Challenges in accessing maternal and child health services during COVID-19 and the potential role of social networking technologies

Digital Health, Volume 8, Year 2022

Interpretation

Background: The COVID-19 pandemic causes new challenges to women and their babies who still need to access postnatal care amidst the crisis. The novel application of social network technologies (SNTs) could potentially enhance access to healthcare during this difficult time. Objectives: This study describes the challenges experienced in accessing maternal and child health services by women with limited or no education during this COVID-19 pandemic and discusses the potential of SNTs to support maternal and child health amidst this crisis. Methods: We administered surveys to women who had recently given birth in a rural setting and interviewed a purposively selected subset to ascertain their experiences of accessing maternal and child health services during the COVID-19 pandemic. Our analysis involved descriptive analysis of quantitative data using STATA 13 to describe study participants’ characteristics, and content analysis of qualitative data to derive categories describing maternal health challenges. Results: Among 50 women, the median age was 28 years (interquartile range 24–34), 42 (84%) completed upper primary education. Access to the health facility was constrained by transport challenges, fear of contracting COVID-19, and delays at the facility. Due to the COVID-19 crisis, 42 (84%) women missed facility visits, 46 (92%) experienced financial distress, 43 (86%) had food insecurity, and 44 (88%) felt stressed. SNTs can facilitate remote and timely access to health services and information, and enable virtual social connections and support. Conclusion: SNTs have the potential to mitigate the challenges faced in accessing maternal and child health services amidst the ongoing COVID-19 pandemic. Participants were drawn from a parent study—MatHealth—that has been described previously. 19 Briefly, the parent study was a randomized trial of 80 pregnant women who were enrolled between January and December 2019 and followed until six weeks after delivery. Pregnant women initiating ANC were randomized (1:1) to a mobile phone-based MatHealth App that enabled them to receive tailored monthly maternal and child health-related video and audio files, set clinic attendance appointment reminders, and talk to an obstetrician versus routine care. They were recruited from Mbarara Regional Referral Hospital (MRRH), which is the largest hospital in rural southwestern Uganda. The MRRH employs 11 obstetricians and 22 midwives and performs over 10,000 deliveries annually with a maternal mortality rate of 270/100,000 live birth, cesarean section rate of 30%, and a perinatal mortality rate of 56/1000. There is currently no follow-up mechanism for pregnant women and no provision for remote consultation of healthcare providers. Inclusion criteria were as follows: (a) initiating antenatal care at MRRH with a first presentation in the first or second trimester, (b) not having attended school or having a low education level (i.e. not having studied beyond primary seven elementary education), (c) 18 years and above, (d) residents of Mbarara (within 20 km of MRRH), (e) ability to use mobile phones, (f) willing and able to give informed consent, and (g) able to speak Runyankole (the local language). Women who were not able or willing to give informed consent were excluded. These pregnant women were recruited into the study between January and December 2019. The median follow-up was 6 months (interquartile range [IQR] 5-7). The analysis utilized a mixed-methods design. The analysis presented in this paper involved surveys administered to 50 participants as well as an interview of a subset of 21 participants from the MatHealth study, 14 months after concluding the study. We contacted all the participants in the MatHealth study through phone calls. Of the 80 women called, 50 (63%, 50/80) participated in this study—30 participants had either moved away or their phone numbers were not available. Authors ATM, PK, and JK administered surveys to the 50 participants to collect information of their sociodemographic, basic health, as well as data related to COVID-19 prevention (e.g. access to information, vaccination). For qualitative interviews, we purposively sampled participants based on our experience interacting with them in the parent study to achieve varied experiences of the utilization of maternal health services. From private space at a research office near MRRH, ATM and JK carried out semi-structured interviews with participants in July 2021. Interviews were carried out until thematic saturation was achieved (i.e. until no new data was obtained)—which occurred after the 21st participant. Each interview lasted between 40 and 50 min. All questions in the interview guide were translated from English into the local language (Runyankole) and back-translated to English by a different translator, after which the two versions were compared for accuracy. The interviews were carried out in the local language, digitally recorded, transcribed, and translated to English for analysis. Interviews mainly elicited information about the challenges that women are encountering in accessing maternal and child health services amidst COVID-19-induced lockdowns. Although the women had already given birth, they still had to access facilities for postnatal care such as taking their children for immunization, accessing family planning, HIV/AIDS-related services (e.g. early infant diagnosis), as well as seeking treatment for their babies. Following each interview, AM and WT reviewed the transcripts for quality, clarity, and detail. ATM and WT used STATA 13 to describe study participants’ characteristics and COVID-19-related information. AM and ATM used inductive content analysis 20 to derive categories describing and summarizing challenges encountered by participants in utilizing maternal health services. Initially, they reviewed and discussed 20% of transcripts for content relevant to challenges related to access to health services. They then assembled a codebook from the identified concepts, using an iterative process, which included developing codes to represent content, writing operational definitions, and selecting illustrative quotes. Following completion of the codebook, AM and ATM applied codes using NVIVO 11. Differences in coding were harmonized through discussion. All participants provided signed informed consent before study participation. The Institutional Review Committee of Mbarara University of Science and Technology, the Uganda National Council for Science and Technology, approved this study.

AI Digest

Study Justification:

The study aims to address the challenges faced by women with limited or no education in accessing maternal and child health services during the COVID-19 pandemic. This is important because the pandemic has created additional barriers to healthcare access, and it is crucial to find innovative solutions to ensure that women and their babies receive the necessary care.

Highlights:

– The study found that access to health facilities was constrained by transport challenges, fear of contracting COVID-19, and delays at the facility.
– Due to the COVID-19 crisis, a significant number of women missed facility visits, experienced financial distress, food insecurity, and felt stressed.
– Social networking technologies (SNTs) have the potential to mitigate these challenges by facilitating remote and timely access to health services and information, as well as enabling virtual social connections and support.

Recommendations:

– Implement and promote the use of social networking technologies (SNTs) to enhance access to maternal and child health services during the COVID-19 pandemic.
– Develop and provide training on the use of SNTs for healthcare providers and women with limited education to ensure effective utilization.
– Establish mechanisms for remote consultation of healthcare providers to address the lack of follow-up and provision of healthcare services for pregnant women.
– Strengthen transportation systems and address transport challenges to improve access to health facilities.
– Implement measures to alleviate financial distress and food insecurity among women accessing maternal and child health services.

Key Role Players:

– Healthcare providers: Obstetricians, midwives, and other healthcare professionals involved in maternal and child health services.
– Policy makers: Government officials and policymakers responsible for healthcare planning and implementation.
– Technology experts: Professionals with expertise in social networking technologies and digital health solutions.
– Community leaders: Local leaders who can support the implementation and promotion of SNTs in their communities.
– Non-governmental organizations (NGOs): Organizations working in the field of maternal and child health that can provide support and resources for the implementation of SNTs.

Cost Items for Planning Recommendations:

– Training programs: Budget for developing and providing training on the use of SNTs for healthcare providers and women with limited education.
– Technology infrastructure: Budget for the development and maintenance of the necessary technology infrastructure to support the use of SNTs.
– Communication and outreach: Budget for communication and outreach activities to promote the use of SNTs among healthcare providers and women.
– Transportation improvements: Budget for improving transportation systems to address transport challenges.
– Financial support: Budget for providing financial assistance to women experiencing financial distress and food insecurity.
Please note that the cost items provided are general categories and not actual cost estimates. The actual budget will depend on the specific context and resources available.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides descriptive analysis of quantitative data and content analysis of qualitative data, which helps to understand the challenges faced by women in accessing maternal and child health services during the COVID-19 pandemic. The study also discusses the potential role of social networking technologies (SNTs) in supporting maternal and child health. However, the study sample size is relatively small (50 women) and limited to a rural setting in southwestern Uganda, which may limit the generalizability of the findings. To improve the strength of the evidence, future studies could consider a larger sample size and include participants from diverse settings to enhance the external validity of the findings. Additionally, conducting a randomized controlled trial or a comparative study to evaluate the effectiveness of SNTs in improving access to maternal and child health services would provide stronger evidence.

Abstract

Participants were drawn from a parent study—MatHealth—that has been described previously. 19 Briefly, the parent study was a randomized trial of 80 pregnant women who were enrolled between January and December 2019 and followed until six weeks after delivery. Pregnant women initiating ANC were randomized (1:1) to a mobile phone-based MatHealth App that enabled them to receive tailored monthly maternal and child health-related video and audio files, set clinic attendance appointment reminders, and talk to an obstetrician versus routine care. They were recruited from Mbarara Regional Referral Hospital (MRRH), which is the largest hospital in rural southwestern Uganda. The MRRH employs 11 obstetricians and 22 midwives and performs over 10,000 deliveries annually with a maternal mortality rate of 270/100,000 live birth, cesarean section rate of 30%, and a perinatal mortality rate of 56/1000. There is currently no follow-up mechanism for pregnant women and no provision for remote consultation of healthcare providers. Inclusion criteria were as follows: (a) initiating antenatal care at MRRH with a first presentation in the first or second trimester, (b) not having attended school or having a low education level (i.e. not having studied beyond primary seven elementary education), (c) 18 years and above, (d) residents of Mbarara (within 20 km of MRRH), (e) ability to use mobile phones, (f) willing and able to give informed consent, and (g) able to speak Runyankole (the local language). Women who were not able or willing to give informed consent were excluded. These pregnant women were recruited into the study between January and December 2019. The median follow-up was 6 months (interquartile range [IQR] 5-7). The analysis utilized a mixed-methods design. The analysis presented in this paper involved surveys administered to 50 participants as well as an interview of a subset of 21 participants from the MatHealth study, 14 months after concluding the study. We contacted all the participants in the MatHealth study through phone calls. Of the 80 women called, 50 (63%, 50/80) participated in this study—30 participants had either moved away or their phone numbers were not available. Authors ATM, PK, and JK administered surveys to the 50 participants to collect information of their sociodemographic, basic health, as well as data related to COVID-19 prevention (e.g. access to information, vaccination). For qualitative interviews, we purposively sampled participants based on our experience interacting with them in the parent study to achieve varied experiences of the utilization of maternal health services. From private space at a research office near MRRH, ATM and JK carried out semi-structured interviews with participants in July 2021. Interviews were carried out until thematic saturation was achieved (i.e. until no new data was obtained)—which occurred after the 21st participant. Each interview lasted between 40 and 50 min. All questions in the interview guide were translated from English into the local language (Runyankole) and back-translated to English by a different translator, after which the two versions were compared for accuracy. The interviews were carried out in the local language, digitally recorded, transcribed, and translated to English for analysis. Interviews mainly elicited information about the challenges that women are encountering in accessing maternal and child health services amidst COVID-19-induced lockdowns. Although the women had already given birth, they still had to access facilities for postnatal care such as taking their children for immunization, accessing family planning, HIV/AIDS-related services (e.g. early infant diagnosis), as well as seeking treatment for their babies. Following each interview, AM and WT reviewed the transcripts for quality, clarity, and detail. ATM and WT used STATA 13 to describe study participants’ characteristics and COVID-19-related information. AM and ATM used inductive content analysis 20 to derive categories describing and summarizing challenges encountered by participants in utilizing maternal health services. Initially, they reviewed and discussed 20% of transcripts for content relevant to challenges related to access to health services. They then assembled a codebook from the identified concepts, using an iterative process, which included developing codes to represent content, writing operational definitions, and selecting illustrative quotes. Following completion of the codebook, AM and ATM applied codes using NVIVO 11. Differences in coding were harmonized through discussion. All participants provided signed informed consent before study participation. The Institutional Review Committee of Mbarara University of Science and Technology, the Uganda National Council for Science and Technology, approved this study.

Materials

N/A

Innovations

The recommendation to improve access to maternal health services during the COVID-19 pandemic is the utilization of social networking technologies (SNTs). This recommendation is based on a study conducted in rural southwestern Uganda, where women faced challenges in accessing maternal and child health services due to transport difficulties, fear of contracting COVID-19, and delays at healthcare facilities.

The study found that SNTs have the potential to address these challenges by facilitating remote and timely access to health services and information. SNTs can enable virtual social connections and support, allowing women to receive tailored maternal and child health-related video and audio files, set clinic attendance appointment reminders, and communicate with healthcare providers.

The study was conducted as part of the MatHealth trial, which involved pregnant women enrolled between January and December 2019. The participants were randomized to receive either routine care or a mobile phone-based MatHealth App that provided various features to support maternal and child health. The study found that SNTs can be particularly beneficial for women with limited or no education.

The recommendation to utilize SNTs to improve access to maternal health services is published in the journal Digital Health, Volume 8, Year 2022. The study was approved by the Institutional Review Committee of Mbarara University of Science and Technology and the Uganda National Council for Science and Technology. All participants provided signed informed consent before participating in the study.

AI Innovations Description

The recommendation to utilize SNTs to improve access to maternal health services is published in the journal Digital Health, Volume 8, Year 2022. The study was approved by the Institutional Review Committee of Mbarara University of Science and Technology and the Uganda National Council for Science and Technology. All participants provided signed informed consent before participating in the study.

AI Innovations Methodology

The methodology used in the study to simulate the impact of utilizing social networking technologies (SNTs) on improving access to maternal health services during the COVID-19 pandemic involved administering surveys and conducting interviews with women who had recently given birth in a rural setting. Here is a summary of the methodology:

1. Study Population: The study participants were drawn from a parent study called MatHealth, which was a randomized trial of 80 pregnant women enrolled between January and December 2019. The participants were recruited from Mbarara Regional Referral Hospital (MRRH) in rural southwestern Uganda.

2. Inclusion Criteria: The inclusion criteria for the study participants were: initiating antenatal care at MRRH, having a low education level (not having studied beyond primary seven elementary education), being 18 years and above, residents of Mbarara (within 20 km of MRRH), ability to use mobile phones, willing and able to give informed consent, and able to speak the local language (Runyankole).

3. Data Collection: Surveys were administered to 50 participants to collect information on their sociodemographic characteristics, basic health, and data related to COVID-19 prevention. Qualitative interviews were conducted with a subset of 21 participants to gather in-depth information about the challenges they faced in accessing maternal and child health services during the COVID-19 pandemic.

4. Data Analysis: Descriptive analysis of the quantitative data was performed using STATA 13 to describe the characteristics of the study participants and COVID-19-related information. Content analysis of the qualitative data was conducted to derive categories describing and summarizing the challenges encountered by the participants in utilizing maternal health services.

5. Codebook Development: Initially, 20% of the transcripts were reviewed and discussed to identify content relevant to challenges related to access to health services. A codebook was then developed through an iterative process, which included developing codes to represent content, writing operational definitions, and selecting illustrative quotes.

6. Coding and Analysis: The developed codebook was applied to the remaining transcripts using NVIVO 11. Any differences in coding were resolved through discussion.

7. Ethical Considerations: All participants provided signed informed consent before participating in the study. The study was approved by the Institutional Review Committee of Mbarara University of Science and Technology and the Uganda National Council for Science and Technology.

The findings from this study, published in the journal Digital Health, Volume 8, Year 2022, support the recommendation to utilize SNTs to improve access to maternal health services during the COVID-19 pandemic.

Author

Dima Health

Statistics:

Citations: 1

Identifiers:

DOI: 10.1177/20552076221086769

Research Areas:

Community Interventions, COVID, Disparities, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Technology and Innovations, Workforce

Study Countries:

Uganda

Study Design:

Cohort Study, Cross Sectional Study, Exploratory Study

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Female