The ZIKApp for detection of potential arbovirus infections and pregnancy complications in pregnant women in Jamaica: a pilot study (Preprint)
Authors: Ruiz-Burga Elisa , Bruijning-Verhagen Patricia , Palmer Paulette , Sandcroft Annalisa , Fernandes Georgina , de Hoog Marieke , Bryan Lenroy , Pierre Russell , Bailey Heather , Giaquinto Carlo , Thorne Claire , DC Christie Celia ,   For the ZIKAction Consortium
Published: October 2021

BACKGROUND

Evidence of the benefits of mHealth technology including symptom tracking Apps for research, surveillance and prevention is growing, including for arboviruses and for pregnancy interventions. No study has yet addressed arbovirus symptom tracking in pregnancy.

OBJECTIVE

To evaluate the use of a smartphone app (“ZIKApp”) designed to self-report arbovirus symptoms and pregnancy complications, and to assess compliance with daily symptom diaries until the end of pregnancy in a cohort of women in an arbovirus endemic, subtropical, middle-developing country (Jamaica).

METHODS

Pregnant women aged 16 and over, having a smartphone, and planning on delivering at the recruiting centre were enrolled from an antenatal clinic in February-July 2020. The ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arboviral infection and/or pregnancy complications that triggered automatic notifications to participants. Socio-demographic, epidemiological and obstetric information was collected at enrolment, with additional review of medical records; and users' perception through an exit survey. Descriptive analyses and logistic regression of possible factors associated with diary adherence were performed.

RESULTS

Of 173 women enrolled, 90% (157) used ZIKApp for median duration of 155 days between enrolment and pregnancy end, six used the app for < 7days and 10 exited the study early. For each successive 30 day period from enrolment up to 150 days post-enrolment, 77-82% of these 157 women completed their daily symptom diary; 32-36% did so on the same day. Overall, 50 (31.9%) women had ‘good adherence’ to diary reporting (i.e. completed same day or 2-3 days later for ≥80% of days enrolled). There were three-fold higher odds of good adherence for participants >34 years versus those 25-29 (AOR 3.14 95%CI 1.10-8.98) and two-fold higher odds for women with tertiary versus secondary education (AOR 2.26, 95% CI 1.06-4.83). Of 161 women who ever made a diary entry, a total of 5454 individual symptom reports were made (median 17 per woman, max 278). Nine (5.3%) women reported symptom combinations triggering a “potential arbovirus episode” (none had an adverse pregnancy outcome) and 55 (32.9%) women reported painful uterine contractions, or vaginal bleeding, mainly in the month before delivery. The exit survey showed that 52% (71/137) of women rated the App as an excellent experience and were less likely to be poor diary adherers (p=.04); 138/139 women reported that the App was easy to understand and to use.

CONCLUSIONS

In the era of telemedicine and mHealth, adherence to the ZIKApp in pregnancy was high. The pilot has demonstrated the feasibility and usability of the App in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arboviral infections in pregnancy and promise for implementation by direct treatment and care teams to optimise maternal care.

CLINICALTRIAL