Telemedicine and maternal health outcomes in the Amansie West District, Ghana.

ABSTRACT Maternal health outcomes remain gruesome in less developed, middle and low income countries due to weak health systems, geographical barriers, socio-cultural and economic factors and shortage of health professionals. In Ghana and other parts of the world hit by high maternal mortality, there are consistent efforts aimed at addressing maternal mortality, however, the values of using information, communication and technology (ICT) in maternal healthcare delivery remain under exploited. This study was conducted to assess the use and influence of telemedicine on maternal health outcomes, obstetric referrals and health care seeking behavior of mothers to inform implementation of telemedicine in Ghana. A before and after study sandwiched by a prospective sub-study were conducted in the Amansie West district in Ashanti region of Ghana. The before (phase 1) and after study (phase 3) involved randomly selected 720 pregnant women while the prospective study (phase 2) involved 300 pregnant women diagnosed in second trimester (from ANC register) with no diseases, followed up from Antenatal Clinic (ANC) till completion of Post Natal Clinic (PNC) period which lasted for nine months. The baseline study was conducted before a district-wide implementation of telemedicine and an after study in 2017. The study participants served as their own controls with no comparison group. Both quantitative and qualitative data were collected using structured questionnaire, interview guides and observation checklist. The study spanned from February 2015 to January 2017. Trend analysis of maternal health outcomes from 2008 to 2016 was undertaken using data from DHIMS II to validate the findings from the surveys. Multiple regression models were used to estimate the influence of socio-economic status, access to healthcare and service quality on utilization of maternal healthcare and obstetric referrals on maternal outcomes. Differences in maternal outcomes in relation to experience with telemedicine were assessed using Chi-square (2 ) in r X n tables. The results showed a high level of acceptability of telemedicine among mothers and health workers, who also had positive perception of the influence of telemedicine on maternal healthcare. The positive influence of telemedicine on maternal outcomes was however not statistically significant. Proportion of women who had >3 antenatal care visits, access to skilled delivery and postnatal care were 68.5%, 41.1% and 33.6% at baseline and 43.6%, 59.6%; 59.0% at endline respectively. The mothers‟ socio-economic background and health access influenced their utilization of maternal healthcare, 21.7% and 6.4% of the women studied honoured referral by a community health worker to the next level of care in the baseline and endline studies respectively. Some of the pregnant women however refused referrals to the next level due to lack of money (58%) and lack of transport (17%), in the baseline study. Women who perceived their disease conditions as emergencies and severe were more likely to honour obstetric referral (OR=2.3; 95% CI=1.3, 3.9), baseline. Findings from this study suggest suboptimal utilization of maternal healthcare in the district. Clients‟ perception about severity of health condition and low income remain as barriers to healthcare seeking and disincentives to honour obstetric referrals in a setting with inequitable access to healthcare. Although telemedicine holds the promise of bridging these gaps for improved maternal healthcare, the programme is yet to substantiate its positive impact quantitatively on maternal health outcomes. Improving the socio-economic status and maternal health related promotion activities could improve the yield of telemedicine in the study area.

Source: KNUST