oerther et al #humtech2014 mhealth at the bottom of the pyramid

Utilizing mobile health technologyat the bottom of the pyramid

SE Oerther, P Manjrekar, DB OertherMissouri EDGE, Hinduja Hospital,

Missouri S&T

• Reduce by 3/4 the maternal mortality ratio• Achieve universal access to reproductive health

MMR: USA (28), Brazil (69), Russia (24), China (32)India (190); Chad (980) (data from World Bank)

Our team: nurses and engineers

Our approach

1. Describe maternal challenges faced by women in India

2. Adapt existing survey instruments for target populations

3. Evaluate emerging technologies to enable humanitarian assistance within India

4. Scale as appropriate

Common ground: definitions

• Electronic health – convergence of wide-reaching technologies; and use of those technologies to support patient care

• Mobile health – a subset of eHealth using mobile devices to deliver health services

• Bottom of the pyramid – 2 billion people who live on less than $ 2 per day (Sub-Saharan Africa plus endemic poor within China/India)

• Holistic nursing – caring for the body, mind, and spirit

India

Maternal health, prenatal, and antenatal wellness depend upon:

knowledge and financial resources of the mother

+ family structure.

Family structure

SESFamily

composition Urbanization

Role, power& status

Familyrelationships

Family unity Individualdevelopment

Adapted from: Conceptual frameworks for understanding family. Desai 1994.

India

Maternal health, prenatal, and antenatal wellness depend upon:

knowledge and financial resources of the mother

+ family structure.

Family structure

SESFamily

composition Urbanization

Role, power& status

Familyrelationships

Family unity Individualdevelopment

Adapted from: Conceptual frameworks for understanding family. Desai 1994.

Gender rights

Cheap technology

mHealth:Peer coachingNursing access

I want to get pregnant, and I have

questions???I’m pregnant, and I have questions???

I’m caring for my baby, and I have

questions???

Mother in lawAuntie, Her friends

I want to get pregnant, and I have

questions???I’m pregnant, and I have questions???

I’m caring for my baby, and I have

questions???

Mother

Peer coaches

Nurses

mHealth solutions

• Mobile phones are prevalent because they are cheap, simple, and fast.

• Mobile phones enable mHealth (voice, SMS, or data).

• A recent study describes 51 mHealth projects operating in 26 BOP markets around the world (Akter et al, Info Mgmt 2013).

California, Maternal andInfant Health Assessment• annual, statewide-representative survey of

women with a recent live birth• self-reported information about:– maternal and infant experiences and– maternal attitudes and behaviors before, during

and shortly after pregnancy• http://www.cdph.ca.gov

India

MIHA in CA, USA

$ $$ $$$

PhD

Rural v Urban

Age…

Survey findings; 1

• Indian women reported health status prior to pregnancy as ‘excellent’ (similar to CA)– Positive self perception

• Diabetes and obesity substantially lower among Indian women; folic acid prevalent– Nutrition status seems adequate

• Weight gain during pregnancy substantially lower among India women– Need to encourage adequate caloric uptake

Survey findings; 2

• No reports of food insecurity among Indian women– Positive attitude

• “Do you have a lot of unpaid bills?” (Indian women, ‘nope’…)– Perception is an important part of mental wellness

• Rural Indian women breastfeed the most– Poverty necessitates a best practice

Survey findings; 3

• Regular use of SMS among all Indian (urban) women– Potential for use

• Language and literary a concern for Indian (rural) women– SMS or data may not work as well as audio (or

perhaps pictures necessary?)

E Mamta, Government of Gujarat

Our approach





Our approach





Family structure

MIHA

E Mamta

oerther et al #humtech2014 mhealth at the bottom of the pyramid

Health & Medicine