Improving perinatal care in the rural regions worldwide by wireless enabled antepartum fetal monitoring: a demonstration project.

Roberto Tapia-Conyer,Michael Casale,Shelley Lyford,Ricardo Mujica,Daniel Estrada,Rodrigo Saucedo,Hector Gallardo,Joseph Smith,Carlos Meier,Ramon Sabido,Karen Becerra,Jonathan Mack,Antonio Sanchez

doi:10.1155/2015/794180

Abstract

Background. Fetal and neonatal morbidity and mortality are significant problems in developing countries; remote maternal-fetal monitoring offers promise in addressing this challenge. The Gary and Mary West Health Institute and the Instituto Carlos Slim de la Salud conducted a demonstration project of wirelessly enabled antepartum maternal-fetal monitoring in the state of Yucatán, Mexico, to assess whether there were any fundamental barriers preventing deployment and use. Methods. Following informed consent, high-risk pregnant women at 27–29 weeks of gestation at the Chemax primary clinic participated in remote maternal-fetal monitoring. Study participants were randomized to receive either prototype wireless monitoring or standard-of-care. Feasibility was evaluated by assessing technical aspects of performance, adherence to monitoring appointments, and response to recommendations. Results. Data were collected from 153 high-risk pregnant indigenous Mayan women receiving either remote monitoring (n = 74) or usual standard-of-care (n = 79). Remote monitoring resulted in markedly increased adherence (94.3% versus 45.1%). Health outcomes were not statistically different in the two groups. Conclusions. Remote maternal-fetal monitoring is feasible in resource-constrained environments and can improve maternal compliance for monitoring sessions. Improvement in maternal-fetal health outcomes requires integration of such technology into sociocultural context and addressing logistical challenges of access to appropriate emergency services.

Highlights

While most historical efforts to improve health outcomes in rural communities across the world have focused on prevention and treatment of infectious disease, in recent years attention has turned to noncommunicable disease, as well as maternal-child health (MCH)
The Salud Maya project was implemented in the jurisdiction of Valladolid, which encompasses the city of Valladolid and surrounding indigenous communities such as Chemax
Data analysis indicated no differences between individuals receiving the intervention and the control with respect to the proportion of deliveries at home versus hospital or in terms of term gestation, birth weights, or obstetric complications due to preeclampsia, eclampsia, hemorrhage, or sepsis (Table 7)

Summary

Introduction

While most historical efforts to improve health outcomes in rural communities across the world have focused on prevention and treatment of infectious disease, in recent years attention has turned to noncommunicable disease, as well as maternal-child health (MCH). Within Mexico, the nationwide strategy Equal Start in Life was implemented in 2001 to enable pregnant women and families to access quality health services [1]. The Equal Start in Life program is focused on achieving universal coverage and equal quality care conditions to women during pregnancy, childbirth, and postpartum, as well as to children (boys and girls) from birth through two years of age. This program, which included mobile health units, increased roles of community healthcare workers (CHWs), enhanced family planning services, and made significant advances in regard to maternal and child mortality. Improvement in maternal-fetal health outcomes requires integration of such technology into sociocultural context and addressing logistical challenges of access to appropriate emergency services

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