Nagpur doctor’s cellphone therapy boosts mother-child health

NAGPUR: A decade ago when the cellphone was not as common as today, city-based paediatrician Dr Archana Patel had the idea of utilizing the gadget for spreading awareness about health issues. Though not deemed acceptable or practical then, the idea has helped improve the health of newborns, pregnant women and lactating mothers in villages of Central India.
Dr Patel had suggested using cellphone-based counselling to improve nutrition among children below six months of age during the ‘Innovations for Nutrition, South Asian Development Market Place’, a competition organized by the World Bank in 2009.A year later, finding the idea feasible and useful, the Bill and Melinda Gates Foundation funded Dr Patel’s research titled ‘CommCare M-SAKHI project’ and more than 500 women from the urban poor background benefited.
“As a trial, we started working with women (pregnant and post-delivery) and infants of low socio-economic strata with poor nutrition, residing in slums and attending government and trust hospitals. We had regular SMSes and phone calls through which their health was monitored from the sixth month of pregnancy to six months after birth,” said Dr Patel, the principal investigator of the study.
Having seen positive outcomes from the intervention, the project was extended to several primary health centres with the aim of empowering rural women.
Th co-principal investigator Dr Leena Dhande stated that since cellphone was shared among family members, it helped sensitize all of them about advantages of exclusive breast feeding (EBF). “Most of the changes in behaviour continued for the entire duration of the study among the people undergoing counselling. The improvement we saw after the project was implemented could also be attributed to the improved family support which is particularly relevant in India as the mother-in-law or mother makes most decisions for a pregnant woman,” she said.
The team consisted of the Accredited Social Health Activists (ASHAs) who were in direct contact with the subjects, whose work was being monitored by a team from Lata Medical Research Foundation (LMRF) run by Dr Patel. They came across some faulty traditional beliefs like the infant needs water during hot weather which were overcome through counselling.
Nursing mothers also sought advice on health issues other than lactation problems from the counsellors. In several cases, the counsellors could help in providing timely intervention to avert emergencies and reduce unnecessary hospital visits, with much lower rates of infant hospitalization within 24 hrs of delivery, increased maternal attendance of scheduled hospital visits, lower rates of bottle feeding, greater infant weight, timely start of complimentary foods at 6 among other benefits.
Dr Patel believes that the project can be turned into a regular intervention mechanism through the government health care delivery systems. “Tele-operating systems can be used through basic phones for data collection, visit reminders, counselling, immunization reminders, etc. This can also help expand access to training using basic protocols of essential obstetric and neonatal care, integrated management of childhood Illness, and nutritional counselling,” she said.
BENEFITS OF BREATFEEDING FOR MOTHER AND CHILD
CommCare M-SAKHI Project
Lata Medical Research Foundation (LMRF) and Dimagi, a US-based social organization, utilized the latter’s open source app for improving maternal and child health in villages of Central India. M-SAKHI stands for Mobile Solutions Aiding Knowledge for Health Improvement. It consisted of collecting data for monitoring antenatal care, postnatal care and infant nutrition up to 6 months of birth. Accredited Social Health Activists (ASHAs) were used as the front line data collectors and counsellors. 80 pregnant and lactating women, their infants and families living in five different villages were the beneficiaries.
Breast feeding in India
56.7% children were breastfed between 6-9 months of age
Only 23% initiated breastfeeding within first hour of death
Exclusive breastfeeding can prevent up to 13% of deaths of kids below five years
Objectives
Timely initiation of breastfeeding, at one hour after birth
Exclusive breastfeeding till 6 months
Timely introduction of semi solids in diet
Reduce infant morbidity
Observations
Well accepted, found useful by entire family
Enhanced rapport and confidence with health worker
Can be scaled up in public as well as private institutions
Gives the scope of having PPP projects and CSR
Outcome and lessons
Rates of early initiation of breastfeeding rose to 37% from 24%, exclusive BF for 14 weeks after delivery went up to 96% from 71%, and was 97% rather than the normal 49% six months from birth
Bottle feeding rates were significantly lower at 1% from 12% 14 weeks after birth and 1% from 18% after six months
Common reasons reported by mothers for lack of exclusive breast feeding were – choice of the participant 19.9%, perception of insufficient secretions in 12.5% and prescription of infant food by practitioners in 12.7%
Infant illness was reported in 7.5% of cases of mothers not exclusively breastfeeding, and it was 0.8% in the other group