Abstract
BackgroundToll free mobile telephone intervention to support mothers in pregnancy and delivery period was tested in one sub district of Bangladesh. Qualitative research was conducted to measure the changes of mobile phone use in increasing communication for maternal and neonatal complications.MethodsIn-depth interviews were conducted among twelve Community Skilled Birth Attendants and fourteen mothers along with their husbands prior to intervention. At intervention end, six Community Skilled Birth Attendants were purposively selected for in-depth interview. Semi structured interviews were conducted among all 27 Community Skilled Birth Attendants engaged in the intervention. One Focus Group Discussion was conducted with 10 recently delivered mothers. Thematic analysis and triangulation of different responses were conducted.ResultsPrior to intervention, Community Skilled Birth Attendants reported that mobile communication was not a norm. It was also revealed that poor mothers had poor accessibility to mobile services. Mothers, who communicated through mobile phone with providers noted irritability from Community Skilled Birth Attendants and sometimes found phones switched off. At the end of the project, 85% of mothers who had attended orientation sessions of the intervention communicated with Community Skilled Birth Attendants through mobile phones during maternal health complications. Once a complication is reported or anticipated over phone, Community Skilled Birth Attendants either made a prompt visit to mothers or advised for direct referral. More than 80% Community Skilled Birth Attendants communicated with Solution Linked Group for guidance on maternal health management. Prior to intervention, Solution Linked Group was not used to receive phone call from Community Skilled Birth Attendants. Community Skilled Birth Attendants were valued by the mothers. Mothers viewed that Community Skilled Birth Attendants are becoming confident in managing complication due to communication with Solution Linked Group.ConclusionsThe use of mobile technology in this intervention took a leap from simply rendering information to providing more rapid services. Active participation of service providers along with mothers’ accessibility motivated both the service providers and mothers to communicate through mobile phone for maternal health issues. These altogether made the shift towards adoption of an innovation.
Highlights
Toll free mobile telephone intervention to support mothers in pregnancy and delivery period was tested in one sub district of Bangladesh
All the mothers included in the Focus group discussion (FGD) were residing in a union which was 10 km away from the health complex and living in a family with a monthly income between $100-200
The Community skilled birth attendants (CSBAs) included in the intervention had secondary level of education and all were married
Summary
There are many factors responsible for maternal death in Bangladesh; the factors are more than 80% of deliveries are conducted at home with untrained birth attendants [2], delays in recognition of maternal complications [3] and limited referral linkages and transportation for emergency obstetric care [4,5]. Lack of knowledge on maternal and newborn danger signs could delay the access to health care during maternal health complications and delayed access to care affect poor birth outcomes [6]. Birth outcomes are once more affected due to lack of skilled providers; World Health Organization (WHO) country cooperation strategy 2008–2013, Bangladesh [8] reported that Bangladesh continues to face a chronic shortage and imbalance in the health work force skill mix for maternal and neo-natal health.
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