Abstract
BackgroundMobile health (mHealth) presents one of the potential solutions to maximize health worker impact and efficiency in an effort to reach the Sustainable Development Goals 3.1 and 3.2, particularly in sub-Saharan African countries. Poor-quality clinical decision-making is known to be associated with poor pregnancy and birth outcomes. This study aims to assess the effect of a clinical decision-making support system (CDMSS) directed at frontline health care providers on neonatal and maternal health outcomes.Methods/designA cluster randomized controlled trial will be conducted in 16 eligible districts (clusters) in the Eastern Region of Ghana to assess the effect of an mHealth CDMSS for maternal and neonatal health care services on maternal and neonatal outcomes. The CDMSS intervention consists of an Unstructured Supplementary Service Data (USSD)-based text messaging of standard emergency obstetric and neonatal protocols to providers on their request. The primary outcome of the intervention is the incidence of institutional neonatal mortality. Outcomes will be assessed through an analysis of data on maternal and neonatal morbidity and mortality extracted from the District Health Information Management System-2 (DHIMS-2) and health facility-based records. The quality of maternal and neonatal health care will be assessed in two purposively selected clusters from each study arm.DiscussionIn this trial the effect of a mobile CDMSS on institutional maternal and neonatal health outcomes will be evaluated to generate evidence-based recommendations for the use of mobile CDMSS in Ghana and other West African countries.Trial registrationClinicalTrials.gov, identifier: NCT02468310. Registered on 7 September 2015; Pan African Clinical Trials Registry, identifier: PACTR20151200109073. Registered on 9 December 2015 retrospectively from trial start date.
Highlights
Mobile health presents one of the potential solutions to maximize health worker impact and efficiency in an effort to reach the Sustainable Development Goals 3.1 and 3.2, in sub-Saharan African countries
Inequalities still exist in birth outcomes for mothers and their babies globally; the lifetime risk of a woman dying from maternal causes in sub-Saharan Africa (SSA) is 1 in 36 as compared to a lifetime risk of 1 in 4900 in high-income countries (HIC) [2]; neonates born in SSA are six times more likely to die compared to neonates born in HIC [12]
We have described the protocol for a cluster randomized controlled trial (CRCT) to evaluate the effect of an Mobile health (mHealth) clinical decision-making support system compared to routine care on maternal and neonatal mortality and morbidity in a context of high maternal and neonatal mortality using the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Checklist [52]
Summary
Mobile health (mHealth) presents one of the potential solutions to maximize health worker impact and efficiency in an effort to reach the Sustainable Development Goals 3.1 and 3.2, in sub-Saharan African countries. Maternal deaths were halved and under-5 mortality rate (U5MR) declined by more than half over the 25 years of the MDGs [1]. Despite this success, maternal, neonatal and child health care remains a prominent public health concern, in subSaharan Africa and Southern Asia where most countries did not attain MDGs 4 and 5 [2,3,4,5]. Inequalities still exist in birth outcomes for mothers and their babies globally; the lifetime risk of a woman dying from maternal causes in SSA is 1 in 36 as compared to a lifetime risk of 1 in 4900 in high-income countries (HIC) [2]; neonates born in SSA are six times more likely to die compared to neonates born in HIC [12]. It is projected that the global composition of U5MR will continue to shift towards a younger age structure, and that if decreases in child mortality do not focus on neonatal deaths, neonatal deaths will account for about 44.9% of under-5 mortality by 2030 [3]
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