Project Lead(s): Tabassum Firoz
Every two minutes, at least one woman dies from pregnancy complications and 99% of these deaths are in low- and middle-income countries, where it is often a leading cause of death in reproductive-age women. Most maternal deaths occur in the community and most are avoidable, as they are due to modifiable factors.
Three delays have been shown to be related to adverse maternal outcomes: delay in deciding to seek care, delay in transit from home to the health facility, and delay in getting treatment once the woman has reached a health facility. While the second delay is clearly geographical, the first and third delay are implicitly so, due to pervasive factors linked to the social and physical environment, as well as the healthcare system.
Developed in Mozambique, Mapping Outcomes for Mothers (MOM) is a mHealth application that utilizes geographic mapping techniques to create a picture of maternal health in the context of local, social and physical environments.
MOM is designed to be used by minimally trained community health workers to generate a risk profile for individual women, based on her characteristics and those of her community. MOM is unique because it looks at pregnancy risk in four dimensions:
1) The social environment
2) The physical environment
3) The healthcare system
4) The woman’s individual characteristics.
A scoping review early in this work revealed that geographic methods have largely been used for evaluating access to maternal health services. We sought to extend the use of these methods to quantify maternal health risk, by relating maternal outcomes to their environmental influences/determinants. This was achieved using a mix of qualitative techniques and geographical information systems (GIS) to map maternal outcomes, as well as the seasonal variation in access to maternal health facilities.
MOM partnered with PRE-EMPT (Pre-eclampsia/Eclampsia Monitoring, Prevention and Treatment) by using the existing surveillance platform of one of the trials, Community-Level Interventions for Pre-eclampsia (CLIP). As part of the project, a total of 50,652 households consented to participate in a household census. Households in the survey included 80,506 women of reproductive age, of whom 14,640 had been pregnant in the preceding 12 months. Of these, 18 women were suspected to have died from pregnancy-related causes, as was determined through a verbal autopsy of all deaths of women of reproductive age.
Five key factors emerged as having statistically significant associations with the maternal mortality:
- Family support (financial and transport)
- Women’s financial autonomy in pregnancy
- Quality of roads
- Marital status
- Isolation, measured by the travel distance to the nearest major road.
As output from the app, community health workers (CHWs) are presented with a list of these risk factors, as well as protective factors and recommendations relevant to the pregnant woman’s personal condition and the community where she lives.
Knowledge was disseminated through conferences, high-level working groups and several publications, including in the International Journal of Gynecology and Obstetrics.
The project team intends to take MOM to scale, and will apply to Grand Challenges Canada for a Phase II grant. The team envisions the MOM app being used by CHWs for pregnancy surveillance, while health administrators get access to location-based services for monitoring trends in maternal health and planning interventions.
The process of pursuing potential partnerships with other organizations has been initiated, including a telecommunications (Econet wireless) company in Zimbabwe. The National Mapping Agency in Mozambique has agreed to validate the mapping processes.