Maternal/neonatal mortality rate is unacceptably high in rural Uganda where 90% of the population lives. Poverty, low education levels, and high rates of childbirths characterize this population with almost 7 births per woman, minimal family planning (FP), and lack of infrastructure making access to health services extremely difficult.
A project was undertaken to verify various baseline need assessments, prior to implementing a holistic strategy for improving maternal/neonatal health (MNH). Simultaneously, we created an electronic health database by enrolling 1600 women of reproductive age (WRA) and their families. The use of a cell phone network and mHealth technology affirmed the value of gathering real-time data by the community health workers (CHWs) and overcoming communication gaps between community residents and the health center.
To test our initial hypotheses, we recruited and trained 50 CHWs from 25 villages from Busujju County in Mityana. A 10-day intensive workshop was conducted for CHWs in FP, HIV/AIDS, MNH, and child survival. The initial pilot was completed in three weeks with 5500 residents registered.
The data revealed huge gaps in health delivery including the lack of HIV testing (70%) and FP (86%) in WRA who were never pregnant. Pregnant WRA also lacked postnatal care (79%) and mosquito nets (39%). 91% of children under 5 were never tested for HIV, 27% were not fully immunized and 46% did not use any mosquito nets. 46% of husbands/partners never used condoms, 70% were never counseled on FP, 43% were not tested for HIV, 66% of them did not attend antenatal care with their wives, and lastly 52% did not use any mosquito nets.
The realistic portrait indicates major gaps in health delivery. Our hypothesis is that CHWs using mHealth technology to monitor patients in real time will improve outcomes facilitating a cost-effective, replicable and sustainable model to strengthen health systems.
Additional data analysis is forthcoming and will be made available on the website and be submitted for publication.