title: An mHealth monitoring system for traditional birth attendant-led antenatal risk assessment in rural Guatemala.
abstract: Limited funding for medical technology, low levels of education and poor infrastructure for delivering and maintaining technology severely limit medical decision support in low- and middle-income countries. Perinatal and maternal mortality is of particular concern with millions dying every year from potentially treatable conditions. Guatemala has one of the worst maternal mortality ratios, the highest incidence of intra-uterine growth restriction (IUGR), and one of the lowest gross national incomes per capita within Latin America. To address the lack of decision support in rural Guatemala, a smartphone-based system is proposed including peripheral sensors, such as a handheld Doppler for the identification of foetal compromise. Designed for use by illiterate birth attendants, the system uses pictograms, audio guidance, local and cloud processing, SMS alerts and voice calling. The initial prototype was evaluated on 22 women in highland Guatemala. Results were fed back into the refinement of the system, currently undergoing RCT evaluation.
authors.affiliation: a Centre for Doctoral Training in Healthcare Innovation, Institute of Biomedical Engineering, Department of Engineering Science , University of Oxford , Oxford , UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Stroux
authors.affiliation: b Wuqu' Kawoq Maya Health Alliance, Santiago Sacatepéquez , Guatemala.
authors.forename: Boris
authors.initials: B
authors.lastname: Martinez
authors.affiliation: b Wuqu' Kawoq Maya Health Alliance, Santiago Sacatepéquez , Guatemala.
authors.forename: Enma
authors.initials: E
authors.lastname: Coyote Ixen
authors.affiliation: b Wuqu' Kawoq Maya Health Alliance, Santiago Sacatepéquez , Guatemala.
authors.forename: Nora
authors.initials: N
authors.lastname: King
authors.affiliation: c Departments of Anthropology and Public Health , Agnes Scott College , Atlanta , GA , USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hall-Clifford
authors.affiliation: b Wuqu' Kawoq Maya Health Alliance, Santiago Sacatepéquez , Guatemala.
authors.forename: Peter
authors.initials: P
authors.lastname: Rohloff
authors.affiliation: d Departments of Biomedical Informatics and Biomedical Engineering , Emory University and Georgia Institute of Technology , Atlanta , GA , USA.
authors.forename: Gari D
authors.initials: GD
authors.lastname: Clifford
mesh_terms: D000293:Adolescent; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D005323:Fetal Monitoring; D005333:Fetus / Q000502:physiology; D006166:Guatemala; D006347:Heart Sounds; D006801:Humans; D008427:Maternal Health Services; D008880:Midwifery; D011247:Pregnancy; D018570:Risk Assessment; D012424:Rural Population; D055815:Young Adult
keywords: Intrauterine growth restriction; mHealth; perinatal monitoring; resource constrained healthcare