An mHealth monitoring system for traditional birth attendant-led antenatal risk assessment in rural Guatemala

• Published in: Journal of medical engineering & technology 2016-11, Vol.40 (7-8), p.356-371
• Main Authors: Stroux, Lisa, Martinez, Boris, Coyote Ixen, Enma, King, Nora, Hall-Clifford, Rachel, Rohloff, Peter, Clifford, Gari D.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Feasibility Studies; Female; Fetal Monitoring; Fetus - physiology; Guatemala; Heart Sounds; Humans; Intrauterine growth restriction; Maternal Health Services; mHealth; Midwifery; perinatal monitoring; Pregnancy; resource constrained healthcare; Risk Assessment; Rural Population; Young Adult
• ISSN: 0309-1902; 1464-522X
• DOI: 10.1080/03091902.2016.1223196

Limited funding for medical technology, low levels of education and poor infrastructure for delivering and maintaining technology severely limit medical decision support in low- and middle-income countries. Perinatal and maternal mortality is of particular concern with millions dying every year from potentially treatable conditions. Guatemala has one of the worst maternal mortality ratios, the highest incidence of intra-uterine growth restriction (IUGR), and one of the lowest gross national incomes per capita within Latin America. To address the lack of decision support in rural Guatemala, a smartphone-based system is proposed including peripheral sensors, such as a handheld Doppler for the identification of foetal compromise. Designed for use by illiterate birth attendants, the system uses pictograms, audio guidance, local and cloud processing, SMS alerts and voice calling. The initial prototype was evaluated on 22 women in highland Guatemala. Results were fed back into the refinement of the system, currently undergoing RCT evaluation.