Impact of a Smartphone Intervention on Tanzanian Women's Childbirth Location

Not Applicable

Completed

• Conditions: Obstetric Complication; Delivery Complication; Birth Injuries; Delivery; Injury, Maternal; Maternal Death Affecting Fetus or Newborn; Delivery Problem for Fetus
• Interventions: Behavioral: SUSTAIN Smartphone training of CHW (SP+); Behavioral: SUSTAIN Paperbased training of CHW (SOC)

• Registration Number: NCT03161184
• Lead Sponsor: University of Toronto

Brief Summary

This study investigates whether training Community Health Workers (CHW) to use a smartphone-based prenatal counseling application as a "job aid" instead of the existing paper based standard is associated with increased women's use of maternal health services in Singida region, Tanzania.

Detailed Description

In low-income countries, frontline community health workers (CHWs) have potential to improve women's access to maternal health services through prenatal counseling and referral. However, CHW performance can often be enhanced with sufficient training, incentives, supportive supervision and job aids. Smartphone-based applications designed to assist CHWs with referrals, health education and client counseling may improve the quality of care delivered during household visits. There is a need for rigorous scientific studies on the impact of such interventions.

This study investigates whether CHWs' use of a smartphone-based application increases women's use of maternal health services in Singida region, Tanzania. It is hypothesized that smartphone-assisted counselling by CHWs can increase use of health facility-based delivery services compared to a control group of CHWs using standard paper-based protocols. This study is conducted within the context of larger project - SUSTAIN-MNCH Project (Supporting Systems to Improve Nutrition, Maternal, Newborn and Child Health), implemented by World Vision through multiple partners.

Study Timeline

• Study Start: 2013-07-23
• Primary Completion: 2014-06-25
• Study Completion: 2014-06-25
• Status Verified: 2017-05
• Study First Submitted: 2017-05-01
• Study First Submitted QC: 2017-05-18
• Last Update Submitted: 2017-05-18
• Study First Posted: 2017-05-19
• Last Update Posted: 2017-05-19

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 572

Inclusion Criteria

• client of one of the CHWs enrolled in the mHealth study
• visited at least once by a CHW following intervention (baseline training for CHWs) and during their most recent pregnancy
• most recent delivery was a live birth and the child is still living

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Exclusion Criteria

• None

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention (Smart phone assisted)	SUSTAIN Paperbased training of CHW (SOC)	Women received prenatal household visits from CHWs trained on the following: A) National i-MNCH programme; and B) Smartphone-assisted counseling protocol: a smartphone application designed to assist with identification of danger signs during pregnancy, referral to health facilities, and MNCH counseling , i.e. received intervention "SUSTAIN Smartphone training of CHW (SP+)"
Intervention (Smart phone assisted)	SUSTAIN Smartphone training of CHW (SP+)	Women received prenatal household visits from CHWs trained on the following: A) National i-MNCH programme; and B) Smartphone-assisted counseling protocol: a smartphone application designed to assist with identification of danger signs during pregnancy, referral to health facilities, and MNCH counseling , i.e. received intervention "SUSTAIN Smartphone training of CHW (SP+)"
Control (paper based)	SUSTAIN Paperbased training of CHW (SOC)	Women received prenatal household visits from CHWs who were trained on the Tanzania Ministry of Health and Social Welfare's National integrated Maternal, Newborn and Child Health (i-MNCH) paper-based protocols, i.e. received intervention "SUSTAIN Paperbased training of CHW (SOC)"

Primary Outcome Measures

Name	Time	Method
Delivery in a facility	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Participant delivered at or on the way to a health facility, measured by retrospective report at time of interview, after delivery
Antenatal care attendance	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether participant attended 4 ANC visits or more during their most recent pregnancy

Secondary Outcome Measures

Name	Time	Method
Gestational age at first contact/ANC	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Number of months into pregnancy the participant had first ANC visit
Iron supplementation during pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether participant received 100 IFA tablets during pregnancy
HIV screening HIV Screening	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether the participant was screened for HIV during pregnancy
De-worming treatment during pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether the participant reported during interview taking any listed de-worming medication during pregnancy
Bednet use	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether the participant slept under an insecticide treated bed net during pregnancy
Malaria prophylaxis during pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether the participant reported during interview receiving two doses of IPTp during pregnancy
Tetanus Toxoid Vaccination	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether the participant received two TT vaccinations during pregnancy
Referrals	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether the participant was referred to a clinic during pregnancy by a CHW
Referral uptake	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether a referred participant went to the facility during pregnancy
Presence of partner at ANC	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether the participant's husband/spouse accompanied her to at least one ANC visit
Birth plan	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether the participant developed a birth plan during pregnancy
Early initiation of breastfeeding	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether the participant initiated breastfeeding within 1 hour after birth
Exclusive breastfeeding at 7 days	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether the participant breastfed exclusively for the first week after birth
BCG vaccination	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Whether the participant's child received BCG vaccination within the first week of life
Maternal knowledge of danger signs during pregnancy	Time between the participant's first prenatal visit by a trained CHW and the date of the postnatal household interview (up to 10 months)	Number of pregnancy danger signs listed by participant