Good Start III (Saving Newborn Lives)

KwaZulu-Natal, South Africa

This large landmark mHealth assisted study initiated by the South African Medical Research Council in 2008 in a disadvantaged urban community in Durban, South Africa, has convincingly provided sound evidence that Community Health Workers using low-cost mobile phones linked instantaneously to their supervisors by Mobenzi Researcher as a management tool, can effectively track the progress of women from early pregnancy through the delivery of the baby into early infancy.

The MRC’s “Good Start” study focused on interventions for the Prevention of Mother to Child Transmission (PMTCT) of HIV and strategies to improve neonatal survival. The project involved over 40 members of staff and, over the course of its 3 year term, several thousand participants.

Following the successful completion of two preceding phases, participant recruitment of pregnant mothers residing in Umlazi, a township located outside Durban South Africa by Community-based Health Workers (CHWs) began in 2008. Consenting participants, randomly assigned to a control or intervention group based on their household location, received antenatal and postnatal CHW visits with the view to assess the effectiveness of the intervention strategy.

"I cannot imagine how much paper we would have used to capure all the information we have now and how long it would have taken us to link up different pieces of data to the participants."
 

Antenatal visit dates were based on the mother’s expected date of delivery. Postnatal visits took place at specific intervals dependent on the date on which the mother was discharged from her delivery facility. Operational information from each visit was relayed to supervisors to facilitate planning and ensure adherence to the visit schedule. Birth information was gathered and disseminated immediately to allow for timecritical postnatal visits to take place on time.

The duration a participant remained active in the study varied between 3 and 12 months depending on when she was identified and enrolled. Upon the completion of applicable visits, an assessment interview was held at Prince Mshiyeni Hospital in Umlazi with a data collector.

Complexities relating to participant exclusions, additional visits for low birth weight infants, multiple possible delivery locations, and severely limited infrastructure posed significant challenges to the MRC’s team.

Mobenzi Researcher Implementation

Mobenzi Researcher, which was used in phase two of the project to collect the baseline data on 25,000 households, was again leveraged as the data collection and communication platform and formed the base on which the development of a portal to cater for the project’s custom logistical, operational and reporting requirements was built. CHWs could use their entry level handsets (used previously for the collection of baseline data), to complete surveys about each participant visit. This feedback, along with information regarding enrolment and birth events from data collectors –also captured via low cost mobile phones– was exposed by the Mobenzi Researcher Application Programming Interface (API) for incorporation into the purpose-built web portal – the Good Start Management Console (GSMC).

The GSMC leveraged information from a variety of sources, including data captured on mobile phones to schedule, track, monitor and coordinate the operational activities necessary to fulfil the project mandate. Supervisors, administrators and managers could login to see, at a glance, the current status of a participant, their upcoming milestones, notes, observations and previous interactions. Only specific information based on a user’s role was available ensuring that blinding – a common requirement for most intervention studies – was not compromised.

Impact

The weekly meetings held with CHWs were informed by the wealth of information managed by the GSMC. Visit schedules which were automatically generated by the system based on the most recent interactions could be printed for each CHW. As visits took place and were captured in the field, the web-based portal updated to reflect a near real-time view of the progress on the ground. Reported births from data collectors triggered scheduling of postnatal visits and notifications to supervisors.

Paper forms were largely removed and data became centralised and available to authorised project staff for their specific operational, analysis and reporting needs.

Based on the implementation, a paper was published; “The use of mobile phones as a data collection tool: A report from a household survey in South Africa”, which in conclusion highlights the benefits of this data collection method; relating to quality control, data collector supervision, scalability, improved data integrity and resolving connectivity related issues associated with some high end devices as opposed to the mobile phone.

About The MRC

The South African Medical Research Council is a statutory council mandated by government to improve the nation's health and quality of life through promoting and conducting relevant and responsive health research.

As one of the largest research organisations in the country, the MRC is able to embark on large-scale long-term projects which break new ground in a range of areas including HIV/AIDS.

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