Uganda has one of the highest maternal mortality ratios in the world where 435 mothers are estimated to die for every 100,000 live births.1 This compares to 16 per 100,000 in developed countries highlighting a vast global disparity and a need for strengthening of the Ugandan health system. Accurate characterization of the problem is essential for developing efficient policy to address system-wide deficiencies. The maternal mortality estimates we rely on are limited by variability, periodicity, and their wide confidence intervals.2
In recent years, researchers and developers have taken an interest in mobile communication technology to improve health-related services in the developing world. A huge surge in mobile phone (mHealth) projects across sub-Saharan Africa has emerged as mobile phones are penetrating the region in ways that healthcare infrastructure has not. Since public health and healthcare practitioners strive to provide and capturte accurate information in a timely fashion, mobile phones are an obvious message delivery and data collection tool.
As part of last summer’s family planning series in the Lancet, the authors called for “infectious disease surveillance approaches” applied to maternal health. If every maternal death is reported in real-time via mobile phones then accurate, real-time, geographically stratified surveillance data could replace periodic estimates and improve data quality. Monitoring and evaluating the burden of maternal death and serious pregnancy complications is a key step in achieving Millennium Development Goal 5.
With the fast proliferation of mHealth projects across Uganda, the Ministry of Health (MoH) now recognizes significant gaps between these interventions and their outputs, evaluations, and results. To streamline and improve efficiency in this fast growing field, the MoH now requires approval before implementation of an mHealth project. Endorsement from policymakers and coordination between government, healthcare providers, researchers, and technology developers is essential to ensure interventions align with the objectives and priorities of the local stakeholders.
Investigators at the University of Wisconsin School of Medicine and Public Health and Mbarara University of Science and Technology are designing a pilot study to initiate a maternal health surveillance system in rural Uganda using mobile phones that connects output data with local decision makers. Here are a few words on the proposal from Ajay Sethi, PhD at the Wisconsin Global Heath Institute’s 2013 symposium.
- World Health Organization: Maternal Mortality Fact Sheet May 2012. http://www.who.int/mediacentre/factsheets/fs348/en/index.html accessed July 20, 2012.
- Gilmore K, Gebreyesus TA. What will it take to eliminate preventable maternal deaths? Lancet July 10, 2012, Vol 380.