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

Journal article
Authors I. Al-Shammari
L. Roa
R. R. Yorlets
C. Akerman
A. Dekker
T. Kelley
R. Koech
J. Mutuku
R. Nyarango
D. Nzorubara
N. Spieker
M. Vaidya
J. G. Meara
David Ljungman
Published in PLoS ONE
Volume 14
Issue 10
ISSN 1932-6203
Publication year 2019
Published at Institute of Clinical Sciences, Department of Surgery
Language en
Keywords adult, Article, breast feeding, childbirth, cohort analysis, controlled study, dyspareunia, feasibility study, feces incontinence, female, follow up, hospital mortality, human, information processing, Kenya, major clinical study, mental health, morbidity, obstetric delivery, patient referral, patient satisfaction, patient-reported outcome, pilot study, postnatal care, prenatal care, prospective study, puerperium, third trimester pregnancy, urine incontinence
Subject categories Obstetrics and gynaecology, Public health science


Background Limited data exist on health outcomes during pregnancy and childbirth in low- and middleincome 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. Methods 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. Results 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%). Conclusion 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. © 2019 Al-Shammari et al.

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