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

• Published in: PloS one 2019, Vol.14 (10), p.e0222978-e0222978
• Main Authors: Al-Shammari, Ishtar, Roa, Lina, Yorlets, Rachel R, Akerman, Christina, Dekker, Annelies, Kelley, Thomas, Koech, Ramona, Mutuku, Judy, Nyarango, Robert, Nzorubara, Doriane, Spieker, Nicole, Vaidya, Manasi, Meara, John G, Ljungman, David
• Format: Article
• Language: English
• Subjects: Adult; Aftercare - economics; Aftercare - organization & administration; Aftercare - statistics & numerical data; Births; Breast feeding; Cell Phone; childbirth; Childbirth & labor; Children & youth; Clinical outcomes; cohort analysis; Consortia; controlled study; Data collection; Data Collection - methods; dyspareunia; Feasibility Studies; feasibility study; feces incontinence; Female; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; follow up; Health care; Health Plan Implementation; hospital mortality; Hospitals; human; Humans; Infant, Newborn; information processing; International standardization; Kenya; Low income groups; major clinical study; Maternal & child health; Maternal mortality; Medicine and Health Sciences; Mental disorders; Mental health; Mobile Applications; Morbidity; obstetric delivery; Obstetrics; Obstetrics, Gynecology and Reproductive Medicine; Parturition; patient referral; Patient Reported Outcome Measures; Patient satisfaction; patient-reported outcome; People and Places; Perinatal Care - economics; Perinatal Care - organization & administration; Perinatal Care - statistics & numerical data; Pilot Projects; pilot study; Polls & surveys; postnatal care; Postpartum; Pregnancy; prenatal care; prospective study; Public health; Public Health, Global Health, Social Medicine and Epidemiology; puerperium; Quality; Quality Indicators, Health Care - standards; Reproduktionsmedicin och gynekologi; Research and Analysis Methods; Social change; Social Sciences; Surgery; Technology; Telemedicine - economics; Telemedicine - organization & administration; Telemedicine - statistics & numerical data; Text messaging; third trimester pregnancy; Urinary incontinence; urine incontinence; Womens health; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0222978

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. 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. 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%). 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.