Wuqu' Kawoq | Maya Health Alliance, 2a. Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala.
Department of Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA.
Reprod Health. 2018 Jul 4;15(1):120. doi: 10.1186/s12978-018-0554-z.
BACKGROUND/OBJECTIVE: Guatemala's indigenous Maya population has one of the highest perinatal and maternal mortality rates in Latin America. In this population most births are delivered at home by traditional birth attendants (TBAs), who have limited support and linkages to public hospitals. The goal of this study was to characterize the detection of maternal and perinatal complications and rates of facility-level referral by TBAs, and to evaluate the impact of a mHealth decision support system on these rates.
A pragmatic one-year feasibility trial of an mHealth decisions support system was conducted in rural Maya communities in collaboration with TBAs. TBAs were individually randomized in an unblinded fashion to either early-access or later-access to the mHealth system. TBAs in the early-access arm used the mHealth system throughout the study. TBAs in the later-access arm provided usual care until crossing over uni-directionally to the mHealth system at the study midpoint. The primary study outcome was the monthly rate of referral to facility-level care, adjusted for birth volume.
Forty-four TBAs were randomized, 23 to the early-access arm and 21 to the later-access arm. Outcomes were analyzed for 799 pregnancies (early-access 425, later-access 374). Monthly referral rates to facility-level care were significantly higher among the early-access arm (median 33 referrals per 100 births, IQR 22-58) compared to the later-access arm (median 20 per 100, IQR 0-30) (p = 0.03). At the study midpoint, the later-access arm began using the mHealth platform and its referral rates increased (median 34 referrals per 100 births, IQR 5-50) with no significant difference from the early-access arm (p = 0.58). Rates of complications were similar in both arms, except for hypertensive disorders of pregnancy, which were significantly higher among TBAs in the early-access arm (RR 3.3, 95% CI 1.10-9.86).
Referral rates were higher when TBAs had access to the mHealth platform. The introduction of mHealth supportive technologies for TBAs is feasible and can improve detection of complications and timely referral to facility-care within challenging healthcare delivery contexts.
Clinicaltrials.gov NCT02348840 .
背景/目的：危地马拉的土著玛雅人口是拉丁美洲围产期和孕产妇死亡率最高的人群之一。在该人群中，大多数分娩是由传统的接生员（TBA）在家里进行的，他们获得的支持和与公立医院的联系有限。本研究的目的是描述 TBA 对产妇和围产期并发症的发现以及向医疗机构转诊的比率，并评估移动健康决策支持系统对这些比率的影响。
与 TBA 合作，在农村玛雅社区开展了一项关于移动健康决策支持系统的实用一年可行性试验。TBA 以非盲法随机分为早期接入或后期接入移动健康系统。早期接入组的 TBA 在整个研究期间使用移动健康系统。后期接入组的 TBA 在研究中点之前单向交叉到移动健康系统之前，提供常规护理。主要研究结果是调整分娩量后，每月向医疗机构转诊的比率。
44 名 TBA 被随机分配，23 名进入早期接入组，21 名进入后期接入组。对 799 例妊娠进行了结果分析（早期接入组 425 例，后期接入组 374 例）。早期接入组每月向医疗机构转诊的比率明显较高（中位数 33 例/100 例分娩，IQR22-58），而后期接入组中位数为 20 例/100 例分娩（IQR0-30）（p=0.03）。在研究中点，后期接入组开始使用移动健康平台，其转诊率增加（中位数 34 例/100 例分娩，IQR5-50），与早期接入组无显著差异（p=0.58）。两个组的并发症发生率相似，除了妊娠高血压疾病，在早期接入组中明显更高（RR3.3，95%CI1.10-9.86）。
当 TBA 可以使用移动健康平台时，转诊率更高。在具有挑战性的医疗保健提供环境中，为 TBA 引入移动健康支持技术是可行的，可以提高对并发症的发现并及时转诊到医疗机构护理。
Clinicaltrials.govNCT02348840。
