Community based weighing of newborns and use of mobile phones by village elders in rural settings in Kenya: a decentralised approach to health care provision

Peter Gisore, Evelyn Shipala, Kevin Otieno, Betsy Rono, Irene Marete, Constance Tenge, Hillary Mabeya, Sherri Bucher, Janet Moore, Edward Liechty, Fabian Esamai, Peter Gisore, Evelyn Shipala, Kevin Otieno, Betsy Rono, Irene Marete, Constance Tenge, Hillary Mabeya, Sherri Bucher, Janet Moore, Edward Liechty, Fabian Esamai

Abstract

Background: Identifying every pregnancy, regardless of home or health facility delivery, is crucial to accurately estimating maternal and neonatal mortality. Furthermore, obtaining birth weights and other anthropometric measurements in rural settings in resource limited countries is a difficult challenge. Unfortunately for the majority of infants born outside of a health care facility, pregnancies are often not recorded and birth weights are not accurately known. Data from the initial 6 months of the Maternal and Neonatal Health (MNH) Registry Study of the Global Network for Women and Children's Health study area in Kenya revealed that up to 70% of newborns did not have exact weights measured and recorded by the end of the first week of life; nearly all of these infants were born outside health facilities.

Methods: To more completely obtain accurate birth weights for all infants, regardless of delivery site, village elders were engaged to assist in case finding for pregnancies and births. All elders were provided with weighing scales and mobile phones as tools to assist in subject enrollment and data recording. Subjects were instructed to bring the newborn infant to the home of the elder as soon as possible after birth for weight measurement.The proportion of pregnancies identified before delivery and the proportion of births with weights measured were compared before and after provision of weighing scales and mobile phones to village elders. Primary outcomes were the percent of infants with a measured birth weight (recorded within 7 days of birth) and the percent of women enrolled before delivery.

Results: The recorded birth weight increased from 43 ± 5.7% to 97 ± 1.1. The birth weight distributions between infants born and weighed in a health facility and those born at home and weighed by village elders were similar. In addition, a significant increase in the percent of subjects enrolled before delivery was found.

Conclusions: Pregnancy case finding and acquisition of birth weight information can be successfully shifted to the community level.

Figures

Figure 1
Figure 1
Location of the Global Network - Kenya site. The left panel depicts each of the 16 clusters. Each dot represents an individual village headed by a village elder. The right panel shows where within Kenya the clusters are located.
Figure 2
Figure 2
Top panel shows the percent of infants in each month that had an actual birth weight recorded. The lower panel shows the percent of pregnancies in each month enrolled after the birth date.
Figure 3
Figure 3
Box-plot of birth weight distributions for infants born and weighed in a health facility and those born at home and weighed by a village elder. The box encloses 25th to 75th percentile, and whiskers denote 1st quartile - 1.5(interquartile range) and 3 rd quartile + 1.5(interquartile range). Medians were compared by Wilcoxon test.

References

    1. Abbatt F. Scaling Up Health And Education Workers: Community Health Workers: Literature Review. DFID Health Systems Resource Centre; 2005.
    1. Celletti F, Wright A, Palen J, Frehywot S, Markus A, Greenberg A, de Aguiar RA, Campos F, Buch E, Samb B. Can the deployment of community health workers for the delivery of HIV services represent an effective and sustainable response to health workforce shortages? Results of a multicountry study. AIDS. 2010;24(Suppl 1):S45–57. doi: 10.1097/01.aids.0000366082.68321.d6.
    1. Dhaene G, Goufack J, Tatah EA. The Douala Action Plan. Human resource for Health in Africa, Experiences Challenges and Realities. Geneva 27, Switzerland: WHO; 2008.
    1. Belizan JM, McClure EM, Goudar SS, Pasha O, Esamai F, Patel A, Chomba E, Garces A, Wright LL, Koso-Thomas M, Neonatal death in Low-Middle Income Countries: A Global Network Study. Amer J Perinatology. 2012. in press .
    1. Mullany LC, Darmstadt GL, Coffey P, Khatry SK, LeClerq SC, Tielsch JM. A low cost, colour coded, hand held spring scale accurately categorises birth weight in low resource settings. Arch Dis Child. 2006;91(5):410–413. doi: 10.1136/adc.2005.088781.
    1. Chhanabhai PN, Holt A. The Disparity Information and Communication Technology for Developing Countries has in the Delivery of Healthcare Information. The Open Medical Informatics Journal. 2010;4:195–201.
    1. Kaplan WA. Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries? Global Health. 2006;2:9. doi: 10.1186/1744-8603-2-9.
    1. Hoffman JA, Cunningham JR, Suleh AJ, Sundsmo A, Dekker D, Vago F, Munly K, Igonya EK, Hunt-Glassman J. Mobile direct observation treatment for tuberculosis patients: a technical feasibility pilot using mobile phones in Nairobi, Kenya. Am J Prev Med. 2010;39(1):78–80. doi: 10.1016/j.amepre.2010.02.018.
    1. Chan CV, Kaufman DR. A technology selection framework for supporting delivery of patient-oriented health interventions in developing countries. J Biomed Inform. 2010;43(2):300–306. doi: 10.1016/j.jbi.2009.09.006.
    1. Tomlinson M, Solomon W, Singh Y, Doherty T, Chopra M, Ijumba P, Tsai AC, Jackson D. The use of mobile phones as a data collection tool: a report from a household survey in South Africa. BMC Med Inform Decis Mak. 2009;9:51. doi: 10.1186/1472-6947-9-51.
    1. Bielli E, Carminati F, La Capra S, Lina M, Brunelli C, Tamburini M. A Wireless Health Outcomes Monitoring System (WHOMS): development and field testing with cancer patients using mobile phones. BMC Med Inform Decis Mak. 2004;4:7. doi: 10.1186/1472-6947-4-7.
    1. WHO HSaSH, editor. WHO. Task-Shifting: Global Recommendations and Guidelines. Geneva: World Health Organization; 2007. pp. 1–92.
    1. KenyaMOH. Taking the Kenya Essential Package of Health to the Community. A strategy for Delivery of Level One Services. In: Health Mo, editor. Health Sector Reform Secretariat, Nairobi, Republic of Kenya. Nairobi, Republic of Kenya: Health Sector Reform Secretariat; 2006.
    1. Lehmann U, Sanders D. Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Evidence and Information for Policy. 2007.
    1. Swider SM. Outcome effectiveness of community health workers: an integrative literature review. Public Health Nurs. 2002;19(1):11–20. doi: 10.1046/j.1525-1446.2002.19003.x.
    1. Nemcek MA, Sabatier R. State of evaluation: community health workers. Public Health Nurs. 2003;20(4):260–270. doi: 10.1046/j.1525-1446.2003.20403.x.
    1. Bolton-Moore C, Mubiana-Mbewe M, Cantrell RA, Chintu N, Stringer EM, Chi BH, Sinkala M, Kankasa C, Wilson CM, Wilfert CM. et al.Clinical outcomes and CD4 cell response in children receiving antiretroviral therapy at primary health care facilities in Zambia. JAMA. 2007;298(16):1888–1899. doi: 10.1001/jama.298.16.1888.
    1. Simon AL, Susan AM-B, Claire AG, Karen AD, Xavier AB-C, E AvWB, Jan AO-J, Marit AJ, N AAG, Merrick AZ, Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database of Systematic Reviews: Reviews 2010. 2010.

Source: PubMed

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