(1/7/2015) Update: Consolidated refinement Q&A pdf
(1/7/2015) Update: User experience map for mother and family members
(1/6/2015) Update: Consolidated refinement Q&A pdf
(1/5/2015) Update: Interview transcript containing notes and feedback from the various stakeholders in the ecosystem.
(12/19/2014) Update: Video on pilot of Maitri newborn care kit in Govt. District hospital, Bangalore, Karnataka
(12/17/2014) Update: User experience map for healthcare provider
How will Maitri + mobile messaging work?
The newborn kit will be made available at healthcare institutions to be used by healthcare providers immediately after birth to prevent neonatal mortality. The hygiene care components (disposable baby wiping cloth, cotton and gauze, receiving blanket, and chlorhexidine) will ensure infection prevention. The mucus extractor will prevent asphyxia. The thermal care components (dress, cap, and blanket with hood) will prevent temperature loss and subsequent hypothermia. A breastfeeding guide can be used as a reference by both the healthcare provider and the mother to understand and convey ideal practices in breastfeeding. [Updated 12/19/14] We interviewed (transcript uploaded) stakeholders (mothers/soon to be mothers, Doctors (OBGYN) and nurses across three hospitals in Karnataka (Vani Vilas Govt. District hospital, St. Johns Medical college hospital, St. Philomena's hospital). After reflecting on their feedback, we found the need to be more inclusive and make provision for safe and clean birth besides essential newborn care for the first 48 hours in the same ecosystem. Clean birth ensures higher impact on neonatal health, specifically by reducing avenues for infections to occur. Studies have shown that 36% of infant mortality, that is caused due to infection can be reduced through easy measures of hygiene maintenance during birth.
A newborn care kit cannot be a standalone solution for essential newborn care without the provisions for safe and hygienic birth. Many institutions lack the infrastructure and trained medical professionals to handle increased volume of births. As a result, unsanitary birthing conditions persist even in hospital settings and infection rates remain high; both are leading causes of maternal and infant mortality.Hence, we would like to consider the clean birth kit (JANMA) an an inclusive component of the newborn care kit (Maitri). The components for clean birth include:
2. Surgical scalpel blade (Gamma
3. Cord clamp (ETO sterile)
4. Sterile gloves
5. Bar of soap
6. Instruction sheet for usage
The above kit will be an inclusive solution that will ensure safe and hygenic birth and adequate essential newborn care, in order to ensure reduction in the high neonatal and maternal mortality rates.
2) MOBILE MESSAGING
ayzh is in the process of developing a mobile training program that will empower health care providers and mothers with information that is accessible and actionable, making adherence to best practices in newborn care feasible in the communities in which they work. Healthcare providers facilitating essential newborn care become the most effective agent of change. The messages tailored towards health care providers will contain information about processes that need to be followed during newborn care; information that the providers know but may forget in the accelerated pace of life in the health care facilities.
The messages will be made accessible to:
(1) Healthcare providers, as a reinforcement and training tool that is accessible during critical time before delivery, or for counseling mothers on best practices. [Updated 12/17/14] Within this segment there are many different groups of providers whom we could target: Village Health Workers, Auxillary Nurse Midwives, ASHA workers, Nurses, Doctors, etc. Through continued interviews and research, we will identify which group(s) would benefit the most from this mobile messenging program. To do this, we will need to understand more about where women currently get their health information, who they trust for health information, which groups of providers have the most contact with these women before, during and after birth, etc.
ayzh recently completed a pilot for the mobile messaging program in which we recruited 400 health care providers and trained them on the 'six cleans' (BOX III.3.8) by sending them pre-recorded voice messages at a time and interval of their choosing. This provides a great starting point for a newborn care curriculum, or other modules we detect a need for in the future.
(2) Mothers, to be able to access information of essential newborn care at home.
[Updated 12/17/14] After an interview with the Vice Prinicple of MMM College of Nursing in Chennai (a community health nurse herself), we think it would be best to reach out to women even in the early stages of prenancy, at her suggestion. This way we can reach them when they come for prenatal care (which many do, because it is required to receive the government incentive scheme, Janani Suraksha Yojana) and get them registered for the mobile messenging program. If the information is delivered beginning in the prenatal stage, the mother will be able to have a healthier pregnancy, and be more adequately prepared for delivery and post-natal care, she says.
[Update 12/17/14] In the past few weeks, we have received a wealth of information from doctors and nurses (including the aforementioned Vice Principle) about the gaps in education for mothers on post-natal care (for themselves and the newborn). We are learning more about the realities of postnatal care (by asking mothers if the community health workers actually visit their home, as they are supposed to), and the most common complaints and health complications among mothers and newborns during postnatal visits. As a next step, we are in talks with some experts in the field who have taken an interest in our program, about being our partners for curriculum development.
[update 12/29/14] After consolidating information from dozens of interviews with health care providers over the past year, we have identified gaps in knowledge among mothers in regards to newborn care. Based on their insight, it is clear that simple but fundamental information should be delivered to mothers in resource poor areas in order to initiate or change current newborn care behaviors. Some recurring themes from these interviews are helping us shape our initial plans for a curriculum. Repeatedly, health care providers comment on cleanliness and washing, breastfeeding, and thermal care, as crucial areas for education to mothers (which will supplement our kit well). A call to action from a doctor at St. Johns medical college in Bangalore: “Basic newborn care lies in simple practices like hand washing that mothers and immediate family members fail to practice.”
More specifically, a doctor working in a government hospital in Bangalore states “simple cleanliness practices are not observed. Scenarios like hand washing before handling the baby, transferring the baby between many people, and before and during breastfeeding.” He continues on to discuss methods for washing a newborns umbilical cord, eyes, and bottom to prevent rashes from diapers and infection. He also warns against the use of coconut oil to treat rashes, aid in temperature regulation, or for use on the umbilical cord. Most of the other doctors we interviewed made related comments on hygiene and breastfeeding. We will continue to collect information in this fashion and use it to develop the mobile voice-messaging curriculum.
Other doctors in Bangalore commented on the importance of kangaroo care, stating the mother need to be aware of the advantages and best practices in order to promote behavior change.
[update 1/6/2015] The information sent through the mobile voice messaging program can also be used to dispell myths about breastfeeding, which are common and potentially harmful to both mothers and their newborns. After some experience attending babies in a NICU, a nursing students tells us: "there are so many myths around breastfeeding: Mothers don't want to do it if the baby is sleeping, and they think if they feed often they won't be able to produce enough milk, etc." This comment echos that of the aforementioned Vice Prinicple who was adament about the importance of giving mothers information on proper breastfeeding and breast care to encourage positive behavior change.
One doctor at St. Philomena’s Hospital in Bangalore demonstrating the need for mothers to receive a mobile messaging program: “Lack of awareness: education and literacy are not necessarily a reason for lack of awareness. Even literate parents do not know about basic babycare measures. The doctor to patient ratio is so skewed and the process is broken. The parents depend on us to tell them everything. The mid level nurses do not have proper training for imparting the knowhow.” Furthermore, a doctor at Vani Villas states: “a newborn care kit’s aim should be towards preventative care and awareness.” This is our aim and we will continue to seek feedback to create the best intevention possible.
Due to the high penetration of mobile phones among our target users, and their familiarity with voice messaging services, ayzh can leverage the already existing ecosystem to provide information/ education, which will be essential for the required behavior change towards proper adherence to newborn care practices. [update 1/6/2015] As we interview more stakeholders, we find that new mothers rely very heavily on their own mothers as a reliable source of health information for a variety of reasons. Unfortunately this often perpetuates the cycle of myths and harmful traditions passed down through generations, which will continue as long as mothers are left in the dark, and left to their own devices to seek health information. We belive that the mobile voice messaging program is a very appropriate program to fill in this gap/ address this issue by providing new mothers with a private, individualized source of information on essential postnatal care for themselves and their newborn.
[Update 12/17/14] Although SMS messages have been suggested to us, we decided on voice messages so that the program can lend itself to illiterate women as well. This was confirmed during an interview we had this week with a women's group in rural Tamil Nadu, who told us that they do not know how to use SMS messaging, and would not prefer that method of communication. And, to address a comment below, we do plan to provide a call back number at the end of each message, which the mother can call if she needs clarification or additional counseling on any of the topics covered in the voice message.
We also envision the mobile messaging as a tool for advocacy around newborn health care. For example, In India, heath care institutions recommend dry umbilical cord care. Often cultural norms in India encourage people to use substances like oil/mud/cow dung/ etc. exposing the newborn to life threatening infections. Chlorhexidine is a component used widely in Nepal, Pakistan, Bangladesh, and Myanmar, and has successfully reduced mortality rates due to infection in these areas. We are trying to encourage the adoption of the same in India by looking for avenues to work with the Government at policy level to encourage primary care givers to adopt usage of Chlorhexidine. Meanwhile we will continue to study current practices to identify gaps where the training program can facilitate the required behavior change from the stakeholders in the community.
How Maitri + mobile messaging works & why it will succeed:
We have found an imminent need for basic necessities required to ensure clean, safe and comfortable experience in childbirth. Health care providers (nurses, nursing students, midwives, health workers in communities) face significant challenges in delivering adequate neonatal health care: our idea, providing Maitri and associated mobile messaging education, will address these barriers to proper care while promoting positive behavior change among health care providers and mothers.
We are in the process of obtaining extensive stakeholder feedback to refine the product and develop a final prototype. We have distributed 100 kits to health care institutions in various geographic locations and are gathering their feedback to ensure high acceptance and adoption of the kit. The kit was recently accepted as a commitment to the United Nation’s Every Newborn Action Plan, who recognizes it as a “high-impact commodity that can improve newborn health and survival” (p. 17).