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Completed

NCT Number: NCT03161184

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

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.

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Key information

Conditions

Maternal Death Affecting Fetus or Newborn Birth Injuries Congenital, Hereditary, and Neonatal Diseases and Abnormalities Delivery Complication Delivery Problem for Fetus Delivery; Injury, Maternal Infant, Newborn, Diseases Obstetric Complication Wounds and Injuries

Age range

16 year–49 year

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

About this study

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.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

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

Exclusion criteria

  • None

Treatment and study plan

SUSTAIN Smartphone training of CHW (SP+)

Behavioral

Intervention (Smart phone assisted): During prenatal household visits, the smart phone based application guides CHW through electronic "decision tree" protocols, directing them to specific health/nutrition counseling topics and messages based on each woman's gestational age, and her answers to a specific series of diagnostic questions. Based on the client's gestational age, the tool directs CHW to lessons in an accompanying photo book, and reminds them to counsel on the importance of accessing timed and targeted maternal health services at health facilities. The application also assists CHW to identify danger signs during pregnancy, flags clients who require immediate referral to health facilities, and reminds CHW to follow-up with clients who were previously referred to clinics.

SUSTAIN Paperbased training of CHW (SOC)

Behavioral

SUSTAIN Paperbased training of CHW (SOC): During prenatal household visits, the CHW asks a specific series of diagnostic questions based on the client's gestational age, offers counsel on the importance of accessing appropriate maternal health services at health facilities and uses lessons in an accompanying photo book to deliver messages on a variety of maternal and newborn health and nutrition topics. CHW are trained to identify danger signs during pregnancy, flag clients who require immediate referral to health facilities, and follow-up with clients who were previously referred to clinics.

Primary outcomes

  1. Delivery in a facility

    Time frame: 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

  2. Antenatal care attendance

    Time frame: 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 outcomes

  1. Gestational age at first contact/ANC

    Time frame: 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

  2. Iron supplementation during pregnancy

    Time frame: 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

  3. HIV screening HIV Screening

    Time frame: 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

  4. De-worming treatment during pregnancy

    Time frame: 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

  5. Bednet use

    Time frame: 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

  6. Malaria prophylaxis during pregnancy

    Time frame: 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

  7. Tetanus Toxoid Vaccination

    Time frame: 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

  8. Referrals

    Time frame: 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

  9. Referral uptake

    Time frame: 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

  10. Presence of partner at ANC

    Time frame: 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

  11. Birth plan

    Time frame: 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

  12. Early initiation of breastfeeding

    Time frame: 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

  13. Exclusive breastfeeding at 7 days

    Time frame: 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

  14. BCG vaccination

    Time frame: 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

  15. Maternal knowledge of danger signs during pregnancy

    Time frame: 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

Sponsors and collaborators

Lead sponsor

University of Toronto

Other

Collaborators

  • Muhimbili University of Health and Allied Sciences
  • World Vision

Registry information

Official study title

Evaluation of an mHealth Intervention to Improve Women's Access to Maternal Health Services in Rural Tanzania

Acronym: SUSTAIN1

Important dates

Study start
2013
Primary completion
2014
Study completion
2014
First posted
May 19, 2017
Registry last updated
May 19, 2017

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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