Co-authors:
Bernice Dahn, MD, MPH
University of Liberia
76X3+MX3, Monrovia, Liberia
Joseph Sieka, MD, MSc
University of Liberia
76X3+MX3, Monrovia, Liberia
Aloysius Nyanplu,
Bong County Health Team
2CHW+77Q, Phebe, Liberia
Christopher W. Reynolds, BS
University of Michigan Medical School
1301 Catherine St, Ann Arbor, MI 48109, USA
Claire Edson
University of Michigan School of Nursing,
426 N Ingalls St, Ann Arbor, MI 48109, USA
Nancy Lockhart, MS
University of Michigan School of Nursing,
426 N Ingalls St, Ann Arbor, MI 48109, USA
Jody R. Lori, PhD
University of Michigan School of Nursing
426 N Ingalls St, Ann Arbor, MI 48109, USA
Running title:
MOBILE OBSTETRIC EMERGENCY SYSTEM FOR OBSTETRIC REFERRAL IN LIBERIA
Abstract :
Objective : The purpose of this study was to examine the
association between the implementation of a mobile obstetric emergency
system (MORES) and referral time for obstetric emergencies as well as
maternal/newborn outcomes.
Design : Pre/post intervention descriptive study.
Setting : Liberia’s caesarean section (CS) coverage is about 5%,
lower than 9-19% coverage associated with decreased maternal mortality.
Delays in the referral process from a rural health facility (RHF) to a
district hospital for comprehensive emergency obstetric and newborn care
(CEmONC) services such as CS contribute to the high maternal mortality.
Sample : Women with referral data from both RHFs (n=20) and
hospitals (n=2) within Bong County, Liberia.
Methods : A pre/post descriptive analysis was conducted on data
collected from RHFs and two hospitals in Bong County, Liberia.
Descriptive analysis and logistic regression models examined the
relationship between the intervention’s implementation and mode of
delivery, maternal outcome, newborn outcome, and transfer time from RHF
to district hospital.
Main outcome measures: Mode of delivery, maternal outcome,
newborn outcome, and transfer time.
Results : Women had higher odds of undergoing a CS at endline (OR:
1.86 95%; CI: 0.99- 3.46) compared to baseline. Additionally, newborns
had lower odds of showing depressive symptoms (OR: 0.31; 95%CI:
0.14-0.68), defined as a non-vigorous newborn with poor respiratory
effort, muscle tone or heart rate <100 beats per minute.
Conclusion : MORES is a promising means to increase timely care
seeking along the referral pathway which may enhance access to caesarean
section as well as improved newborn outcomes in low- and middle-income
countries.
Funding : Bill & Melinda Gates Foundation (INV-023274) and the
USAID PEER Grant (Project 9-518).
Keyword :
Obstetric referral, whatsapp, continuum of care, referral system,
messaging application, mobile health