Innovative Mobile Technology for Maternal and Child Health Care in Cambodia (i-MoMCARE): A Cluster Randomized Controlled Trial

Goal and objectives

To test, implement, and evaluate the applicability and efficacy of the i-MoMCARE to support VHSGs and health center staff in rural communities to increase the coverage of and access to MCH services in Cambodia. Specific objectives include:

1. To capture changes in MCH coverage, maternal mortality ratio (MMR), the infant mortality rate (IMR), and other key indicators that are of national program's priorities.
2. To identify gaps in MCH care through conducting a literature review, consulting with local partners, and qualitative need assessments to understand the barriers to MCH services provided or facilitated by VHSGs.
3. To identify technology components that provide solutions to fill the gaps in MCH care.
4. To pilot and qualitatively evaluate the operational delivery of the intervention.
5. To deliver the intervention among VHSGs and health center staff.
6. To evaluate the acceptability, feasibility, and usefulness of the components of the i-MoMCARE application.
7. To conduct a cost-effectiveness analysis to adapt and scale up the intervention in Cambodia.

Methods This study is a two-arm stratified multi-stage cluster randomized controlled trial (RCT). The digital health technology will be deployed in five provinces. The five provinces have been selected based on the composite index of the MCH indicators and socio-economic status indicators and consultation with the National Maternal and Child Health Center (NMCHC) of Cambodia's Ministry of Health. A literature review and gap analysis using in-depth interviews (IDIs), key informant interviews (KIIs), and focus group discussions (FGDs) will be conducted to acquire information necessary for adapting to the digital health technology, successfully deployed in Gujarat in India to the Cambodian setting.

The randomization will be done at the operational district (OD) level (cluster), the third tier of the health system in Cambodia. To address the issue of contamination that may arise and maintain comparability between the two arms at baseline, we will perform a matched-pair selection of 10 provinces (five for each arm) out of the 25 provinces in Cambodia based on similar levels of MCH-SES index and recommendation from NMCHC. We will use the principal component analysis approach to construct the provinces' MCH-SES index from a basket of indicators of ANC, delivery, and PNC from the Cambodia Demographic and Health Survey (CDHS 2021) and indicators of socioeconomic status from the national population census in 2019 (National Institute of Statistics, 2020a) and Cambodia Socio-economic Survey (CSES 2019. The indicators from CDHS 2021 include the proportion of at least four antenatal care (ANC) visits among mothers, the proportion of women delivered in a health facility, the proportion of women having a postnatal visit in the first two days after delivery, the proportion of fully vaccinated (basic antigen) children aged 12-23 months, the proportion of fully vaccinated (according to the national schedule) among children aged 12-23 months, and proportion of no vaccinations among children aged 12-23 months. The indicators from the population census 2019 include population density (number per square kilometer), literacy rate of the population aged at least 7 years, the proportion of the population aged at least 15 years with primary education without completion, the proportion of households with city electricity, and proportion of households with piped water into a dwelling while median monthly income per capita in thousand Khmer riel is from the CSES 2019.