Implementation of an international standardized set of outcome indicators in pregnancy and childbirth in Kenya: Utilizing mobile technology to collect patient-reported outcomes

PLoS One. 2019 Oct 16;14(10):e0222978. doi: 10.1371/journal.pone.0222978. eCollection 2019.

Abstract

Background: Limited data exist on health outcomes during pregnancy and childbirth in low- and middle-income countries. This is a pilot of an innovative data collection tool using mobile technology to collect patient-reported outcome measures (PROMs) selected from the International Consortium of Health Outcomes Measurement (ICHOM) Pregnancy and Childbirth Standard Set in Nairobi, Kenya.

Methods: Pregnant women in the third trimester were recruited at three primary care facilities in Nairobi and followed prospectively throughout delivery and until six weeks postpartum. PROMs were collected via mobile surveys at three antenatal and two postnatal time points. Outcomes included incontinence, dyspareunia, mental health, breastfeeding and satisfaction with care. Hospitals reported morbidity and mortality. Descriptive statistics on maternal and child outcomes, survey completion and follow-up rates were calculated.

Results: In six months, 204 women were recruited: 50% of women returned for a second ante-natal care visit, 50% delivered at referral hospitals and 51% completed the postnatal visit. The completion rates for the five PROM surveys were highest at the first antenatal care visit (92%) and lowest in the postnatal care visit (38%). Data on depression, dyspareunia, fecal and urinary incontinence were successfully collected during the antenatal and postnatal period. At six weeks postpartum, 86% of women breastfeed exclusively. Most women that completed the survey were very satisfied with antenatal care (66%), delivery care (51%), and post-natal care (60%).

Conclusion: We have demonstrated that it is feasible to use mobile technology to follow women throughout pregnancy, track their attendance to pre-natal and post-natal care visits and obtain data on PROM. This study demonstrates the potential of mobile technology to collect PROM in a low-resource setting. The data provide insight into the quality of maternal care services provided and will be used to identify and address gaps in access and provision of high quality care to pregnant women.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aftercare / economics
  • Aftercare / organization & administration
  • Aftercare / statistics & numerical data
  • Cell Phone
  • Data Collection / methods
  • Feasibility Studies
  • Female
  • Health Plan Implementation
  • Humans
  • Infant, Newborn
  • Kenya
  • Mobile Applications*
  • Parturition
  • Patient Reported Outcome Measures*
  • Perinatal Care / economics
  • Perinatal Care / organization & administration*
  • Perinatal Care / statistics & numerical data
  • Pilot Projects
  • Pregnancy
  • Quality Indicators, Health Care / standards*
  • Telemedicine / economics
  • Telemedicine / organization & administration*
  • Telemedicine / statistics & numerical data
  • Young Adult

Associated data

  • figshare/10.6084/m9.figshare.9920084

Grants and funding

This research project received funding from the Dutch Ministry of Foreign Affairs. The health care services received by women in this study were funded by Gertrude’s Hospital Foundation and Gilead. Gilead had no role in the study design; collection, analysis, and interpretation of data; no role in the writing of the paper; and no role in the decision to submit for publication the project. LR is funded by the Ronda Stryker Global Surgery Fellowship Fund at Harvard Medical School. JGM is supported by an unrestricted grant from General Electric Foundation. DL is funded by the Fulbright Commission, Swedish Medical Society, Björnsson Foundation, Sweden-America Foundation, and Adlerberth Research Foundation. The Gates Foundation (OPP1161450, Kruk, Commission on High Quality Health Systems) supported the open access publication of this manuscript. The funders did not play any role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.