Effect of a community health worker mHealth monitoring system on uptake of maternal and newborn health services in Rwanda

Background:In an effort to improve access to proven maternal and newborn health interventions,Rwanda implemented a mobile phone(mHealth)monitoring system called RapidSMS.RapidSMS was scaled up across Rwanda in 2013.The objective of this study was to evaluate the impact of RapidSMS on the utilization of maternal and newborn health services in Rwanda.Methods:Using data from the 2014/15 Rwanda demographic and health survey,we identified a cohort of women aged 15-49 years who had a live birth that occurred between 2010 and 2014.Using interrupted time series design,we estimated the impact of RapidSMS on uptake of maternal and newborn health services including antenatal care(ANC),health facility delivery and vaccination coverage.Results:Overall,the coverage rate at baseline for ANC(at least one visit),health facility delivery and vaccination was very high(>90%).The baseline rate was 50.30%for first ANC visit during the first trimester and 40.57%for at least four ANC visits.We found no evidence that implementing RapidSMS was associated with an immediate increase in ANC(level change:-1.00%(95%CI:-2.30 to 0.29)for ANC visit at least once,-1.69%(95%CI:-9.94 to 6.55)for ANC(at least 4 visits),-3.80%(95%CI:-13.66 to 6.05)for first ANC visit during the first trimester),health facility delivery(level change:-1.79,95%CI:-6.16 to 2.58),and vaccination coverage(level change:0.58%(95%CI:-0.38 to 1.55)for BCG,-0.75%(95%CI:-6.18 to 4.67)for polio 0).Moreover,there was no significant trend change across the outcomes studied.Conclusion:Based on survey data,the implementation of RapidSMS did not appear to increase uptake of the maternal and newborn health services we studied in Rwanda.In most instances,this was because the existing level of the indicators we studied was very high(ceiling effect),leaving little room for potential improvement.RapidSMS may work in contexts where improvement remains to be made,but not for indicators that are already very high.As such,further research is required to understand why RapidSMS had no impact on indicators where there was enough room for improvement.

Effects of scaling up various communitylevel interventions on child mortality in Burundi,Kenya,Rwanda,Uganda and Tanzania:a modeling study

Background:Improving child health remains one of the most significant health challenges in sub-Saharan Africa,a region that accounts for half of the global burden of under-five mortality despite having approximately 13%of the world population and 25%of births globally.Improving access to evidence-based community-level interventions has increasingly been advocated to contribute to reducing child mortality and,thus,help low-and middle-income countries(LMICs)achieve the child health related Sustainable Development Goal(SDG)target.Nevertheless,the coverage of community-level interventions remains suboptimal.In this study,we estimated the potential impact of scaling up various community-level interventions on child mortality in five East African Community(EAC)countries(i.e.,Burundi,Kenya,Rwanda,Uganda and the United Republic of Tanzania).Methods:We identified ten preventive and curative community-level interventions that have been reported to reduce child mortality:Breastfeeding promotion,complementary feeding,vitamin A supplementation,Zinc for treatment of diarrhea,hand washing with soap,hygienic disposal of children’s stools,oral rehydration solution(ORS),oral antibiotics for treatment of pneumonia,treatment for moderate acute malnutrition(MAM),and prevention of malaria using insecticide-treated nets and indoor residual spraying(ITN/IRS).Using the Lives Saved Tool,we modeled the impact on child mortality of scaling up these 10 interventions from baseline coverage(2016)to ideal coverage(99%)by 2030(ideal scale-up scenario)relative to business as usual(BAU)scenario(forecasted coverage based on prior coverage trends).Our outcome measures include number of child deaths prevented.Results:Compared to BAU scenario,ideal scale-up of the 10 interventions could prevent approximately 74,200(sensitivity bounds 59,068-88,611)child deaths by 2030 including 10,100(8210-11,870)deaths in Burundi,10,300(7831-12,619)deaths in Kenya,4350(3678-4958)deaths in Rwanda,20,600(16049-25,162)deaths in Uganda,and 28,900(23300-34,002)deaths in the United Republic of Tanzania.The top four interventions(oral antibiotics for pneumonia,ORS,hand washing with soap,and treatment for MAM)account for over 75.0%of all deaths prevented in each EAC country:78.4%in Burundi,76.0%in Kenya,81.8%in Rwanda,91.0%in Uganda and 88.5%in the United Republic of Tanzania.Conclusions:Scaling up interventions that can be delivered at community level by community health workers could contribute to substantial reduction of child mortality in EAC and could help the EAC region achieve child health-related SDG target.Our findings suggest that the top four community-level interventions could account for more than threequarters of all deaths prevented across EAC countries.Going forward,costs of scaling up each intervention will be estimated to guide policy decisions including health resource allocations in EAC countries.