The Development and Evaluation of the Mobile Obstetric Referral Emergency System (MORES) in Bong County, Liberia [ID 2683571

Abstract

INTRODUCTION: Liberia and much of sub-Saharan Africa lacks a standard triage system for obstetric emergencies. Research conducted in low- and middle-income (LMICs) has shown that maternal mortality is directly related to inadequate triage systems. This study aimed to implement a novel mobile obstetric referral emergency system to improve obstetric triage in Liberia. METHODS: Ninety-seven midwives were recruited from 18 rural health facilities (RHFs) and two referral hospitals in Bong County, Liberia. The study utilized WhatsApp, an encrypted messaging platform, to enable communication between providers at RHFs and referral hospitals. Training sessions at RHFs on sending patient referral data including indication, age, gravidity/parity, gestational age, method of transportation, and delays were conducted. Midwives at referral hospitals were instructed to send messages confirming arrival and outcome. RESULTS: A total of 380 referral messages were sent, with significantly more referrals completing the referral process than not (60%). Both hypertension and hemorrhage accounted for 12% of referrals. Nonemergent obstetric causes accounted for 34%. Of women who arrived, 31% delivered via cesarean section. Significantly more women transported via ambulance arrived compared to self-transport or taxi. When money was identified as a barrier, only 45% of women arrived. CONCLUSION: This is the first study to introduce a real-time two-way mobile-phone obstetric triage platform for use in Liberia. Strengthening the obstetric triage system is critical to prevent delays in reaching care and improve obstetric outcomes. Addressing socioeconomic barriers is vital to increasing access to maternal health care. Future work includes country-wide scale-up in Liberia and assessment of the sustainability of the MORES intervention.