INTRODUCTION:

A shortage of health workers is one of the main barriers to delivery of quality maternity services in Nigeria. This gap is often filled by community-based health workers who may be insufficiently trained to manage obstetric emergencies. There is great opportunity in Nigeria for mHealth strategies as mobile networks are often available in remote villages where other infrastructure is limited. The use of anmHealth decision support applications to identify and advise action for high-risk pregnancies has the potential to reduce maternal and perinatal morbidity and mortality. 

This manuscript aims to assess the ability of community-based health workers to use an mHealth platform for the triage of pre-eclampsia and eclampsia in Ogun State, Nigeria. 

METHODOLOGY:

The Community Level Interventions for Pre-eclampsia (CLIP) study was implemented by community-based health workers in Ogun State, Nigeria from March 2014 to January 2016. Health workers utilized the Pre-eclampsia Integrated Estimate of RiSk (PIERS) On the Move mHealth application to guide antenatal and postnatal visits. Health workers were trained to conduct regular visits in pregnancy and postpartum at primary health centres, identify those women at risk of adverse outcome related to pre-eclampsia, and triage high-risk cases for treatment and/or referral. Furthermore, the accuracy and completeness of visits conducted by community-based health workers was assessed. 

RESULTS/KEY FINDINGS:

One hundred and seventy community-based health workers in Nigeria used the PIERS On the Move application to successfully complete 32,785 obstetric visits. The average number of visits per pregnancy was 3.73 [SD 2.85]. Approximately one third of the study population received visits every four weeks as per the study protocol. All visits (n=32,781, 99.9%) included blood pressure measurement for the identification of the hypertensive disorders of pregnancy. Community-based health workers rarely reported blood pressure measurements out of the expected range (systolic blood pressure <70mmHg>240mmHg) (n=55, 0.2%). Proteinuria was measured by urine dipstick on the first visit in pregnancy and in all visits where hypertension was recorded (n=23,051). There was a very low rate of data entry errors (1.81%) by community-based health workers, demonstrating a high level of effectiveness.

CONCLUSION:

The use of the PIERS On the Move mobile application for clinical care by community-based health workers in Ogun State enhanced their capacity to take on new and challenging tasks, such as measuring proteinuria. It also enabled this cadre of health workers to achieve efficiencies and improvements that likely benefit the delivery of health care services. 

KEY RECOMMENDATIONS:

The findings of this study demonstrate the ability of community-based health workers in this setting to take on additional responsibilities in caring for pregnant women in their community. The use of mHealth strategies can assist in overcoming the challenges of human resource constraints while improving health indices in Nigeria.