K4Health
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This Digital Health Resource Library houses three legacy collections previously maintained by the Knowledge for Health (K4Health) Project. K4Health’s work was made possible by the support of the American People through the United States Agency for International Development (USAID) . K4Health was supported from 2008-2019 by USAID's Office of Population and Reproductive Health, Bureau for Global Health, under cooperative agreements with the Johns Hopkins University. K4Health was implemented by the Johns Hopkins Center for Communication Programs (CCP) in collaboration with FHI 360, Management Sciences for Health (MSH), and IntraHealth International. The K4Health Project ended in September 2019.
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Browsing K4Health by Subject "Antenatal care"
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- ItemAcceptability and user satisfaction of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus.(2014-12-31) Hirst, Jane E; Mackillop, Lucy; Loerup, Lise; Kevat, Dev A; Bartlett, Katy; Gibson, Oliver; Kenworthy, Yvonne; Levy, Jonathan C; Tarassenko, Lionel; Farmer, AndrewThe increase in gestational diabetes mellitus GDM is challenging maternity services We have developed an interactive smartphone based remote blood glucose BG monitoring system GDm health The objective was to determine women s satisfaction with using the GDm health system and their attitudes toward their diabetes care In a service development program involving 52 pregnant women September 2012 to June 2013 BG was monitored using GDm health from diagnosis until delivery Following birth women completed a structured questionnaire assessing 1 general satisfaction 2 equipment issues and 3 relationship with the diabetes care team Responses were scored on a 7 point Likert type scale Reliability and validity of the questionnaire were assessed using statistical methods Of 52 women 49 completed the questionnaire 32 had glucose tolerance test confirmed GDM gestation at recruitment 29 4 weeks mean SD and 17 women previous GDM recommended for BG monitoring 18 6 weeks In all 45 of 49 women agreed their care was satisfactory and the best for them 47 of 49 and 43 of 49 agreed the equipment was convenient and reliable respectively 42 of 49 agreed GDm health fitted into their lifestyle and 46 of 49 agreed they had a good relationship with their care team Written comments supported these findings with very positive reactions from the majority of women Cronbach s alpha was 89 with factor analysis corresponding with question thematic trends This pilot demonstrates that GDm health is acceptable and convenient for a large proportion of women Effects on clinical and economic outcomes are currently under investigation in a randomized trial clinicaltrials gov NCT01916694
- ItemAfrica Regional Meeting on Digital Health: Medic Mobile Antenatal Care(2015)Presentation from the Digital Health for Ending Child and Maternal Death EPCMD and Achieving Universal Health Care UHC Meeting May 2015 Malawi
- ItemApplication of smart phone in "Better Border Healthcare Program": a module for mother and child care.(2010-11-24) Kaewkungwal, Jaranit; Singhasivanon, Pratap; Khamsiriwatchara, Amnat; Sawang, Surasak; Meankaew, Pongthep; Wechsart, ApisitBACKGROUND To assess the application of cell phone integrating into the healthcare system to improve antenatal care ANC and expanded programme on immunization EPI services for the under served population in border area METHODS A module combining web based and mobile technology was developed to generate ANC EPI visit schedule dates in which the healthcare personnel can cross check identify and update the mother s ANC and child s EPI status at the healthcare facility or at the household location when performing home visit with additional feature of sending appointment reminder directly to the scheduled mother in the community RESULTS The module improved ANC EPI coverage in the study area along the country border including for both Thai and non Thai mothers and children who were either permanent resident or migrants numbers of ANC and EPI visit on time as per schedule significantly increased there was less delay of antenatal visits and immunizations CONCLUSIONS The module integrated and functioned successfully as part of the healthcare system it is proved for its feasibility and the extent to which community healthcare personnel in the low resource setting could efficiently utilize it to perform their duties
- ItemBump Buddy and Baby Buddy smartphone apps trialled.(2013-08-30)TWO FREE mobile phone apps to help young women prepare for parenthood are being tested with the backing of the RCN Royal College of Paediatrics and Child Health and the Royal College of Midwives
- ItemCell phones to collect pregnancy data from remote areas in Liberia.(2012-09-03) Lori, Jody R; Munro, Michelle L; Boyd, Carol J; Andreatta, PamelaPURPOSE To report findings on knowledge and skill acquisition following a 3 day training session in the use of short message service SMS texting with non and low literacy traditional midwives DESIGN A pre and post test study design was used to assess knowledge and skill acquisition with 99 traditional midwives on the use of SMS texting for real time remote data collection in rural Liberia West Africa METHODS Paired sample t tests were conducted to establish if overall mean scores varied significantly from pre test to immediate post test Analysis of variance was used to compare means across groups The nonparametric McNemar s test was used to determine significant differences between the pre test and post test values of each individual step involved in SMS texting Pearson s chi square test of independence was used to examine the association between ownership of cell phones within a family and achievement of the seven tasks FINDINGS The mean increase in cell phone knowledge scores was 3 67 with a 95 confidence interval ranging from 3 39 to 3 95 Participants with a cell phone in the family did significantly better on three of the seven tasks in the pre test turns cell on without help 2 1 9 15 p 003 identifies cell phone coverage 2 1 5 37 p 024 and identifies cell phone is charged 2 1 4 40 p 042 CONCLUSIONS A 3 day cell phone training session with low and nonliterate traditional midwives in rural Liberia improved their ability to use mobile technology for SMS texting CLINICAL RELEVANCE Mobile technology can improve data collection accessibility and be used for numerous health care and public health issues Cell phone accessibility holds great promise for collecting health data in low resource areas of the world
- ItemCellular telephone networks in developing countries.(2008-02-25) Byass, Peter; D'Ambruoso, Lucia
- ItemDesigning and Implementing an Innovative SMS-based alert system (RapidSMS-MCH) to monitor pregnancy and reduce maternal and child deaths in Rwanda.(2013-01-18) Ngabo, Fidele; Nguimfack, Judith; Nwaigwe, Friday; Mugeni, Catherine; Muhoza, Denis; Wilson, David R; Kalach, John; Gakuba, Richard; Karema, Corrine; Binagwaho, AgnesINTRODUCTION With the continuous growth of mobile network coverage and unprecedented penetration of mobile devices in the developing world several mHealth initiatives are being implemented in developing countries This paper aims to describe requirements for designing and implementing a mobile phone based communication system aiming at monitoring pregnancy and reducing bottlenecks in communication associated with maternal and newborn deaths and document challenges and lessons learned METHODS An SMS based system was developed to improve maternal and child health MCH using RapidSMS a free and open sourced software development framework To achieve the expected results the RapidSMS MCH system was customized to allow interactive communication between a community health worker CHW following mother infant pairs in their community a national centralized database the health facility and in case of an emergency alert the ambulance driver The RapidSMS MCH system was piloted in Musanze district Nothern province of Rwanda over a 12 month period RESULTS A total of 432 CHW were trained and equipped with mobile phones A total of 35 734 SMS were sent by 432 CHW from May 2010 to April 2011 A total of 11 502 pregnancies were monitored A total of 362 SMS alerts for urgent and life threatening events were registered We registered a 27 increase in facility based delivery from 72 twelve months before to 92 at the end of the twelve months pilot phase Major challenges were telephone maintenance and replacement Disctrict heath team capacity to manage and supervise the system was strengthened by the end of pilot phase Highly committed CHWs and effective coordination by the District health team were critical enablers CONCLUSION We successully designed and implemented a mobile phone SMS based system to track pregnancy and maternal and child outcomes in limited resources setting Implementation of mobile phone systems at community level could contribute to improving emergency obstetric and neonatal care yet it requires a well organized community health structure in limited resource settings
- ItemDeveloping content for a mHealth intervention to promote postpartum retention in prevention of mother-to-child HIV transmission programs and early infant diagnosis of HIV: a qualitative study.(2014-09-03) Odeny, Thomas A; Newman, Maya; Bukusi, Elizabeth A; McClelland, R Scott; Cohen, Craig R; Camlin, Carol SBACKGROUND Maternal attendance at postnatal clinic visits and timely diagnosis of infant HIV infection are important steps for prevention of mother to child transmission PMTCT of HIV We aimed to use theory informed methods to develop text messages targeted at facilitating these steps METHODS We conducted five focus group discussions with health workers and women attending antenatal postnatal and PMTCT clinics to explore aspects of women s engagement in postnatal HIV care and infant testing Discussion topics were informed by constructs of the Health Belief Model HBM and prior empirical research Qualitative data were coded and analyzed according to the construct of the HBM to which they related Themes were extracted and used to draft intervention messages We carried out two stages of further messaging development messages were presented in a follow up focus group in order to develop optimal phrasing in local languages We then further refined the messages pretested them in individual cognitive interviews with selected health workers and finalized the messages for the intervention RESULTS Findings indicated that brief personalized caring polite encouraging and educational text messages would facilitate women bringing their children to clinic after delivery suggesting that text messages may serve as an important cue to action Participants emphasized that messages should not mention HIV due to fear of HIV testing and disclosure Participants also noted that text messages could capitalize on women s motivation to attend clinic for childhood immunizations CONCLUSIONS Applying a multi stage content development approach to crafting text messages informed by behavioral theory resulted in message content that was consistent across different focus groups This approach could help answer why and how text messaging may be a useful tool to support maternal and child health We are evaluating the effect of these messages on improving postpartum PMTCT retention and infant HIV testing in a randomized trial
- ItemEffect of mobile phone reminders on follow-up medical care of children exposed to or infected with HIV in Cameroon (MORE CARE): a multicentre, single-blind, factorial, randomised controlled trial.(2014-06-26) Bigna, Jean Joel R; Noubiap, Jean Jacques N; Kouanfack, Charles; Plottel, Claudia S; Koulla-Shiro, SinataBACKGROUND Missed scheduled HIV appointments lead to increased mortality resistance to antiretroviral therapy and suboptimum virological response We aimed to assess whether reminders sent to carers by text message mobile phone call or concomitant text message and mobile phone call increase attendance at medical appointments for HIV care in a population of children infected with or exposed to HIV in Cameroon We also aimed to ascertain the most cost effective method of mobile phone based reminder METHODS MORE CARE was a multicentre single blind factorial randomised controlled trial in urban semi urban and rural settings in Cameroon Carers of children who were infected with or had been exposed to HIV were randomly assigned electronically in blocks of four and allocated 1 1 1 1 sequentially to receive a text message and a call a text message only a call only or no reminder control Investigators were masked to group assignment Text messages were sent and calls made 2 or 3 days before a scheduled follow up appointment The primary outcomes were efficacy the proportion of patients attending a previously scheduled appointment and efficiency attendance measures of staff working time cost of the reminders as a measure of cost effectiveness The primary analysis was by intention to treat This study is registered with the Pan African Clinical Trials Register number PACTR201304000528276 FINDINGS The study took place between Jan 28 and May 24 2013 We randomly assigned 242 adult child carer patient pairs into four groups text message plus call n 61 call n 60 text message n 60 and control n 61 54 participants 89 in the text message plus call group 51 85 in the call group 45 75 in the text message group and 31 51 in the control group attended their scheduled appointment Compared with control the odds ratios for improvement in the primary efficacy outcome were 7 5 95 CI 2 9 19 0 pUnder0 0001 for text message plus call 5 5 2 3 13 1 p 0 0002 for call and 2 9 1 3 6 3 p 0 012 for text message No significant differences were seen in comparisons of the three intervention groups with each other and there was no synergism between text messages and calls For the primary efficiency outcome the mean difference for text message versus text message plus call was 1 5 95 CI 0 7 to 2 4 p 0 002 for call versus text message plus call was 1 2 0 7 to 1 6 pUnder0 0001 and for call versus text message was 0 4 1 3 to 0 6 p 0 47 INTERPRETATION Mobile phone based reminders of scheduled HIV appointments for carers of paediatric patients in low resource settings can increase attendance The most effective method of reminder was text message plus phone call but text messaging alone was the most efficient ie cost effective method FUNDING No external funding
- ItemAn emerging model of maternity care: smartphone, midwife, doctor?(2014-03-24) Tripp, Nadia; Hainey, Kirsten; Liu, Anthony; Poulton, Alison; Peek, Michael; Kim, Jinman; Nanan, RalphBACKGROUND Mobile technology in the form of the smartphone is widely used particularly in pregnancy and they are an increasing and influential source of information AIM To describe the diverse nature of pregnancy related applications apps for the smartphone and to flag that these apps can potentially affect maternity care and should be considered in future planning of care provision METHODS The 2 smartphone platforms Apple and Android were searched for pregnancy related apps and reviewed for their purpose and popularity FINDINGS iTunes and Google Play returned 1059 and 497 pregnancy related apps respectively Forty percent of the apps were informative 13 interactive 19 had features of a medical tool and 11 were social media apps By far the most popular apps calculated as the number of reviews multiplied by average reviewer rating were those with interactive features DISCUSSION The popularity of pregnancy related apps could indicate a shift towards patient empowerment within maternity care provision The traditional model of shared maternity care needs to accommodate electronic devices into its functioning Reliance on healthcare professionals may be reduced by the availability of interactive and personalised information delivered via a smartphone This combined with the fact that smartphones are widely used by many women of childbearing age has the potential to modify maternity care and experiences of pregnancy Therefore it is important that healthcare professionals and policy makers are more aware of these new developments which are likely to influence healthcare and alter health seeking behaviour In addition healthcare professionals need to consider whether to discuss the use of apps in pregnancy with the women in their care
- ItemHelping mothers to get the message about influenza: are texts the future for increased immunization?(2015-02-16) Kharbanda, Elyse OlshenPregnant women and children are at increased risk of severe influenza infections Despite existing recommendations uptake of influenza vaccine in these vulnerable groups remains low Text message reminder recalls are a feasible and scalable method for promoting influenza vaccination In randomized controlled trials text message interventions have demonstrated small but significant increases in influenza vaccine coverage They should be considered one of many tools available for increasing vaccination and thus improving maternal and child health
- ItemInterest of pregnant women in the use of SMS (short message service) text messages for the improvement of perinatal and postnatal care.(2012-09-25) Cormick, Gabriela; Kim, Natalie A; Rodgers, Ashlei; Gibbons, Luz; Buekens, Pierre M; Belizán, José M; Althabe, FernandoBACKGROUND Mobile health mHealth is emerging as a useful tool to improve healthcare access especially in the developing world where limited access to health services is linked to poor antenatal care and maternal and perinatal mortality The objective of this study is to 1 understand pregnant women s access and usage of cell phones and 2 survey the health information needs and interests in a population attending public hospitals and health centers of two cities in Argentina This information is not available and it is the basis to develop a strategy for improving maternal care via cell phones METHODS Questionnaires were verbally administered to pregnant women who were attending an antenatal care visit in community health centers and public hospitals in Rosario Santa Fe and Mercedes Corrientes Participants were 18 years of age or older and had previously given birth The data obtained was qualitative and analyzed using SPSS version 18 RESULTS A total of 147 pregnant women meeting inclusion criteria Rosario 63 Mercedes 84 were approached and verbally consented to participate The average age was 29 5 years most lived in urban areas 89 with a mean travel time of 43 4 minutes required to get to the health center and 57 3 minutes to get the hospital Ninety six percent of women n 140 responded that they would like to receive text messages and cell phone calls with information regarding prenatal care although the topics and period of time to receive information varied greatly CONCLUSIONS Considering the vast majority of the interviewed women had access to and were interested in receiving text messages and calls with educational information regarding pregnancy and infant health pregnant women in Argentina could benefit from such an mHealth program The low access to Internet suggests it is not an option for this population however this cannot be assumed as representative of the country s situation To retain active participation other forms of health communication such as a 2 way text message systems or toll free numbers could be considered in the future Cost of use and implementing these options should be studied
- ItemmHealth for midwives: a call to action.(2013-02-04) Speciale, Anna Maria; Freytsis, MariaThe use of mobile phones has grown exponentially in the last decade including in some of the most remote and low resource regions of the world With the geographic expansion of mobile phone use information and communication technology for development ICT4D was born and innovative uses for mobile technologies in various fields including health care have emerged This use of mobile technology in health care is known as mHealth mHealth interventions are being used internationally to improve maternal and child health Be it the use of a mobile phone to call for emergency transport remote consultation or large scale short message service SMS based community education programs mHealth is demonstrating its utility in reproductive health programs throughout the world This article describes the evolution and challenges of mHealth discusses the role of mHealth in achieving Millennium Development Goals 4 and 5 and addresses the potential impact of mHealth for midwives mHealth represents a new area of global health that warrants the attention of midwifery advocates Midwifery leadership in the field of mHealth at this early stage of its development will ensure future health programming that is relevant to the needs of women and the midwives who care for them
- ItemMicrofluidic CD4+ and CD8+ T lymphocyte counters for point-of-care HIV diagnostics using whole blood.(2013-12-05) Watkins, Nicholas N; Hassan, Umer; Damhorst, Gregory; Ni, Hengkan; Vaid, Awais; Rodriguez, William; Bashir, RashidRoughly 33 million people worldwide are infected with HIV disease burden is highest in resource limited settings One important diagnostic in HIV disease management is the absolute count of lymphocytes expressing the CD4 and CD8 receptors The current diagnostic instruments and procedures require expensive equipment and trained technicians In response we have developed microfluidic biochips that count CD4 and CD8 lymphocytes in whole blood samples without the need for off chip sample preparation The device is based on differential electrical counting and relies on five on chip modules that in sequence chemically lyses erythrocytes quenches lysis to preserve leukocytes enumerates cells electrically depletes the target cells CD4 or CD8 with antibodies and enumerates the remaining cells electrically We demonstrate application of this chip using blood from healthy and HIV infected subjects Erythrocyte lysis and quenching durations were optimized to create pure leukocyte populations in less than 1 min Target cell depletion was accomplished through shear stress based immunocapture using antibody coated microposts to increase the contact surface area and enhance depletion efficiency With the differential electrical counting method device based CD4 and CD8 T cell counts closely matched control counts obtained from flow cytometry over a dynamic range of 40 to 1000 cells l By providing accurate cell counts in less than 20 min from samples obtained from one drop of whole blood this approach has the potential to be realized as a handheld battery powered instrument that would deliver simple HIV diagnostics to patients anywhere in the world regardless of geography or socioeconomic status
- ItemMobile Alliance for Maternal Action (MAMA) Lessons Learned(2018-05-14) Radha, R; Liu, A; Ollis, S; Sullivan, EUnderp This document highlights key operational lessons learned from four country programs Bangladesh South Africa India and Nigeria that implemented the Mobile Alliance for Maternal Action MAMA approach The MAMA approach uses age and stage based messaging directed toward pregnant women new mothers and families to foster behavior change and improve maternal and child health outcomes This report aims to share operational lessons that country program implementers learned and the strategies they used to overcome implementation challenges Under p
- ItemMobile health evaluation methods: the Text4baby case study.(2012-05-02) Evans, W Douglas; Abroms, Lorien C; Poropatich, Ronald; Nielsen, Peter E; Wallace, Jasmine LMobile phones have been shown effective in several public health domains However there are few evaluations of the effectiveness of mobile health in health promotion Also although many studies have referenced behavioral theory none appears to have explicitly tested theoretical assumptions or demonstrated mechanisms of change More robust evaluation models that incorporate theory and measurement of behavioral mediators are needed As in all public health programs mobile health operates within a social ecological context For example organizational and individual level programs seek to influence health and health care practices and individual health behaviors New programs such as Text4baby demonstrate how theory and explicit testing of mediators can be incorporated in evaluations There are challenges and opportunities facing mHealth evaluations given the nature of the mobile channel Mobile communication is ubiquitous available at all times and places and thus experimental control is often difficult Natural experiments using variation in dosage of mHealth and place or location based designs may increase experimental control Text4baby is a text messaging program that provides prenatal care messages to pregnant women and new mothers It uses a partnership model with health care facilities often serving as local implementation partners The authors review a case example of the evaluation of Text4baby at Madigan Army Medical Center Participants were randomized to usual prenatal care plus text messaging or usual care alone The evaluation has a theoretical model of behavior change and measures mediators as well as behavioral outcomes Results will inform how behavioral theory works within mobile health programs
- ItemMobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: a cluster-randomised controlled trial.(2012-08-13) Lund, S; Hemed, M; Nielsen, B B; Said, A; Said, K; Makungu, M H; Rasch, VOBJECTIVE To examine the association between a mobile phone intervention and skilled delivery attendance in a resource limited setting DESIGN Pragmatic cluster randomised controlled trial with primary healthcare facilities as the unit of randomisation SETTING Primary healthcare facilities in Zanzibar POPULATION Two thousand five hundred and fifty pregnant women 1311 interventions and 1239 controls who attended antenatal care at one of the selected primary healthcare facilities were included at their first antenatal care visit and followed until 42 days after delivery All pregnant women were eligible for study participation METHODS Twenty four primary healthcare facilities in six districts in Zanzibar were allocated by simple randomisation to either mobile phone intervention n 12 or standard care n 12 The intervention consisted of a short messaging service SMS and mobile phone voucher component MAIN OUTCOME MEASURES Skilled delivery attendance RESULTS The mobile phone intervention was associated with an increase in skilled delivery attendance 60 of the women in the intervention group versus 47 in the control group delivered with skilled attendance The intervention produced a significant increase in skilled delivery attendance amongst urban women odds ratio 5 73 95 confidence interval 1 51 21 81 but did not reach rural women CONCLUSIONS The mobile phone intervention significantly increased skilled delivery attendance amongst women of urban residence Mobile phone solutions may contribute to the saving of lives of women and their newborns and the achievement of Millennium Development Goals 4 and 5 and should be considered by maternal and child health policy makers in developing countries
- ItemMobile phones improve antenatal care attendance in Zanzibar: a cluster randomized controlled trial.(2014-01-22) Lund, Stine; Nielsen, Birgitte B; Hemed, Maryam; Boas, Ida M; Said, Azzah; Said, Khadija; Makungu, Mkoko H; Rasch, VibekeBACKGROUND Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems Antenatal care has the potential to reduce maternal morbidity and improve newborns survival but this benefit may not be realized in sub Saharan Africa where the attendance and quality of care is declining We evaluated the association between a mobile phone intervention and antenatal care in a resource limited setting We aimed to assess antenatal care in a comprehensive way taking into consideration utilisation of antenatal care as well as content and timing of interventions during pregnancy METHODS This study was an open label pragmatic cluster randomised controlled trial with primary healthcare facilities in Zanzibar as the unit of randomisation 2550 pregnant women 1311 interventions and 1239 controls who attended antenatal care at selected primary healthcare facilities were included at their first antenatal care visit and followed until 42 days after delivery 24 primary health care facilities in six districts were randomized to either mobile phone intervention or standard care The intervention consisted of a mobile phone text message and voucher component Primary outcome measure was four or more antenatal care visits during pregnancy Secondary outcome measures were tetanus vaccination preventive treatment for malaria gestational age at last antenatal care visit and antepartum referral RESULTS The mobile phone intervention was associated with an increase in antenatal care attendance In the intervention group 44 of the women received four or more antenatal care visits versus 31 in the control group OR 2 39 95 CI 1 03 5 55 There was a trend towards improved timing and quality of antenatal care services across all secondary outcome measures although not statistically significant CONCLUSIONS The wired mothers mobile phone intervention significantly increased the proportion of women receiving the recommended four antenatal care visits during pregnancy and there was a trend towards improved quality of care with more women receiving preventive health services more women attending antenatal care late in pregnancy and more women with antepartum complications identified and referred Mobile phone applications may contribute towards improved maternal and newborn health and should be considered by policy makers in resource limited settings
- ItemNewborn health on the line: the potential mHealth applications.(2014-07-16) Agarwal, Smisha; Labrique, Alain
- ItemOpen source handheld-based EMR for paramedics working in rural areas.(2002-12-04) Anantraman, Vishwanath; Mikkelsen, Tarjei; Khilnani, Reshma; Kumar, Vikram S; Pentland, Alex; Ohno-Machado, LucilaWe describe a handheld based electronic medical record EMR for use in certain rural settings The system is based on the Linux operating system and allows access to large mobile databases The open source system is designed for paramedical health workers serving remote areas in rural India A PDA loaded with the handheld based EMR provides workers who have little access to medical doctors with different kinds of decision support and alerts It addresses two important problems in developing countries prenatal care and child health This paper describes the technical challenges and innovation needed in the design development adaptation and implementation of the handheld EMR in a real setting in India