to Antenatal Care (ANC), skilled delivery and post-natal check within 48 hours of delivery are associated with adverse pregnancy outcomes. Unequal uptake of these interventions in Kenya has resulted in large regional disparities with 15 out of 47 counties classified as high-priority. We implemented a digital health solution in a high-priority county to improve MNH uptake and evaluated its effectiveness. Methods: Between July 2017 and March 2019, we implemented an integrated community and hospital digital health information system (STONE-HMIS) in 10 primary and secondary health facilities and in 4 catchment community health units (CHUs), in Turkana County in rural Northern Kenya. We estimated the proportion of mothers who attended at least 4 ANC visits, received skilled assistance at delivery, and post-natal check within 48 hours of delivery in two of the CHUs, at baseline and at end-line 12 months later. We compared the results with those of the sub-county of extraction and the County of Turkana as reported in the Kenya Health Information System (KHIS). Results: Out of a catchment population of 4,300 women of reproductive age (WRA) in the study CHUs, a total of 692 and 608 women were interviewed at baseline and end-line respectively. We observed a 5%, 23% and 16% improvement in 4th ANC visits, skilled delivery rates and newborn post-natal check within 48 hours of delivery respectively, over the period of implementation. For the same evaluation period, at the sub-county and county levels, 57.7% and 65.8% WRA attended at least 4 ANC visits, 39.5% and 67.8% delivered with a skilled assistant, and 23.5% and 24% had post-natal check respectively. Conclusions: The integration of provider facility and community level digital health systems and alignment with health system priorities and processes contributed to the improvement of Maternal and Newborn health indicators in an under-served and difficult to reach locality. Funding Statement: The work evaluated by this study was funded through the UKAID-County Innovation Challenge Fund. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Informed consent was sought from every eligible participant. The study was approved by the AMREF ethical review committee and was conducted in consideration of the ICH GCP guidelines on study on human subjects.