Louis Fazen, a doctoral candidate at the School of Public Health, is part of an international team of researchers that has been awarded a $250,000 grant from the Bill & Melinda Gates Foundation for a project that uses smartphones to reduce infant and maternal mortality in Kenya.

Fazen, who is currently in his sixth year of the MD/PhD program and a student in the division of Epidemiology of Microbial Diseases, is part of a research group that was recently awarded a Grand Challenges grant for its “Saving Lives at Birth” project.

Fazen and his colleagues will work with the Kenya Ministry of Health and a government-sponsored HIV-prevention program called the Academic Model Providing Access to Healthcare to train and support Community Health Workers (CHWs) to address a rising level of maternal and infant mortality. The grant funds the development of an information technology system that uses cutting-edge technology to foster rapid communication and feedback between mothers, their communities and their health care providers.

This Mother-Baby Health Network will use the phones to facilitate home- and group-based care through CHWs and to improve collective advocacy. It will rely on an electronic medical record system that can be sent directly to CHWs using smartphones, allowing women and their newborns to be correctly triaged for care.

“Addressing these health needs requires a rapid and efficient information management system that extends from health facilities to individual households, crossing over geographic and socioeconomic divisions,” said Louis, who currently lives in Eldoret, Kenya. It will, he said, provide communities with the information and communication tools they need to ensure that every mother and child has access to essential care at time of delivery and within the first 48 hours after giving birth.

Integrated with text messaging, the Mother-Baby Health Network will also be capable of notifying health care providers, alerting nearby GPS-tracked taxis within an emergency transport system, and activating a personalized community of advocates to mobilize local resources. The Mother-Baby Health Network seeks to strengthen dialogue between communities and facilities to create a sustainable, community-driven demand for accountable maternal and newborn care.

Infant and maternal mortality remain serious public health issues in Kenya, Louis said. The World Health Organization estimates that 77 percent of all maternal deaths occur within the first 48 hours of delivery, and the most recent Kenya Demographic and Health Survey indicates half of the mortality under five years of age now occurs in the first week of life. In the Rift Valley fewer than half of all new mothers receive a postnatal check-up from a health provider, with only 15 percent receiving one within those crucial 48 hours after delivery. Moreover, the proportion of deliveries that occur at a health care facility and with skilled providers in attendance has continued to decline in this region since 1989, with women delivering increasingly in their homes in the presence of a friend, relative or simply alone.

As a result of these trends, maternal mortality remains the leading cause of death among women of child-bearing age in Kenya. United Nations interagency figures indicate that maternal deaths have steadily increased from 380 to 530 per 100,000 live births. This 38 percent increase distinguishes Kenya with one of the highest rates of increase between 1990 and 2008.

“Louis has designed a great project with both a randomized controlled trial and a qualitative component,” said Elizabeth Bradley, a professor at the School of Public Health, director of Yale’s Global Health Leadership Institute, and Fazen’s adviser. “If the mobile phone intervention works, he will also find out a lot about implementation, too — hopefully contributing to the development of best practices in this emerging field.” The other members of the research team are Astrid Christoffersen-Deb, MD, of the University of Toronto; Laura Ruhl, MD, of Indiana University; and Julia Songok, MD, of Moi University in Kenya.

The Grand Challenges grants are highly competitive. From over 600 applicants, 75 finalists were selected to complete the final stage of the Saving Lives at Birth program, and 19 were selected as award recipients. Applications are received from across the globe, including institutional applications from non-profits, faith-based organizations, universities and private enterprises.

— Michael Greenwood (reprinted from Yale Public Health)

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