TABLE OF CONTENTS
2. MAIN BODY
2.1. BACKGROUND OF STUDY
2.2. PROBLEM STATEMENT
2.3. RAPID SMS DATA FLOW
The Rwandan CHWs are an important component of health services; they are strength of the health system and avoid the population to take long walks to the nearest health centers.
The CHWs are used in preventing of maternal infant deaths by using the rapid SMS. The study focused on the roles of cellular phone “Rapid SMS” used by CHWs in reducing maternal and infant mortality in Rwanda and if the reduction of maternal and infant mortality is due to the cellular phones “SMS” used by CHWs in Rwanda. As methodology we used analytical, synthetic, statistical, comparative and historical methods. As techniques, the interview, questionnaire and documentation techniques were used.
The results of this study showed that the cellular phone SMS used by CHWs have a significant role in maternal and infant mortality reduction where CHWs involving in the maternal and infant mortality reduction. The results showed that there is a significate reduction of home deliveries which caused maternal complicated including death. There is also reduction of maternal and infant mortality rate due to intervention of Rapid SMS used by CHWs. This is a comparison between the period before and after rapid SMS intervention.
The Rwandan CHWs are an important component of health services; they are strength of the health system and avoid the population to take long walks to the nearest health centers. The CHWs are used in preventing of maternal infant deaths by using the rapid SMS.
2. MAIN BODY
In order to give readers a good understanding of the Rapid SMS intervention used by CHWs, in this section, the researcher make a clearance some theories on maternal and infant mortality, community health workers. The researcher presented the background of the study, problem statement, rapid SMS data flow methodology used and findings
2.1. BACKGROUND OF STUDY
Maternal health is a complex challenge with cultural, medical, and logistical dimensions (WHO, 2007). USAID notes that “Maternal conditions are the largest contributor to the global disease burden of women of reproductive age,” and it is widely understood that factors connected pregnancy and childbirth are leading causes of death in adolescent girls in the poorest countries of the world. It is estimated that about 1,000 women die from pregnancy and childbirth-related conditions each day. These deaths arise from complications directly related to childbirth, as well as the impact of co-morbid conditions, such as HIV/AIDS, tuberculosis, and malaria, and indirect cultural, religious, or logistical factors that create barriers to care (Henry, 2011).
Infant mortality is a particularly useful measure of health status because it both indicates current health status of the population and predicts the health of the next generation (NCHS, 2001). Infant mortality in the U.S. is defined as the death of an infant from time of live birth to the age of 1 year. It does not include still births. Overall infant mortality is composed of neonatal (less than 28 days after birth) and post-neonatal (28 days to 11 months after birth) deaths (WHO, 2002).
Since maternal and infant mortality emerged as a major issue of concern in the international community three decades ago, attempts to combat it have been uneven, insufficient, and significantly hampered by the HIV/AIDS epidemic (among other complicating factors). Through MDG Target 5, the international community committed itself to reducing maternal mortality by three quarters between 1990 and 2015 (WHO, 2003).
In Rwanda, before the Rapid SMS system being implemented, women and children resident and living in different remote areas of Rwanda could not easily access health care facilities. Patients were often carried long distances to health facilities on stretchers and most pregnant women preferred to deliver at home or occasionally delivered on the way to the health center. Now health centers are aware of the number of pregnant women in their community, community health workers can easily communicate with health centers during emergencies, and patients urgently needing care can receive ambulance transportation to health facilities (Candida, 2012).
2.2. PROBLEM STATEMENT
Health indicators, maternal mortality is by far the one that shows the most extreme global disparities. In their report, more than 20 times higher in developing countries than in developed countries, 440 against 20 deaths per 100,000 live births, with an estimated 99% of deaths occurring in developing countries (Kahlo and Guillaume, 2004).
To facilitate the identification of maternal deaths in situations where the cause of death is not correctly attributed, a new category was created in the classification of diseases (10th edition): death associated with pregnancy, is defining as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause (Curtin, 2003).
The World Health Organization (WHO) stresses the need to focus more on the most vulnerable children; the newborns. Many conditions resulting in newborn deaths can either be prevented or treated using low-cost interventions. There is the need for a combined approach to the mother and her baby during pregnancy, to have someone with knowledge and the skills with her during child birth and effective care for both mother and baby after birth (Brundtland, 2002).
In general, the maternal mortality rate remains higher than 100 per 100,000 live in the majority of births in developing countries, with, in most industrialized countries, less than 50 deaths per 100,000 live births rate, as is the case of Scandinavia, the United States, Hong Kong, Singapore, etc.., where the rate is well below 10 deaths per 100,000 live births (Van, 2001).
Every minute a woman dies during labor or delivery. The highest maternal mortality rates are in Africa, with a lifetime risk of 1 in 16; the lowest rates are in Western nations (1:2800), with a global ratio of 400 maternal deaths per 100,000 live births. The main causes of death are postpartum haemorrhage (24%); indirect causes such as anaemia, malaria, and heart disease (20%); infection (15%); unsafe abortion (13%); eclampsia (12%); obstructed labour (8%); and ectopic pregnancy, embolism, and anaesthesia complications (8%). Forty-five percent of postpartum deaths occur within the first 24 hours and 66% occur during the first week. Of the estimated 211 million pregnancies, 46 million result in induced abortions. Sixty percent of these abortions are unsafe and cause 68,000 deaths annually (Jennifer, 2009).
In Mali at present, the developing world bears the brunt of maternal deaths; of the estimated 358,000 maternal deaths in 2008, 99% took place in developing countries (WHO, 2010). Nearly sixty percent of maternal deaths occur in sub-Saharan Africa. Mali has one of the worst maternal mortality ratios in the world 830 maternal deaths/100,000 live births in 2008. A Malian woman’s lifetime risk of dying in childbirth is 1 in 22. Although Mali is characterized as “making progress” towards the Millennium Development Goal 5 to decrease maternal deaths by 75% from 1990 to 2015, it is not yet on track to achieve its 2015 target MMR of 300 (World Bank, 2011).
In Rwanda many mothers and infants die during childbirth or in the first week following child delivery. The infant mortality rate is estimated at 28% of the total infant mortality rate who die before reaching the age of 5 years. In order to attain the Millennium Development Goals, Rwanda is doing whatever is in its power to elaborate specific programs as well as to acquire necessary equipment and tools to improve maternal and child health care at health centers within the first 28 days following child delivery (MOH report 2011).
The cellular phone “SMS” used by CHWs was designed to provide an SMS-based platform, enabling effective and real-time two-way communication for action, between CHWs at community level, and the rest of the health system (ambulance, health facility staff and district hospital and central level) through mobile phones. The primary expected result of the system is an improved access to antenatal, postnatal care, institutional delivery, and emergency obstetric care for maternal and infant mortality reduction (MOH Report 2011).
It was necessary to take measures to deal with health challenges the maternal and infant mortality. Several approaches are possible, such as the introduction of the policy of using cellular phone by CHWs was taken as a strategic option to meet the objectives of reducing the maternal and infant mortality as has suggested in the MDG. However, it seems that where the policy of Rapid SMS was implemented and well managed, it can improve and monitor the state of health of children and mothers (MOH Report 2012).
The study aims to evaluate impact of cellular phone used by CHWs to reduce maternal and infant mortality in Rwanda. A case study of Rwamagana District Hospital 2015-2020.
2.3. RAPID SMS DATA FLOW
The following figure shows the flow of SMS send by CHWs.
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Figure 1: Rapid SMS data Flow
The study is used an analytical method and concentrated on Rapid SMS used by CHWs to reduce maternal and infant mortality in Rwanda. The questionnaires and interviews were used to gather information from community health workers, health officers and documentation technic was used to consult the trend of maternal and infant mortality rates.
The study adopted a descriptive design and scientific methods and techniques have been used and facilitated the researcher to find the study results through the procedures used for the collection, analysis of data and interpretation. By the random sampling technique, the simple size was 7 health Centers in 14 Rwamagana DH, The study adopted a descriptive design and scientific methods and techniques have been used, and facilitated the researcher to find the study results through the procedures used for the collection, analysis of data and interpretation. By the random sampling technique, the simple size was 7 health extracted randomly from 14 health centers located in Rwamagana DH. 7 Health centers had 576 community health workers who use cellular phone SMS in order to prevent maternal and infant mortality in the area of working. A total population health worker was 288 extracted from 576 community health workers and with the systematic sampling procedures by taking ½ of them. The data were collection through questionnaires and the process of data gathering carried out from October 2020 to January 2011. The data were and analyzed with SPSS v20, descriptive statistics, correlation analysis were used.
The main findings are from data collected from three main sources including community health workers sampled, the monthly reports and interview with in charge of community health supervisors. The findings of the study revealed that questions asked at the beginning of the study were answered and the objectives were achieved.
The cellular phones “SMS” used by CHWs playing an important role in reducing maternal and infant mortality in Rwanda at 97% by completing different approaches established by Ministry of Health. The among approaches are identifying and registering all women in reproductive age and pregnant women for following up, the community case management (child treatment) at community level, malnutrition screening, antenatal care follow up, home visit for pregnancies, promotes health behaviors, accompanies women in labor to health facility and nutrition surveillance.
The maternal and infant mortality rate was reduced after introduction the approaches of cellular phone SMS used by community health workers.