1. MATERNAL SUPPORT SYSTEM INTERGRATED WITH MOBILE TECHNOLOGY
BY
SSESANGA SHARIF
KAMYA UMAR
SEMPIJJA MICHAEL
BLISS AFRICA FOUNDATION
A Project Report submitted to the Research Team at Bliss Africa
For the Study Leading to a Project Proposal in Partial Fulfillment of the
Requirements for The Organization’s Objective in bettering Maternal Health
CASE STUDY: MENGO HOSPITAL.
JAN 2016
3. ii
APPROVAL
This Project Report has been submitted for Examination with the approval of the following;
Supervisor;
Signed: ………………………………………………………..
Date: ………………………………………………………….
Research Board,
Bliss Africa Organization.
4. iii
DEDICATION
This report is dedicated to our dear parents and guardians, friends who have cared for,
facilitated and supported the growth of our organization.
5. iv
ACKNOWLEDGEMENT
We praise the almighty God for his loving kindness and grace which accompanied us during
the entire research period.
We thank all our mentors at Bliss Africa Foundation, from whom we have learnt much
throughout our studying in the field of information technology. We are also deeply grateful to
our work mates with whom we shared fun and experience. And the entire staff of Mengo
Hospital in various ways that has enabled us to complete this Fellowship programme
successfully. We further extend our thanks to all the respondents who participated in this
study, may the Lord bless you abundantly.
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Table of Contents
DECLARATION...........................................................................................................................i
APPROVAL................................................................................................................................ii
ACKNOWLEDGEMENT............................................................................................................ iv
LIST OF ABBREVIATIONS......................................................................................................vii
CHAPTER ONE.......................................................................................................................... 1
1.1 Introduction..................................................................................................................... 1
1.2Back ground of the study..........................................................................................................1
1.2 Problem statement.........................................................................................................3
1.3 Objectives ..................................................................................................................... 4
1.3.1 Main Objectives ............................................................................................................... 4
1.3.2 Specific Objectives....................................................................................................4
1.4. Scope ................................................................................................................................ 5
1.4.1 Geographical scope...........................................................................................................5
1.4.2 Time Scope ...................................................................................................................... 5
1.4.3 Content scope................................................................................................................... 5
1.5 Significance of the study......................................................................................................5
1.6 Justification......................................................................................................................... 5
CHAPTER TWO...................................................................................................................... 7
Literature Review ..................................................................................................................... 7
2.0 Introduction ........................................................................................................................ 7
2.1 Maternal support system in Uganda ...................................................................................... 7
2.2 Maternal support system in Kenya........................................................................................ 8
2.3 Maternal support system in India .......................................................................................... 9
2.5 Maternal healthcare mobile systems in India ....................................................................... 10
2.6.0 Maternal support system in America ................................................................................ 11
2.6.1 Mobile systems in maternal health............................................................................. 11
2.6.2 Review of the related mobile application.......................... Error! Bookmark not defined.
2.6.3 Mobile Midwife ....................................................................................................... 12
2.6.4 Text4Baby by Johnson and Johnson................................................................................. 12
2.7.0 Types of Systems............................................................................................................ 13
2.7.1 Automated systems......................................................................................................... 13
2.7.2 Advantages of automated systems.................................................................................... 13
2.7.3 Disadvantages of manual system ..................................................................................... 14
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2.7.4 Manual system ............................................................................................................... 14
2.7.5 Advantages of a manual based information system ........................................................... 14
2.7.8 Disadvantages of manual safety....................................................................................... 14
2.7.9 Types of System implementation ..................................................................................... 14
2.8 Challenges to system implementation ................................................................................. 16
2.8.1System testing ................................................................................................................. 16
2.8.2 Advantages of system testing........................................................................................... 17
2.8.3Challenges to system testing............................................................................................. 17
2.8.4 Conclusion..................................................................................................................... 17
2.8.5 Research questions ............................................................................................................. 18
a) Develop a mobile application for providing maternal healthcare information........................... 18
CHAPTER THREE.......................................................................... Error! Bookmark not defined.
Methodology ................................................................................ Error! Bookmark not defined.
3.0 Introduction ............................................................................ Error! Bookmark not defined.
3.1. Research Design ................................................................. Error! Bookmark not defined.
3.2 Target Population ................................................................ Error! Bookmark not defined.
3.3 Sample size ......................................................................... Error! Bookmark not defined.
3.4 Sampling Technique ............................................................ Error! Bookmark not defined.
3.5 Data Collection Techniques.................................................. Error! Bookmark not defined.
3.5.1 Interviews......................................................................... Error! Bookmark not defined.
3.5.2 Questionnaires .................................................................. Error! Bookmark not defined.
3.5.3 Observation ...................................................................... Error! Bookmark not defined.
3.6 Data Analysis ...................................................................... Error! Bookmark not defined.
3.7 Modelling, design, and system development tools. ................. Error! Bookmark not defined.
3.7.1 Data modelling ................................................................. Error! Bookmark not defined.
3.7.2 System Design............................................................ Error! Bookmark not defined.
3.7.3 System development tools ................................................. Error! Bookmark not defined.
REFERENCES....................................................................................................................... 24
APPENDICES........................................................................................................................ 26
Appendix A FINANCIAL....................................................................................................... 26
Appendix B............................................................................................................................ 27
Appendix C QUESTIONNAIRE.............................................................................................. 28
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LIST OF ABBREVIATIONS
ITU ……………………………………………… International Telecommunication Union
IVR ……………………………………………... Interactive Voice Response
LEA ………… …………………………………..Swahili word for nurturing an infant baby.
LEA is the title of the mobile application
SMS …………………………………………………...Short Messaging System
PC ……………………………………………………..Personal Computer
WHO…………………………………………………..World Health Organization
UDHS…………………………………………………Uganda Demographic Health Survey
UBOS…………………………………………………Uganda bureau of Statistics
MMR………………………………………………….Maternal mortality Rate
AFIC…………………………………………………..African freedom of information center
IMF……………………………………………………Infant Mortality Rate
IT……………………………………………………...Information Technology
UCC………………………………………………......Uganda Communication communion
MDGS……………………………………………….. Millennium Development Goals
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CHAPTER ONE
1.1 Introduction
This chapter looks at the background of the research which will introduce the status and the
theoretical information of maternal mortality, research problem, research objectives (general
and specific objectives), research questions, significance, and scope of the study.
The rapid development of internet and communication technologies in the past twenty years
had changed the lifestyle of human beings in the entire world. People who are leaving in
urban and rural area can have equal access to quality lifestyles. The mobile devices can
improve education, heath, and economics of people everywhere and anywhere through
communication technologies.
In 2005, the numbers of mobile phone users in the world were 2.2 billion as compared to 1
billion internet users, ITU (2006). These growths in mobile phone usage have created the
opportunity for localized mobile content development to reach a wider public. Mobile phone
subscribers are able to get multimedia content such as movie clips and news at higher speed
and affordable rate. Availability of technology Smart Fit to reduce the size of the content for
mobile display Access, (2015), accurate information about pregnancy can be easily delivered
at any possible time and place. This service can be easily accessed even from rural areas
where transportation and medical services are limited.
1.2Back ground of the study
Uganda’s Maternal Mortality Ratio (MMR) is currently estimated at 435/100,000 live births
Uganda Demographic and Health Survey UDHS (2006). This has declined from 527/100,000
live births estimated in 1990. The current maternal mortality ratio of 435 deaths per 100,000
live births translates to about 6000 women dying every year due to pregnancy related causes.
In addition, for every woman who dies, six survive with chronic and debilitating ill health
such as fistulae (leakage of urine or faeces from the birth canal). Similarly, infant mortality
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(IMR) has declined from 88 deaths per 1,000 live births to the current estimate of 76/1000
live births.
Although Uganda has made these achievements, maternal and infant mortality rates are still
high. Maternal and infant health depends on the functioning of the entire health system hence
the persistent high mortality rates are partly due to majorly poor accessibility to health
services, poor quality of care, poorly remunerated staff etc.
Bringing a new life to the world is a wonder to everyone. Experience from each pregnancy
can be different from one pregnancy to the other and from one person to another Zantey,
(2006). Matters are made worse when information past down is mixed with cultural taboos
Bronner, (2000).Healthcare information especially maternal, infant and child health are
among Africa's most challenging health problems APlC, (2010). A mechanism is required to
provide a platform for accessing healthcare information cheaply and faster. Mobile
technology is very well positioned to enable this. The United Nations, Media (Paper,
Television, and Radio) are doing campaigns on ways to alleviate infant deaths caused by lack
of maternal information.
The grim statistics are that 529 000 women die in Uganda every year from pregnancy-related
complications according to UNICEF Report (2015). In the field of maternal health, mobile
technology should be used to provide support during pregnancy (Eugenie et al, 2011). These
systems can offer general health and health-care information to pregnant women, provide
emergency-care tips and alerts, and supply post-delivery support. The same systems can also
be used to offer information about emerging risks to which women are frequently exposed
and remind women of the need for preventive care. There is scanty information about socio-
cultural influences on pregnancy and childbirth. Ministries of Health in any country play an
important role in providing modern health care services. Private organizations and institutions
such as churches, private practitioners; industries and traditional health practitioners also
contribute to health care significantly. The World Health Organization (WHO) estimates that
eighty percent 80% of maternal deaths are caused by direct obstetric causes such as severe
hemorrhage (25%), infection (15%), eclampsia (12%), obstructed labour (8%), unsafe
abortion (13%), While direct causes (8%). Twenty percent of maternal deaths are attributed
to indirect obstetric causes Such as anemia, cardiovascular diseases, malaria and tuberculosis
(Olsen et al 2002).
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Maternal mortality is difficult to measure due to lack of complete vital registration systems in
many developing countries, particularly in rural areas where the problem is typically most
severe, Hatefsvoice(2011). The Uganda Demographic and Health Survey (UDHS) 2005-
2006, holds it that most women in Uganda delivered at home (57.8%) Uganda Bureau of
Statistics (UBOS) and ORC Macro, (2007) Home deliveries in the absence of skilled
professional attendants have been associated with adverse infant and maternal outcome.
However deliveries without a skilled attendant occur for a variety of reasons, including long
distances or difficult access to a health facility, costs of the services and perceived lack of
quality of care in a health facility among others.
The explosion of mobile networks, and the growth in handset ownership, particularly among
vulnerable populations-m-low resource settings; offers a revolutionary way to effectively
deliver timely information to improve awareness of critical health issues and reinforce
positive health behaviors. Sending this information directly to the palms of expectant and
new mothers is an innovative way to empower women in low-resource settings to take action
to improve their own health and the health of their children and families. Access to
information via mobile phone can mean access to information about pregnancy, childbirth
and the first year of life and empower women to make healthy decisions for themselves and
their families. Mobile phones are able to quickly and easily disseminate information that will
inform women of ways to care for themselves during pregnancy, dispel myths and
misconceptions, highlight warning signs, connect women with local health services, reinforce
breast feeding practices, explain the benefits of family planning, and make new mothers
aware of how best to care for their babies.
1.2 Problem statement.
Maternal, infant and child health are among Africa's most challenging health problems.
Currently expectant women rely on outdated sources of maternal information or sources that
are too general to give the required information with less time, effort and cost. Most
expectant women rely on information from the old pregnancy books, stories and myths while
the few with who are literate and have money research from the Internet. There is a lot of
information widely available in printed form but usually this information is general, too
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lengthy and complicated. One of the many easy and fast ways to access information is the
Internet. However, the information is focused on pregnancy in western world setting.
There are very few available pregnancy resources for population in developing parts of the
world. Other drawbacks of getting such information is that the lack of English language
proficiency and computer literacy. Majority of expectant women are left without the crucial
information yet they have access to mobile phones either Internet enabled or not. Teen
pregnant girls are too shy to come out in the open and get access to information that is so
crucial to them like pregnancy complications information. This leads to the current high rates
of infant and child deaths. Missing doctor's appointments is a major issue affecting career
men and women who have a lot to do in the office and end up missing scheduled doctor's
appointments. Mobile technology can be used to schedule these appointments and remind or
alert the user once the appointment time is near.
Lack of a central directory listing doctors and hospitals location and price listing deny
people’s choice of the medication that fits their budget and is within their reach. Mobile
technology can provide a look-up structure of the hospitals and doctors' offices in respective
locality.
1.3 Objectives
1.3.1 Main Objectives
To develop a maternal support system integrated with mobile technology for Mengo hospital
expectant mothers to help them receive maternal information via their mobile phones running
Android operating system.
1.3.2 Specific Objectives
1. To study the existing maternal health support system.
2. To collect data, analyze it to generate the requirements for the maternal health support
system.
3. To design a new maternal health support system integrated with mobile technology.
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1.4. Scope
The study was carried out in three dimensions i.e. geographical, time and content scope.
1.4.1 Geographical scope
The study will be conducted at Mengo hospital located in Kampala, precisely at the maternal
child Health.
1.4.2 Time Scope
The study will take a period of 6 months and this will help the researcher to collect all the required
information for the development of the new system.
1.4.3 Content scope
The study concentrated on the development of maternal support system integrated with
mobile technology in the maternity wards of Mengo hospital targeting pregnant mothers to
quest for maternal healthcare information.
1.5 Significance of the study
The research will be of paramount importance to the researcher as it will enable him to
acquire skills in research methodologies and data analysis.
The development of the system will help to improve about access to relevant and factual
healthcare information will also empower women to exercise their right to maternal health.
The future scholars will also have literature about maternal support system integrated with
mobile technology which they will use to develop other related systems.
1.6 Justification
Uganda is experiencing poor performance in maternal health. The maternal mortality ratio is
438 deaths per 100,000 live births which is equivalent to 6,000 women dying every year due
to pregnancy-related complications. In addition, for every woman who dies, six survive with
chronic and contraceptive prevalence is 24%, less than 50% of the pregnant women complete
4 recommended ANC visits, there is poor knowledge on the danger sign in pregnancy with
only 33% of the rural women knowledgeable about it. At the same time, preventable maternal
deaths still rage one.
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Communities do not know their entitlements in regard to Maternal Sexual Reproductive
Health (MSRH) services and thus they cannot put up claims for services.
Given the above circumstances, it was anticipated that Uganda would not be able to achieve
the MDG 5 targets by 2015. The maternal support system integrated with mobile technology
will thus contribute to the reduction of maternal mortality in not only our local community of
Rubaga division but also the country at large.
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CHAPTER TWO
Literature Review
2.0 Introduction
This section consists of a critical review of research work from journals, internet sources and
other projects already done which is related to the subject area as well as an analysis of
existing literature on the subject with the objective of revealing contributions, weaknesses
and gaps.
Literature review is an explanation and summary of key studies relevant to the proposed
project. This chapter presents us to the various literatures from various researchers on the
different types of mobile application developed for maternal health care, how they operate
their advantages, how they are managed and how effective they are as well as the value they
bring to the heath care centers / hospitals.
2.1 Maternal support system in Uganda
The World Health Organization (WHO) defines maternal health as the health of women
during pregnancy, childbirth and the postpartum period.
According to estimates from UNICEF, Uganda’s maternal mortality ratio, the annual number
of deaths of women from pregnancy-related causes per 100,000 live births, stands at 435 after
allowing for adjustments. Women die as a result of complications during and following
pregnancy and childbirth and the major complications include severe bleeding, infections,
unsafe abortion and obstructed labor.
Uganda is slow in its progress in the fifth goal of improving maternal health in its Millennium
Development Goals. With the 2015 target for maternal mortality ratio at 131 per 100,000
births and proportion of births attended by skilled health personnel set at 100%, Uganda has a
long battle in reaching its intended goals. Moreover, the methodology used and the sample
sizes implemented by the Uganda Demographic Health Survey (UDHS) do not allow for
precise estimates of maternal mortality. This suggests that the estimates collated are
erroneous and it is conceivable that the actual rates could be much higher than those reported.
High maternal mortality rates persist in Uganda due to an overall low use of contraceptives,
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limited capacity of health facilities to manage abortion/miscarriage complications and
prevalence of HIV/AIDS among pregnant women. Despite malaria being one of the leading
causes of morbidity in pregnant women, prevention and prophylaxis services are not well
established.
The health of a mother impacts the family and even the entire community. Her ability and
access to receive necessary healthcare largely determines health outcomes for herself and her
baby. Like many developing countries, Uganda has high maternal mortality rates, which is
often reflective of access to health care services. Even when health care services are
available, they are often understaffed and low on supplies which can also have an effect.
Traditionally, Ugandan women seek to handle birth on their own as it is a time when they can
use their own power and make their own decisions which can also be a factor in such a high
maternal mortality rate. Many women report mistreatment from healthcare personnel as an
additional reason to avoid seeking professional care during pregnancy and labor. A study also
found that a majority of Ugandan women lack health literacy and in turn seek care in more
traditional or homeopathic ways. Malaria is also a substantial issue. Pregnant women and
their newborn babies are particularly susceptible to complications related to malaria, which is
endemic in Uganda. This is also an issue that needs to be addressed in order to improve
maternal mortality in Uganda.
The Human Development Report ranked 183 countries based on a variety of criteria. Uganda
ranked 161 out of 183 countries. It's high ranking put it is under the Low Human
Development category. The Human Development Index (HDI) is a composite index that
measures the achievement of countries in three basic dimensions of human development-a
long and healthy life, knowledge, and a decent standard of living. Uganda received a value of
0.446.
2.2 Maternal support system in Kenya
Maternal health remains a big challenge in much of sub-Saharan Africa, with maternal deaths
estimates still as high as 1000 deaths in 100,000 live births in some countries. In Kenya,
maternal deaths are currently estimated at an average of 560 per 100,000 live births. APHRC
(2006). In urban Kenya, one would expect the number of maternal deaths to be lower given
the existence of many well-equipped health facilities, but this is not necessarily the case.
Research by APHRC in informal settlements (slums) in Nairobi, Kenya’s capital city has
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shown that these areas have a maternal mortality of 706 deaths per 100,000 live births, which
is higher than the country’s average. The research has further revealed that nearly half of
expectant women in slums deliver either at home, with the assistance of traditional birth
attendants or in unlicensed and unregulated health facilities that lack capacity to handle even
minor obstetric complications.
In nearly all informal settlements in urban areas in Kenya, there are no public facilities,
including health care facilities. This void has resulted in many private providers setting up
poor quality health care facilities lacking qualified personnel, equipment and supplies to offer
services to people living in these settlements. APHRC’s research in two slums of Nairobi
shows that most of the facilities where poor women residing in slums seek delivery services
lack the capacity in terms of qualified personnel, equipment and supplies to handle even
minor obstetric complications. The private healthcare providers located within the slums are
not regulated by the government and many are illegal as they are not licensed. While
eclampsia (pregnancy-induced hypertension) is a life-threatening condition, a mere 14.3% of
the health facilities were equipped to manage this complication at the time of the study. A
functioning referral system, which is vital in saving lives in cases of emergencies that require
higher levels of care, is lacking in most facilities. APHRC research shows that about 10% of
births in the slums are handled by traditional birth attendants (TBAs). These attendants lack
skills to handle delivery and Kenya’s National Reproductive Health Policy has banned them
from delivering women. The TBAs however feel that they are offering useful services
especially to poor women who are unable to afford high hospital charges. The TBAs also
argue that many women prefer them to nurses in public health facilities because the nurses
have a bad attitude and are abusive towards the women. The mere fact that TBAs continue to
have client’s means that access to quality public health care, especially by the poor, is still a
challenge.
2.3 Maternal support system in India
Maternal and child health has remained an integral part of the Family Welfare Programme of
India since the time of the First and Second Five-Year Plans (1951-56 and 1956-61) when the
Government of India took steps to strengthen maternal and child health services.
As part of the Minimum Needs programme initiated during the Fifth Five-Year Plan (1974-
79), maternal health, child health, and nutrition services were integrated with family planning
services. In 1992-93, the Child Survival and Safe Motherhood Programme continued the
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process of integration by bringing together several key child survival interventions with safe
motherhood and family planning activities Ministry of Health and Family Welfare, (1992). In
1996, safe motherhood and child health services were incorporated into the Reproductive and
Child Health Program (RCH). The National Population Policy adopted by the Government of
India in 2000 reiterates the government’s commitment to safe motherhood programmers
within the wider context of reproductive health Ministry of Health and Family Welfare,
(2000). Several of the national socio demographic goals for 2010 specified by the policy
pertain to safe motherhood.
For 2010, the goals are that 80 percent of all deliveries should take place in institutions, 100
percent of deliveries should be attended by trained personnel, and the maternal mortality ratio
should be reduced to a level below 100 per 100,000 live births.
To improve the availability of and access to quality health care, especially for those residing
in rural areas, the poor, women, and children, the government recently launched the National
Rural Health Mission for the 2005-2012 period. One of the important goals of the National
Rural Health Mission is to provide access to improved health care at the household level
through female Accredited Social Health Activists (ASHA), who act as an interface between
the community and the public health system. The ASHA acts as a bridge between the ANM
and the village, and she is accountable to the Panchayat. She helps promote referrals for
universal immunization, escort services for RCH, construction of household toilets, and other
health care delivery programmers Ministry of Health and Family Welfare, (2006).
An important objective of NFHS-3, like NFHS-1and NFHS-2, is to provide information on
the use of safe motherhood services provided by the public and private sectors
2.5 Maternal healthcare mobile systems in India
In India, ZMQ Software Systems is developing an SMS application for women in villages to
receive prenatal care The Wall Street Journal, (2008). As this Gurgaon - based mobile
gaming company puts it; first, mobile phones took a stab at replacing radios, television sets
and computers.
Now, they'll get a shot at playing doctor, too. ZMQ develops innovative ICT solutions,
software, and applications for empowering people and enabling sustainable development.
They have launched a program where women in the rural areas will be able to get prenatal
advice via text message. The new offering builds both on efforts to tap into the nearly 300
million mobile phone users in India and parallel attempts to use technology to get basic
19. 11
health care into areas that don't have it. Under ZMQ's new service, once a woman registers
with her date of pregnancy, she will receive weekly tips on what to eat, what vaccines to get,
and when to get check-ups. An interesting and exciting feature is that since men usually carry
the phone, the company is tying up with network providers such as Reliance Communications
Ltd to reward the user with one free phone call each time an expectant mother logs in.
The use of mobile phones may also be a step away from the problems that plagued previous
Strategies to use technology in rural health care. Telemedicine projects, which used a
centrally located doctor to provide advice through telephone and video conferencing with
remote contacts, ran into difficulties of cost and confidence
2.6.0 Maternal support system in America
2.6.1 Mobile systems in maternal health
Mobile devices and other wireless devices and sensors are an attractive technology for
delivering health care services and health promotion messages, collectively referred to as
MHealth, as it is pervasive around the world in all cultural groups, economic levels and ages.
Addo, A (2013.) The world population, comprising those living in rural areas as well, has
access to mobile networks. The international telecommunication union estimated 5.3 billion
mobile subscriptions by end of 2010with rates of subscription plateauing in high-income
countries (1.6%) and increasing to 73% in low- and middle-income countries. ITU (2010)
Extending the reach of the health care system, MHealth is intended to serve as “cue to action”
to promote health care behavior change, thereby replacing the need for face-to-face
interventions delivered at health facilities or at home. Am. J. Prev. Med. (2013,).
MHealth’s interactive two-way communication strategies generally entails short message
service(SMS) text messaging to deliver primary care, provide family planning services,
promote health, direct people to emergency care services, remind patients about follow-up
appointments, collect health information, and promote and support exclusive breastfeeding
Cole-Lewis, H.; Kershaw .( 2010), MHealth is gaining global popularity across maternal and
newborn care, including low- and middle-income countries (e.g., India, Kenya, Peru, South
Africa, Tanzania) where MHealth is seen to potentially help meet targets for Millennium
Development Goals 4 to 6 (i.e., reduce child mortality, improve maternal health, and combat
diseases such as malaria, HIV/AIDS) established during the Millennium Summit of the
United Nations in 2000 .Siriginidi, S.R. Telemat. Inform. (2009)
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In general, MHealth has many positive health benefits: improved access to medical services;
promoted behavior change (e.g., smoking cessation, diabetes self-management, medication
adherence); reduced no-shows at follow-up appointments; enhanced monitoring and
management of diseases such as diabetes; improved data collection, management, and
tracking(e.g., immunization records, prenatal care schedules); and enhanced teaching and
training of both health care providers and patients .
Although these findings demonstrate promise for MHealth use in improving maternal and
newborn health, the evidence informing these strategies lags behind, more so with respect to
unintended harmful consequences characterized as psychosocial, economic, cultural,
environmental, and physical. This commentary addresses the socio-ecological and
environmental consequences of MHealth, emphasizing the postpartum period (i.e., after the
birth of the baby), demonstrating MHealth may be a mixed blessing Int.J. Public Health
(2014)
2.6.2 Mobile Midwife
A mobile phone-based health education program for pregnant women and recent parents in
Ghana sponsored by MoTeCH (Grameen, 2011) MoTeCH is a multi-part project that uses
mobile technology to send pre-natal and post-natal health information to Ghanaian's and
allows community health workers to collect and share health data. Women register for the
program and receive either SMS or voice messages with health information. The organization
designed the messages to be applicable to both men and women, as they anticipated that both
partners would listen to the messages (the report found that 99% of respondents chose to
receive voice messages). The messages were designed to tell women what to expect during
pregnancy, dispel myths and cultural practices, and provide general health information.
The design of Mobile midwife and LEA is the same but the model of delivery is different.
Mobile Midwife uses SMS while LEA uses a mobile application and IVR. Ghana is similar to
Kenya in that both are developing countries and face similar challenges in maternal
healthcare provision.
2.6.3 Text4Baby by Johnson and Johnson
(Brian, 2010) Johnson & Johnson has launched a mobile health initiative similar in aim and
21. 13
execution to Text4Baby for the more than 20 million expectant mothers in China, India,
Mexico, Bangladesh, South Africa and Nigeria. Johnson and Johnson estimates that 1.1
billion women in those countries have a mobile phone today and are likely to sign up for its
new program, Mobile Health for Mothers, which includes free mobile text messages on
prenatal health, appointment reminders and phone calls from health coaches. This will have a
great impact and reach to the users since all mobile phones are enabled to receive text
messages; they are confidential compared to mobile applications as a way to provide
maternal care information.
Johnson & Johnson also launched its BabyCenter mobile campaign with mobile agency Velti
in 2007, first in India (Sailesh et aI, 2011). The target was young, pregnant women since PC
Internet availability was very poor within its demographic .Pregnancy women were invited to
text their due date to join the community and receive advice on maternal information.
2.7.0 Types of Systems
2.7.1 Automated systems
According to (Duchess of Golden, 2013), an automated system is any system where an input
is provided and a machine or computer carries out the process that produces an output.
2.7.2 Advantages of automated systems.
a. Accuracy: Automated systems do very detailed work and follow precise instructions
without error.
b. Speed: they can process information much more quickly than human. This means they
are good for machinery that might need to be adjusted instantly.
c. Safety: having automated machines means having less employees who perform tasks
that can be dangerous and prone to injury, which can make the work environment
safer.
d. Quality and Reliability: Automation is precise and repeatable. It ensures the product
is manufactured with the same specifications and process every time. Repairs are few
and far between.
e. Adaptability: automated system can be programmed to carry out different tasks .For
instance an automated fire extinguisher system can be programmed also to switch off
power supply.
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2.7.3 Disadvantages of automated systems.
a. Less versatility: by having a machine that can perform a certain task limits to the
flexibility and variety of tasks that an employee could do.
b. Security Threats/Vulnerability: An automated system may have a limited level of
intelligence, and is therefore more susceptible to committing errors outside of its
immediate scope of knowledge (e.g., it is typically unable to apply the rules of simple
logic to general propositions).
2.7.4 Manual system
Mc GrawHill, (2003) explains that a manual system is a system involving data process which
does not makes use of stored program computing equipment. Manual database system is a
method of storing data that is quite similar to storing information using a filling system.
2.7.5 Advantages of a manual based information system
a. Flexibility - the manual safety system is flexible unlike the automated which has to
take the prescribed course without external interference.
b. Economical - the cost of establishing a manual safety system is cheaper than an
automated system hence it is economical to operate and maintain.
c. Maintains workers -the manual safety does not replace workers hence maintain the
workers and their work stations.
2.7.8 Disadvantages of manual system
a) Speed - the response speed of the manual system is slow compared to the automated
system and hence more accidents are prone to happen than in automated system.
b) Inaccurate - the manual system is inaccurate as a result of not following the
instructions to details.
c) Inadaptability - the manual safety system cannot be programed to do many tasks a
part from the one it is prescribed to carry out and therefore not economical to use.
d) Manual Records are susceptible to perils such as fire and water.
e) Disaster recovery plan harder to implement with manual system.
2.7.9 Types of System implementation
Direct changeover
23. 15
With this implementation the users stop using the manual system and directly switch to using
the computer system from a given date.
It is of advantage that is less costly in effort and time than any other method of
implementation
The disadvantage of this method is that if problem occur the users do the users do not have
any alternative apart from returning to a manual system which may prove different if it has
been discontinued.
Parallel running
Parallel running is one of the ways to change from an existing system to a new one.
With parallel running, the new system is introduced alongside the existing system. Here both
system (manual and computer, or old computer and new computer system) will be in
operation at the same time system until the system has been tested for efficiency. The
advantage of this is that the results from the new system can be compared with those of the
old system.
However, it has the major disadvantage that each job is done twice and therefore it means a
lot of extra work for the users.
Pilot Implementation
Once the test implementation feedback has been evaluated and selected changes have been
made to the repository, it’s time to launch the pilot implementation to the group identified
during planning.
The pilot group can vary significantly in size. It could range from one department to an entire
institution or multiple institutions. Ideally, your pilot launch should be introduced by
individual/s with prestige in the education community.
Phased implementation
This is a method of changing from an existing system to a new one. Phased implementation is
a changeover process that takes place in stages.
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2.8 Challenges to system implementation
George, (2002) outlines the following as some of the challenges faced when implementing a
new Resistance from different types of users;
Many time projects face resistance from users at different levels in the project process. For
many times project managers do not want to share information ,higher-level manager do not
want to example ,project managers do not want to share information, higher-level managers
do not want to become involved in project decision, and team members find it burdening to
update a common scheduler. To overcome this problem, a change management plan is
integrated with the implementation plan. Raising the awareness within the organization
through workshops-mails, bulletins, newsletters, training, help desk, and upper management
commitment was essential.
Difficult-to-use interface
Sometimes team members fee that the interface of the system are not user-friendly. This
problem is the result of ineffective testing of procedures from a user’s point of view. Some
members become frustrated with the interface and stopped using the whole system or decide
to use only a small part of its functionality. To rectify this problem, we need to have
extensive user involvement in preparing the procedures and designing the interface.
Refusal to use the system
In most cases system designers underestimate the high level of commitment and loyalty that
some users had to the tools and techniques that were already in place, a factor that is apparent
when some legacy tools and techniques conflict with the new system. It took a considerable
amount of time to convince several individuals about the benefits of adopting the new
system.
2.8.1 System testing
According to the Standard computer Dictionary (1990), System of software or hardware is
testing conducted on a complete, integrated system to evaluate the system’s compliance with
its specified requirements.
System testing falls within the scope of black box testing, and as such, should require no
knowledge of the inner design of the code or logic.
25. 17
As a rule, system testing takes, as its input, all of the “integrated “software components that
have passed integration testing and also the software system itself integrated with any
applicable hardware system(s).The purpose of integration testing is to detect any of the
assemblages and the hardware. System testing is a more limited type of testing; it seeks to
defect both within the “inter-assemblages” and also within the system as a whole.
2.8.2 Advantages of system testing
a. Testing ensures that the system meets the need (functional requirements) .The intent
of system test is to find deflects and correct them before go-live. There is no approach
or method to guarantee a system completely free of detects. However following a
system test approach will assist in mitigating risk and ensuring a successful project
b. System testing is phases which help system designers to test for the effiency and
effectiveness of the new designed system
c. Also system testing is testing is used to test the compatibility of the system with the
available platforms such as hardware and software’s.
d. System testing is phase used by programmers and system designers to debug for
errors and test for the logic flow of the system.
2.8.3 Challenges to system testing
The challenge to system testing comes as a result of the testers not following the process
within the organization. Testers are the middleman between developing team and the
customers, handing the pressure from both the sides. This is not the case always. Sometimes
testers may add complications in testing process due to their unskilled way of working.
2.8.4 Conclusion
Pregnancy is not only challenging to mothers but it is equally stressful to fathers as well.
Maternal support system integrated with mobile technology can position itself as a
personalized approach to educate women on pregnancy, central directory listing doctors and
hospitals location and price listing provide a look-up structure of the hospitals and doctors'
offices in respective locality. This will be done through support from mobile phone. With the
availability of good mobile network infrastructure and mobile phone technologies, maternal
support system will be available anytime and anywhere, this will help to reduce the stress and
anxiety related to pregnancy and its complications. The system will assist the pregnant
26. 18
mothers to know respective places to receive maternal care. Women in rural areas will benefit
through this system greatly by preparing for child birth and post-delivery.
2.8.5 Research questions
a) Develop a mobile application for providing maternal healthcare information.
b) To investigate the challenges expectant women face in quest for maternal healthcare
information as detailed out in the problem statement above.
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CHAPTER THREE
METHODOLOGY
3.0 Introduction
This chapter presents the description of the study design, study area, study population,
sample size determination, sampling techniques, data collection procedure, study variables,
data collection tool, data presentation, data analysis ethical considerations and quality
assurance:
3.1. Research Design
The study will be a descriptive cross sectional design as it will enable a collection of data at
one point of time. It will employ both qualitative and quantitative methods in which
questionnaires will be used to collect data.
3.2Target Population
The population to be involved will include; pregnant mothers and management of Mengo
hospital most especially in the maternal child Health.
3.3 Sample size
The Bouton (1965) formula for sample estimation was used.
Sample size= QR/O
Where,
Q – Number of days spent in data collection
R – Number of people interviewed per day
O – Maximum time taken when interviewing
And,
Q – 10 Days
R – 10 Respondents
O – 1 Hour
Therefore,
Sample size= 10 X 10
1
=100 Respondents
Therefore the sample size will include 100 respondents.
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3.4 Sampling Technique
This will be done using the systematic sampling technique of sampling. Using a register, the
first client from every 4 patients entering the MCH outpatient clinic will be selected to be one
of the respondents which give a sampling ratio of 1:4 until the desired sample of 10
respondents will be obtained each day for 10 days.
3.5Data Collection Techniques
Data will be collected by the researcher and research assistant using pretested questionnaires.
The researcher with the assistant would first introduce themselves, explain to the respondent
why the study will be carried out, consent will be requested for and received by a respondent's
signature or ink thumb.
For literate respondents, the questionnaires will be self-administered and pretested.
3.5.1 Interviews
In this method we will come up with questions beginning with what, why how when and
where. Interviews will be both oral guided questions and one-to-one discussion with the
respondents and will be administered between the informer and the informant. These
interviews will help in validating the already gathered information. The responses will be
captured or noted down, analyzed and processed for use during the design and implementation
of the project.
An in-depth interview technique will be used to obtain information directly from both the
health workers and the pregnant mothers of Mengo hospital. Will be interviewed using the
standardized open- ended interviews while we shall use an informal conversational interview
technique on health workers. This will provide us with first hand information.
3.5.2 Questionnaires
We shall use questionnaires where a set of questions containing a list of what we want to know
will be used to gather information from a targeted population for the project objectives to be
attained. The questions shall be short, clear, specific, realistic and in a simple language.
29. 21
In this method a number of related questions will be used basing on the project objectives.
Both open ended and closed questions will be administered. The survey will be conducted on
literate population hence a print out of the questions will be supplied to the respective
respondents who will be required to fill in the questions accordingly.
The questionnaires yield better samples at lower costs in terms of money and time.
Questionnaires will be analyzed to determine the accuracy and consistency according to the
objectives of the topic.
3.5.3 Observation
In this data collection technique, we shall use both direct and participant observations. Direct
observation shall be done on maternal support systems developed in previous years and we
shall carryout participant observation in the field in order to understand information flow
3.6 Data Analysis
3.6.0 Quantitative Data Analysis
Data collected will be checked, coded and edited for completeness and accuracy. The data will
then be analyzed using the statistical package for social scientists (SPSS).
Mean and Standard Deviation was used to determine the error around statements in the study.
Correlation was used to describe sample statistics, significance of the independent variables
and to establish the degree of Pearson’s correlation matrix to seek relationships between study
variables, Regression Analysis will be used to find out the variables with most influence on the
dependent variables, their significance to the study using confidence limits of 95% and to
establish the degree to which hospital adoption has effect on patient satisfaction in Mengo
hospital using R-Square.
3.6.1Qualitative Data Analysis:
Qualitative data analysis is a very personal process with few rigid rules and procedures. For
this purpose, the researcher went through a process called Content Analysis.
Identify the main themes, Assign codes to the main themes, Classify responses under the main
themes, Integrate themes and responses into the text of report as analyzed both quantitatively
and qualitatively
30. 22
3.7 Modelling, design, and system development tools.
3.7.1 Data modelling
According to (Steve, 2014), data modelling is the process of learning about the data, and the
data model is end result of the data modelling process.
Data modelling will be achieved by using entity relationship diagrams to show the data
requirements and model.
Process Modeling
Process modeling in system’s engineering is the activity of representing processes of an
enterprise, so that the current process may be analysed or improved (Harvard and Jorgenson,
2004).
This will be achieved by using Data Flow Diagrams to show processes and external entities in
the system and the end product will be in detailed description of the processes involved
(process models).
3.7.2 System Design
System design the process of defining the architecture, modules, interfaces, and data for a
system to satisfy requirements, system’s design could be seen as the application of systems
theory to product development (Ulrich etal, 2000).
Design will be the first step into the development phase which will be logical and physical
design.
Design is a creative process of applying various techniques and principles for the purpose of
defining a process or a system in sufficient detail to permit its physical realization .The system
design will be used to develop the architectural detail to permit its Physical realization. The
system design will be used to develop the architectural detail required to build a system. The
logical design of employee work assignment and evaluation system will be of structural
analysis which will include process Modeling that will be achieved using Data Flow Diagrams
(DFD) as well as the data Modeling that will be designed by the Entity Relationship Diagrams
(ERD).
31. 23
3.7.3 System development tools
A System development tool is a computer program that software developers use to create,
debug, maintain, or otherwise support other programs and applications. During system
development stage, the following software tools will be used; Microsoft Word to type the
document and drawing tables, WAMP Server will be used. This includes Apache, MYSQL and
php, the necessary technologies for web designing contain information on users. Studio will
also be used to implement the mobile part of the system.
Windows operating system is a platform that will be used in checking compatibility of system
with different operating system like Android smart phones, and windows8. This operating
system will also be used in testing the system performance, efficiency, and its throughput to
ensure proper functioning of the system.
32. 24
REFERENCES
1. Ultrich and Eppinger(2000).Product Design &Development
2. Africa Freedom of Information Centre AFIC, (2010). Statement to African Heads of State and
Government, Access to Information Central to Improving Maternal, Child and In Africa.
3. School of Computer Technology, Sunway University College(2007). Mobile
Based Pregnancy Support System. Last accessed on 12/01/2016.
http://ehealthonline.org/ehealthasia/2007/fullpapers/Jayanthy eHealthAsia07ABS116.pdf
4. InfoDev (2006). Improving Health, connecting people: the role ofICTsinthe health sector of
developing countries. InfoDev, World Bank.
5. Mobile Alliance for Maternal Action (2011). Last accessed on 14/01/2016
http://www.mobilemamaalliance.org/issue.html
6. MoTeCH - Grameen Foundation, (2011) Research: How MoTeCH uses mobile for maternal
health in Ghana. Accessed on 20/10/2011
Access (2004). Netfront for series 60: A whole lot of internet on your mobile phone, Access
Systems Europe GmbH.
2. Access (2007). Smart-Fit Rendering, Access Co Ltd. http://www.access-
lcompany.com/products/netfrontmobile/contentviewer/mcv_tips.htm
3. Bental DS, Cawsey A, Jones R (1999). Patient information systems that tailor to the
individual. Patient Educ Couns., 36:171�80.
4. Britze T.H. (2005), The Danish National e-Health Portal � increasing quality of treatment
and patient life, Technology and Health Care, Vol 13 Issue 5.
5. Cafazzo JA (2000- 2004), A Mobile Phone Based Tele-Monitoring System for Chronic
DiseaseManagement. http://www.ehealthinnovation.org/dh
33. 25
6. CenterSite, LLC (1995-2007), Everyday Life During Pregnancy.
7. Dodero. G, V.Gianuzzi, E.Coscia, S.Virtuoso (2001). Wireless Networking with a PDA: the
Ward-In-Hand project.
8. Giannone. A, La Belle. V, (2005), TELEPET For A Value Added Service Network For PET,
Technology and Health Care, Vol 13 Issue 5
9. InfoDev (2006).Improving health, connecting people: the role of ICTs in the health sector
of developing countries. InfoDev, World Bank, 31 May 2006.
10. ITU (2006). Universal Access to Telecommunication Services: Are Current Practises
Keeping Pace with Market Trends? International Telecommunication Union
http://www.unctad.org/sections/wcmu/docs/c1em30po24_en.pdf
11. Kamel Boulos MN (2003), Location-based health information services: a new paradigm in
personalised information delivery. International Journal of Health Geographics.
12. Kelly Zantey (2006), Pregnancy Symptoms & Signs of Pregnancy � A Comprehensive List.
http://www.bellybelly.com.au/articles/pregnancy/pregnancy-symptom-sign-of-pregnancy.
13. MCMC (2006), “Cellular Phone Subscribers”, Fact and Figures: Statistics and Records,
Malaysian Communications and Multimedia Commission (MCMC). Website :
http://www.mcmc.gov.my/facts_figures/stats/index.asp
14. Yvonne Bronner (2000), “Cross-Cultural Issues during Pregnancy and Lactation:
Implications for Assessment and Counseling”, Nutrition and Pregnant Adolescent, pg 173-180.
15. Unicef 2005: Info by Country: Malaysia, United Nations International Children’s Emergency
Fund. http://www.unicef.org/infobycountry/malaysia.html 2005.
- See more at: http://ehealth.eletsonline.com/2007/02/10944/#sthash.Aldh5nVE.dpuf
34. 26
APPENDICES
Appendix A FINANCIAL BUDGET
Number Item Amount
1 Transport 100000
2 Internet expenses 50,000
3 Software and hardware tools 40,000
4 Feeding 15,0000
5 Airtime 20,000
5 Printing and binding of proposal 17000
6 Data collection/consultations 10,0000
7 Miscellaneous 80,000
TOTAL 55,7000/=
35. 27
Appendix B ACTIVITY PLAN FOR THE RESEARCH 2015/2016
ITEM Month 1 Month2 Month 3 Month 4 Month5 Month6 Month
7
Concept paper designing
Proposal
Chapter four
System Design
System testing,
implementation and
presentation
36. 28
Appendix C QUESTIONNAIRE
We are researchers from Bliss Africa Organization Currently carrying out research on a project
Maternal support System integrated with Mobile Technology and our case study is Mengo
hospital .You have been chosen to answer this questionnaire. Therefore, we are requesting for
your participation by filling this questionnaire. The information you will provide to us will be
treated confidentially and used for academic purpose only and your views will be important for
the success of this project.
Please fill according to your observation
Part 1: Profile
Question
1 Select your age bracket 18-24 25-35 36-4-45
2 Indicate your area of
residence
3 select your employment
status
Unemployed Self-
Employed
Employed
4 Select your level of
education
Primary
School level
Secondary
School level
Graduate
Level
5 Marital statues single married
6 Religion Muslim catholic protestants others
37. 29
Part 2: General Mobile Phone Service and Device Information
1. Do you own a mobile phone? Yes ( ) No ( )
Manufacturer Nokia Samsung Motorola Ericsson Others
(specify )
Phone Model
2. Is your mobile phone Internet enabled? Yes ( ) No ( )
3. Is the Phone Java enabled? Yes ( ) No ( ) I don't Know ( )
4. Do you use your phone to browse the Internet and other programs such as games, social
network applications e.g. facebook? Yes ( ) No ( )
5. Who is your Mobile Service Provider? Mtn () Airtel ( ) Orange ( ) Smart () Other ( )
Part 3: Survey Proper
Strongly
Disagree
Disagree Neutral Agree Strongly
Agree
Questions 0 1 2 3 4
1 Overall am
satisfied on how I
access maternal
information
2 I have access to up
to date maternal
information
3 I am confident to
deal with any
38. 30
pregnancy
complication that
may arise
4 I am able to fully
understand all the
maternal
information I ,
receive
5 I have easy access
to doctors and pre-
natal clinic
6 I know where to get
any maternal care
and assistance
that I need
7 It is difficult to get
answers on any
questions I have
regarding
pregnancy
8 If you know the
proper information,
its possible to avoid
pregnancy
complications
9 Mobile phone use
makes it easy to
access maternal
information
39. 31
10 Doctors and health
workers do not
really give all the
maternal-
information when
needed.
11
It is expensive to
access maternal
heath currently.
12 I frequently use my
mobile phone to
access the internet
13 I would prefer to
access the maternal
information via
mobile phone.
14 I always practice
what I learn from
the maternal
information
15 It is difficult to
trust some ones`
sources of
information
16 I prefer calling and
listening to the
information than
using the mobile
application
40. 32
17 Its easier to get
answers to
questions I have
regarding
pregnancy through
mobile application
THANKS FOR YOUR NICE IDEAS
41. 33
INTERVIEW GUIDE
This interview guide is aimed at getting data for the development of Maternal Support System
support system Integrated with mobile Technology. As a member of this research, you are kindly
requested to provide the information to the best of your knowledge. The study is a partial request
for the award of a Bachelors Degree in Information Technology at Muteesa 1 royal university.
The information collected will be treated with at most confidence.
1. What health care services do you have/give to pregnant women at this facility?
……………………………………………………………………………………
2. What health care services do pregnant women seek in this community?
…………………………………………………………………………………….
3. For each of the health services sought what motivates them to seek those services?
………………………………………………………………………………………..
4. What problems do women face during delivery in this community?
………………………………………………………………………………………………
5. How are these problems faced during delivery dealt with?
……………………………………………………………………………………………..
6. What interventions exist in this community to help majority pregnant women come to health
centers for delivery and during pregnancy?
……………………………………………………………………………………………………
7. How successful are these interventions?
…………………………………………………………………………………………………..
8. In your opinion, how can maternal care be improved in this community? (Probe: What can be
done to bring about the desirable changes?)
…………………………………………………………………………………………………….
42. 34
9 What aspects of midwifery (Obstetrics & Gynecology) require improvement (in terms of
training, equipment, etc) in this community?
………………………………………………………………………………………………….
Thank you for your participation
