Description of Maternal Morbidities Amongst 1000 Women During Pregnancy in Ambanja, Madagascar – Opportunities and Challenges of Using an mHealth System

Elisabeth Garcia Vilaplana,1,2 Patrick Petignat,2 Anne-Caroline Benski,2– 4 Adelia Soaroby,4 Jessica Sormani,2 Pierre Vassilakos,2,5 Nicole C Schmidt2,6 1Faculty of Medicine, University of Geneva, Geneva, Switzerland; 2Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland; 3Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; 4Centre Medical St Damien, Ambanja, Madagascar; 5Geneva Foundation for Medical Education and Research, Geneva, Switzerland; 6Catholic University of Applied Science, Munich, GermanyCorrespondence: Nicole C SchmidtCatholic University of Applied Science, Preysingstraße 95, Munich 81667, GermanyTel +49 89 48092-8499Email nicole.schmidt@ksh-m.deBackground: The estimated burden of maternal morbidities in lower-income countries, such as Madagascar, is high. However, there is still a lack of data on maternal morbidities, in part due to an absence of standardized assessment tools. This cross-sectional study aims to report maternal morbidities among 1015 women in the district of Ambanja, Madagascar, and to describe the advantages and limitations of a mHealth system.Methods: Data were collected using the PANDA (pregnancy and newborn diagnosis assessment) system, an mHealth device that incorporates the WHO recommendations for antenatal care (ANC). Data, including personal and medical information, but also clinical data such as hypertension, anemia or HIV were collected from more than 1000 women attending ANC.Results: A total of 1015 pregnant women were recruited from January 2015 to August 2018. The average age was 24.6 years old, and most women were married (82.3%). The majority lived in urban areas and were unemployed. Prevalence of hypertension and gestational diabetes was relatively low (4% vs 2.2%). Malaria infection was diagnosed in 2.2% and HIV was diagnosed in 1.2% of pregnant women. The most common morbidity was anemia (68.4%) and the only significant factor associated was being single compared to being married (OR 1.68, 95% CI 1.05– 2.70, p-value 0.032).Discussion: The prevalence of anemia in our study population was much higher than previously reported in Sub-Saharan Africa. This finding highlights the need for regular iron supplementation during pregnancy, especially in vulnerable (eg, single) women. The PANDA mHealth system provides unique opportunities due to its standardization of ANC and creation of a digital database accessible from a distance. However, one of the main challenges was that even a mHealth system such as the PANDA remains dependent on the local procurement chain. Therefore, future studies need to access opportunities of mHealth systems to support health service delivery.Trial Registration: Registered on ISRCTN on 14th October 2015, number ISRCTN18270380. Retrospectively registered.Keywords: maternal health, maternal deaths, anemia, antenatal care