BU Using Text Messaging Technology in Zambia to Prevent Mothers’ Death During Childbirth

December 10, 2012

By Mike Trinh

BOSTON UNIVERSITY – This year, the Short Message Service, better known as the text message, turns 20 years old. Although many use the service today for seemingly trivial purposes, BU’s Center for Global Health and Development (CGHD) is trying to take advantage of text messaging to prevent deaths of mothers during childbirth in Zambia.

In the last five years, cell coverage and access to smartphones have spread quickly in the south-central African country. The School of Public Health’s Dr. Donald Thea and his team are seeking to utilize this technological growth to improve healthcare. They had already successfully employed another SMS-based program in Zambia. Called Programme Mwana, the program cut wait times for infant HIV tests in half by allowing laboratories to text results to nurses. The system is currently being scaled up to include every clinic in the country.

“Technology is revolutionizing healthcare in rural areas,” says Thea.

So when the U.S. Department of State looked to CGHD to help develop a program to lower maternal mortality rates in Zambia, Thea decided to expand upon the texting system. The Saving Mothers Giving Life SMS (SMGL-SMS) program went live in July in nine facilities in Zambia’s Kaloma district. Thea’s team set up a system that allows data clerks at antenatal clinics in health facilities to register, via texts, pregnant women who come in for a checkup.

Since prenatal and postnatal care are important steps in preventing maternal mortality, the system then sends automated text messages to volunteer community based agents (CBAs) who would remind mothers when they need to visit a facility. But, sometimes, childbirth complications that local facilities are not equipped to handle will still occur.

“The most important way to prevent maternal death is to identify the problem and then to get the mother to a facility with basic equipment, supplies, and trained staff,” says Thea.

An estimated 440 in every 100,000 childbirths in Zambia result in the mother’s death, a number vastly greater than in the U.S. These mortalities occur because women do not receive proper care when possibly fatal complications arise. SMGL-SMS allows local facilities to send messages to one of the two hospitals in Kaloma district for assistance if a mother needs emergency care.

But even getting transportation to a hospital can be difficult in Zambia’s rural areas, where there are few good roads and even fewer emergency vehicles. As a result, about half of women deliver at home while the other half often have to go through extreme lengths to get to a facility.

“It’s not uncommon for women in labor to have to be carried to a health facility in an oxcart,” says Thea.

To address this issue, the SMGL-SMS purchased Kaloma district’s first ambulance, which will have the sole purpose of transporting mothers if there is an emergency during delivery. Combined with the SMGL-SMS system, mothers in rural communities can now have emergency transportation from her home to a hospital in the district.

By keeping track of women before, during, and after childbirth, Thea hopes to show that a text-based system can save lives in Kaloma district. From there, he wants to implement it in other districts and eventually in all of Zambia.

“Once we prove that this system works, we hope that it will be adopted by the Ministry and expanded to a national level.”

Project Lead Kaluba Mataka adds that SMGL-SMS was designed in a way that, if Zambia’s government wanted to implement it on a national scale, the transition would not be too difficult.

“The way that we built the system is very scalable,” says Mataka.

But before that can happen, the team will have to solve the problems that the program is still experiencing. For example, each mother requires a unique registry ID number in order for the facilities to access the her information.  Mataka has also seen that data clerks still need more time and experience to learn how effectively utilize the system.

“As with all systems, it is only as useful as the people who are using it,” she says.

The same could be said about all technology. They can be important or insignificant, depending on who uses them. Mataka and Dr. Donald Thea have shown that simple things like texts and ambulances – even the Skype service that allows them to update each other weekly from 7,000 miles away – can be applied in truly beneficial ways.