By Pauline Achieng Tom @pauline_tom -June 9 2023

Access to clinically accurate information is a significant barrier for many mothers, preventing them from making informed choices regarding when and where to seek care during and after pregnancy.

Further, lack of awareness about potential complications or the need for urgent medical attention many times leads to delays in seeking proper care, resulting into a severe consequence for both the mother and the baby.

In order to advance positive maternal and child health outcomes Jacaranda Health, a non-profit organization, is working with the Kenyan Ministry of Health and county governments to connect mothers with lifesaving advice and referral to care using artificial intelligence (AI) enabled two-way short messages (SMS) platform.

According to Javan Waita, Head of Programs at Jacaranda health, the digital tool dubbed promoting mums through pregnancy and postpartum through SMS (PROMPTS) identifies and refers mothers to proper care when there is risk of complications.

“PROMPTS AI triage system understands queries and sorts through them to determine urgency. If it spots a question that suggests a high-risk situation or danger sign it moves it up allowing the clinical officers to provide prompt responses,” he explained.

Originally, PROMPTS solely provided one-way texts, but when women began responding that the organization recognized the potential for improvement.

They saw the chance to enhance their AI triage system by incorporating data that would enable it to identify risks and complications, as well as address general pregnancy-related inquiries from women.

This shift transformed PROMPTS into a dynamic two-way conversation, with instant replies that empowers mothers throughout their pregnancy journey while simultaneously gathering valuable information to continually enhance the quality of their services.

At both healthcare facilities and within the community, pregnant women can easily enroll in the PROMPTS program using their mobile phone numbers.

Upon registration, they receive nudging text messages that promote healthy habits and actions. Furthermore, expectant mothers have the opportunity to ask questions, with a dedicated help-desk agent available to provide answers.

If the AI detects any potential risks or danger signals from the questions asked, the mother is promptly directed to the nearest health facility. Additionally, the mother’s digital file is transmitted to the healthcare providers in advance, ensuring seamless continuity of care.

This AI triage feature proved to be a salvation for Josephine Mucoro, a resident of Bungoma county.

Josephine had a tumultuous pregnancy that gave her several health scares. She was introduced to PROMPTS at Chwele Sub County Hospital, following a recommendation by the clinic nurses.

“I received one message saying that if my legs swell and there is no dent when I press them, I should not worry, but if there is a dent, I should go to hospital. Whilst, I had no dents, a few days later I received another message stating that if I feel pain in my upper abdomen, I could be at risk and should head to hospital,” she said.

“One Thursday on my way home from church I felt intense pain in my abdomen that I thought would go away but the message I got from PROMPTS recommended going to the hospital that’s when I decided to call my friend to take me to the hospital,” she narrated.

This swift action saved her life. Once they arrived at the medical facility, her blood pressure was found to be high and she was immediately referred and admitted into urgent care at Chwele Hospital. Her condition was managed treated and her baby was safely delivered.

Another beneficiary of the PROMPTS tool Violet Okuta from Kakamega county is grateful for the program for saving her life despite suffering a miscarriage,

“If it wasn’t for PROMPTS, I might’ve waited until morning. But my husband messaged that I was bleeding a lot, and in minutes PROMPTS referred us for an urgent check-up. It was a lifeline. I miscarried but was safe in the hands of nurses. We’ll continue using PROMPTS as we try for another baby,” she said.

According to World Health Organization (WHO) every two minutes a mother loses her life while giving birth. In Kenya, the maternal mortality rate is 414 for every 100,000 live births, an alarming number compounded with the fact that only 42 percent of births are attended by skilled health-care personnel.

“We know the majority of mothers lack access to accurate information to make informed choices about when or where to seek care during and after pregnancy and therefore miss opportunities to identify life-threatening complications or intervene effectively during emergencies,” Javan said.

“We are fueled by the belief that every mother deserves to experience childbirth safely, and every newborn deserves a safe start in life. And that’s the inspiring story behind our digital health platform, PROMPTS, a tool that’s already empowering countless women and transforming maternal and newborn health.”

So far, over 1 million mothers across 21 counties are enrolled to PROMPTS. Jacaranda health has been able to partner with over 930 hospitals providing access to care to Mothers and encouraging care seeking behavior among them.

“Since 2016, we have been able to reach over 2.3 million mums with our messaging platform with a geographical scope of 21 of the 47 counties in Kenya. We are able to reach over 60 per cent of the deliveries that happened nationally in Kenya,” Javan explained.

“We recognize there are other drivers of maternal mortality but the benefit of having a mum within our platform is tangible. We have seen 98 per cent of mums within our catchment able to attend their expected antenatal care visits with 99 per cent of the mums within our platform seeking care within a health care facility with a skilled provider.”

Jacaranda Health has also invested in training healthcare professionals such as nurses and midwives, and offering the emergency Obstetric & Newborn Care (EmONC) Mentorship program aimed at building life-saving obstetric and newborn care skills the program boasts of over 6,500 health providers trained.

Christine Nowerukoi Head Nurse, Lanet Health Center, Nakuru East spoke on the impact and significance of the PROMPTS program, “Sometimes we receive feedback from mothers saying they are grateful for the care they received. This motivates us.”

While PROMPTS has demonstrated significant potential in improving maternal health outcomes, it is important to acknowledge a limitation regarding its reliance on mobile technology. This affects mothers in remote areas who lack access to mobile phones.

Additionally, certain women may face challenges due to illiteracy or difficulty in reading the life-saving messages and reminders sent by the platform.
Furthermore, connectivity issues in remote areas can cause delays in receiving instant replies, which may hinder the effectiveness of the digital tool.

Language barrier has also been a notable problem while English and Swahili are the national languages in Kenya, some mothers from rural or remote areas only speak their native tongue.

“We acknowledge a number of mums possibly do not have phones or are unable to read Swahili, we are working on an interactive voice response which will allow mums to interact with the platform through voice,” Javan said.

This interactive voice response will also accommodate the visually impaired and those who cannot send short texts for various reason.

“We are also looking on opportunities to leverage on in the next 3 years to ensure every mum in Kenya is able to access our messaging PROMPTS platform,” Javan reassured.

In addition, although PROMPTS is provided to mothers free of charge, the program incurs a cost of slightly less than 1 USD per mother. To support the sustainability and future expansion of the program, the government covers 50 percent of the cost.

“Jacaranda health is open for partnerships with like-minded organizations. The overall goal is to avert preventable maternal and neonatal deaths in Kenya and the world at large,” Javan said.

This story was first published in Health Business

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