Misago Nadine, Habonimana Desire, Ciza Roger, Ndayizeye Jean Paul, Kimaro Joyce Kevin Abalo
Health Healing Network Burundi, Santé Maternelle et Néonatale, Bujumbura, Burundi.
Centre de Recherche Universitaire en Santé (CURSA), Department of Community Medicine, Faculty of Medicine, University of Burundi, Bujumbura, 5190, Burundi.
PLOS Digit Health. 2023 Apr 17;2(4):e0000133. doi: 10.1371/journal.pdig.0000133. eCollection 2023 Apr.
In Burundi, the north-western region continues to grapple with the lowest level of antenatal care (ANC) attendance rate which is constantly about half the national average of 49% ANC4 coverage. Despite a dearth of empirical evidence to understand the determinants of this suboptimal attendance of ANC, widespread evidence informs that women forget scheduled ANC appointments. We designed and tested a digital intervention that uses a reminder model aimed at increasing the number of women who attend at least 4 ANC visits in this region. We enrolled a cohort of 132 pregnant women who were followed until childbirth using a single arm pre- and post-test design. The digital model builds on the collaboration between midwives or nurses, community health workers (CHWs), and pregnant women who are centrally connected through regular automated communications generated by the cPanel of the digital intervention. In addition to ANC attendances, we nested a cross-sectional survey to understand mothers' perceptions and acceptability of the digital intervention using the acceptability framework by Sekhon et al. (2017). Descriptive analyses were performed to observe the trend in ANC attendance and logistic regressions fitted to seize determinants affecting mothers' acceptability of the intervention. Of 132 enrolled pregnant women, 1 (0.76%) dropped out. From a baseline of 23%, nearly 73.7% of mothers attended their subsequent ANC visits after the start of the intervention. From the third month of intervention, about 80% of mothers constantly attended ANC appointments; which corresponds to greater than 200% increase from the baseline. Findings showed that 96.2% of mothers expressed satisfaction, 77.1% positively reacted to automated reminders (attitudes), 70.2% expressed willingness to participate, and 86.3% had the ability to actively participate to the intervention. Conversely, half of mothers confirmed that participation to this programme somewhat affected their time management. A key learning is that digital interventions have a lot of promise to improve pregnancy monitoring in rural settings. However, the overall user acceptability was low especially among mothers lacking personal mobile phone.
在布隆迪，西北地区的产前保健（ANC）就诊率持续处于最低水平，一直约为全国平均49%的四次产前检查（ANC4）覆盖率的一半。尽管缺乏了解这种次优ANC就诊率决定因素的实证证据，但广泛的证据表明，女性会忘记预定的ANC预约。我们设计并测试了一种数字干预措施，该措施采用提醒模式，旨在增加该地区至少进行4次ANC就诊的女性人数。我们招募了一组132名孕妇，采用单组前后测试设计对她们进行追踪直至分娩。该数字模式建立在助产士或护士、社区卫生工作者（CHW）与孕妇之间的合作基础上，他们通过数字干预的cPanel生成的定期自动通信进行集中连接。除了ANC就诊情况，我们还进行了一项横断面调查，以使用Sekhon等人（2017年）的可接受性框架了解母亲们对数字干预的看法和可接受性。进行描述性分析以观察ANC就诊趋势，并进行逻辑回归以确定影响母亲对干预可接受性的决定因素。在132名登记的孕妇中，有1名（0.76%）退出。从23%的基线水平来看，近73.7%的母亲在干预开始后参加了后续的ANC就诊。从干预的第三个月起，约80%的母亲持续参加ANC预约；这比基线水平增加了200%以上。研究结果表明，96.2%的母亲表示满意，77.1%对自动提醒有积极反应（态度），70.2%表示愿意参与，86.3%有能力积极参与干预。相反，一半的母亲确认参与该项目在一定程度上影响了她们的时间管理。一个关键的经验教训是，数字干预在改善农村地区的孕期监测方面有很大潜力。然而，总体用户可接受性较低，尤其是在缺乏个人手机的母亲中。
