title: Usability and feasibility of a mobile health system to provide comprehensive antenatal care in low-income countries: PANDA mHealth pilot study in Madagascar.
abstract: Background Madagascar's maternal health mortality ratio in 2013 was 478 deaths per 100,000 live births. Most deaths are related to direct complications during pregnancy and childbirth and could be reduced by providing comprehensive antenatal care (ANC). Objective The objective of the study was to assess the usability and feasibility of a mobile health system (mHealth) to provide high-quality ANC, according to World Health Organization (WHO) recommendations. Methods PANDA (Pregnancy And Newborn Diagnostic Assessment) is an easy-to-use mHealth system that uses affordable communications technology to support diagnosis and health care worker decision-making regarding ANC. From January to March 2015, a cross-sectional pilot study was conducted in Ambanja District, Madagascar, in which ANC using PANDA was provided to 100 pregnant women. The collected data were transmitted to a database in the referral hospital to create individual electronic patient records. Accuracy and completeness of the data were closely controlled. The PANDA software was assessed and the number of abnormal results, treatments performed, and participants requiring referral to health care facilities were monitored. Results The PANDA system facilitated creation of individual electronic patient records that included socio-demographic and medical data for 100 participants. Duration of ANC visits averaged 29.6 min. Health care providers were able to collect all variables (100%) describing personal and medical data. No major technical problems were encountered and no data were lost. During 17 ANC visits (17%), an alert function was generated to highlight abnormal clinical results requiring therapy or referral to an affiliated hospital. Participants' acceptability of the system was very high. Conclusion This pilot study proved the usability and feasibility of the PANDA mHealth system to conduct complete and standardised ANC visits according to WHO guidelines, thus providing a promising solution to increase access to high-quality and standardised ANC for pregnant women in remote areas.
authors.affiliation: 1 Department of Obstetrics and Gynecology, University Hospitals of Geneva, Switzerland.|2 Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Anne Caroline
authors.initials: AC
authors.lastname: Benski
authors.affiliation: 3 AISPO, Associazione Italiana Solidarietà tra I Popoli, Milan, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Stancanelli
authors.affiliation: 2 Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Scaringella
authors.affiliation: 2 Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Josea Léa
authors.initials: JL
authors.lastname: Herinainasolo
authors.affiliation: 2 Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Jéromine
authors.initials: J
authors.lastname: Jinoro
authors.affiliation: 1 Department of Obstetrics and Gynecology, University Hospitals of Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Vassilakos
authors.affiliation: 1 Department of Obstetrics and Gynecology, University Hospitals of Geneva, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Petignat
authors.affiliation: 1 Department of Obstetrics and Gynecology, University Hospitals of Geneva, Switzerland.|4 Centre Médico-chirurgical Saint Damien, Ambanja, Madagascar.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003906:Developing Countries; D057286:Electronic Health Records / Q000458:organization & administration; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008270:Madagascar; D017060:Patient Satisfaction; D010865:Pilot Projects; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D011787:Quality of Health Care; D012017:Referral and Consultation; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000458:organization & administration*; D055815:Young Adult
keywords: Antenatal care; Madagascar; mHealth; mobile application; smartphone