Impact of a Smartphone Intervention on Tanzanian Women's Childbirth Location
Condition: Maternal Death Affecting Fetus or Newborn; Delivery Complication; Obstetric Complication; Birth Injuries; Delivery; Injury, Maternal; Delivery Problem for Fetus
MeSH terms: Maternal Death; Dystocia; Birth Injuries; Wounds and Injuries
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): SUSTAIN Smartphone training of CHW (SP+); SUSTAIN Paperbased training of CHW (SOC)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 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): 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.
Intervention MeSH terms: Sulfamethazine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants assigned to one of two groups in parallel for the duration of the study
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: maternal health; community health; health services; Tanzania; evaluation; cluster randomized trial