Boris Martinez|Enma Coyote Ixen|Rachel Hall?Clifford|Michael Juarez|Ann C. Miller|Aaron Francis|Camilo E. Valderrama|Lisa Stroux|Gari D. Clifford|Peter Rohloff
mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial
Probigua|Probigua|Agnes Scott College|Probigua|Harvard Global Health Institute|Harvard University|Emory University|Emory University|University of Oxford|Emory University|Brigham and Women's Hospital
guatemalas indigenous maya population one highest perinatal maternal mortality rates latin america population births delivered home traditional birth attendants tbas limited support linkages public hospitals goal study characterize detection maternal perinatal complications rates facilitylevel referral tbas evaluate impact mhealth decision support system ratesa pragmatic oneyear feasibility trial mhealth decisions support system conducted rural maya communities collaboration tbas tbas individually randomized unblinded fashion either earlyaccess lateraccess mhealth system tbas earlyaccess arm used mhealth system throughout study tbas lateraccess arm provided usual care crossing unidirectionally mhealth system study midpoint primary study outcome monthly rate referral facilitylevel care adjusted birth volumefortyfour tbas randomized 23 earlyaccess arm 21 lateraccess arm outcomes analyzed 799 pregnancies earlyaccess 425 lateraccess 374 monthly referral rates facilitylevel care significantly higher among earlyaccess arm median 33 referrals per 100 births iqr 2258 compared lateraccess arm median 20 per 100 iqr 030 p 003 study midpoint lateraccess arm began using mhealth platform referral rates increased median 34 referrals per 100 births iqr 550 significant difference earlyaccess arm p 058 rates complications similar arms except hypertensive disorders pregnancy significantly higher among tbas earlyaccess arm rr 33 95 ci 110986referral rates higher tbas access mhealth platform introduction mhealth supportive technologies tbas feasible improve detection complications timely referral facilitycare within challenging healthcare delivery contextsclinicaltrialsgov nct02348840