live from SR pilot

The photos show Maame-Yaa working the field, and the team de-briefing. During the pilot the team collected lots of suggestions for register tweaks and some learning about workflow and how to integrate mobile data entry into this process.

Music!: MoTeCH Pregnant Parents App

We’ve heard time and again over the past few months that music is central to Ghanaian culture and could be effective in its application to encouraging health seeking behavior in pregnant parents. To this end we have engaged a singing group in the Upper East Region to perform some songs related to pregnancy in the 2 major local languages, Nankam and Kasim. These songs will be featured in the audio messages made available to parents through phones as part of the “pregnant parents application”. For your interest, a translation of the songs is below, you can listen to a snippet on you tube, and there’s a photo of the singing group attached.

NANKAM

First Song: Antenatal Care

If a woman is pregnant and agrees to go for antenatal clinics and takes all the necessary injections, on the day of her delivery she will deliver safely and a healthy baby as well. This will make her husband happy. This is an advice to all pregnant women and potential mothers.

Second Song: Exclusive Breastfeeding

When you give birth don’t give water to the baby, the doctor said it. When you give birth don’t give water to the baby, the nurse said it. One breast is food for the baby. One breast is water for the baby. Giving the baby good health until six months.

KASIM

First Song: Antenatal Care

If a woman is pregnant, she should attend ante natal clinics for it has great benefits. If you do this on your day of delivery you will give birth to a healthy child and safely.

Second Song: Care Seeking Behavior

The health workers are here for us (the CHOs, community health volunteers and all health workers) to help us and our new born babies. All men should wake up and help us help us achieve this so we can get more help. Men should help their wives go for antenatal care and take their children for child welfare clinics.

BBC: Maternal mortality across the world

Last week, BBC had an interesting piece looking at maternal mortality around the world, including a video of a bicycle ambulance that is anecdotally reducing maternal mortality to zero in one village. I thought this piece would be of interest to everyone:

http://news.bbc.co.uk/2/hi/africa/8320781.stm

"Pregnancy Diaries" from Gaani, UER

On my first visit to Navrongo in July I worked with the health workers in one of the CHPS zones to invite a few women to keep “pregnancy diaries”. Below and attached is a summary of the issues raised.

 

We asked the women to record any issues on their minds related to their current or former pregnancies and their babies. Unfortunately we had not yet received Aliya and her shipment of voice recorders J so we could only ask literate people to take part, so the results are by no means representative. However, they are quite fascinating! Info like this will be very valuable for tailoring PP app content. My general takeaways:

-          It’s great to see questions that we can deal with not only about health issues but also the practice of care-seeking in general (eg the question about child records).

-          The questions reveal the real influence of local myths (eg confusion about value of fruits, night bathing and sleeping on your back) and traditions (eg eating sand).

-          I think it’s quite interesting how committed the women were to keeping their diaries, with so little encouragement over time and no incentives given except for answers to their questions (we committed to answering every question they asked) - an encouraging sign that there is a thirst for information out there.  

 

As an exercise it was all a bit ad hoc but I’m so happy that we’ve been able to hear directly from our customers in this way! I hope the below give us some good early insights, and I look forward to building upon this in a more systematic way as we get Navrongo ramped up over the coming weeks.

 

Jess

 

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Problems Encountered During Pregnancy

-          Feeling Dizzy

-          Sleepless night

-          Swollen legs

-          Feeling pains on the ribs

-          Vomiting after eating

-          Severe headache

-          Body pains

-          Some feel lazy

-          Discharges in the vagina

-          Abdominal pains

-          Pregnant while bleeding

-          Women do encounter several problems during pregnancy – for instance, headaches, vomiting, swollen legs, menstruation and others. Why?

-          During my time of pregnancy I always had pain under one of my breast why?

-          Why is it that you have headache when you are pregnant?

-          Why swollen legs when pregnant?

 

Questions about Pregnancy

-          I want to know why one may give birth to only boys or sometimes girls.

-          Why do you say that fruits are good meanwhile our local people are against that?

-          Why is it that the baby struggles in the womb and does not spoil the womb?

 

Advices during pregnancy given to us by people in our homes. Are these right?

-          Some foods like flour, pork, mudfish, leftover T.Z. are not to be taken.

-          We should have sex with our husbands in the seventh months.

-          We should not sleep on our back.

-          We should not sleep outside when the weather is cold.

-          We are not to be eating fruits.

-          We should not bath in the night.

 

Babies

-          In association with the children, when they are about to develop fresh teeth, they begin to fall sick, experience stomach aches, some unconsciousness, dysentery, followed by malaria. Why?

-          The diseases that usually affect us here are malaria and diarrhoea.

-          Why should they say children should not eat fruits, for they will be attacked by fever but in your [health workers] instruction, you say children should take fruits, why should you say that?.

-          Why is it that when you get malaria sores are always found around you mouth?

-          They say children should be taking eggs, what is the purpose of that?

-          The child health records that we have, please can you tell us the purpose of it?

-          What kind of disease is called kwashiorkor?

-          Feverish condition

-          Vomiting

-          Running diarrhoea

-          Body weakness

-          Crying

-          Things I think are good for my child: Fruits are good, Exclusive Breast feeding, Fruit juice, groundnut, millet and Beans are good for the child. Because of all this we and our children are suffering too much because if you are pregnant some people say that don’t eat fruits like mango and others.

 

Foods that I mostly eat when I am pregnant.

-          Eating a lot of White sand

-          Eating of plenty salt

-          Eating a lot of T.Z and vegetables and groundnut soup

-          Eating a lot of baobab fruits

-          Shea nuts, oranges, water melon, banana and sugar cane

-          Eating a lot of okro stew and Banku 

 

Reasons for pregnant women not allowed to sit one way or lie on their back

-          The baby may die in the womb

-          It may also be difficult for you to give birth

-          It may also cause sickness to the pregnant woman too.

Article: Soil-transmitted helminthiasis

The practice of eating clay, charcoal or soil is common, particularly amongst pregnant women and babies, in this region. I was interested to recently learn how damaging this is for health, particularly for a pregnant woman. Intestinal helminths transmitted through the soil can cause or worsen anemia. In developing countries anemia has an extreme impact on maternal mortality and morbidity, with some studies estimating that 20% of maternal deaths in Africa are attributable to anemia or its related illnesses – it is associated with increased risk of hypotension, tachycardia, preterm birth, and delayed social and emotional development in the child.

 

Here are some articles about this issue which I found interesting:

http://tps.sagepub.com/cgi/pdf_extract/26/3/167

http://linkinghub.elsevier.com/retrieve/pii/S0035920398909105

http://www3.interscience.wiley.com/journal/118667618/abstract?CRETRY=1&SRETRY=0

http://emedicine.medscape.com/article/996482-overview

 

Jess

Ghana: Pregnant Women Turn to Prayer Over Medicine

A while back, I stumbled upon an interesting article titled "Pregnant Women Turn to Prayer Over Medicine"

I wanted to share it with the whole team, because it has some interesting information for the work we're doing and can really inform the design of the MoTeCH system and content delivered by MoTeCH to pregnant parents.

Soon after arriving in Ghana, Jess noticed the importance of appealing to the religious nature of individuals here as a way of fostering adoption, comfort and interest in content we will be delivering to pregnant parents with MoTeCH. I think this article validates Jess's instincts about the value that this could have. It's also very clear that we need to balance this closely with providing really solid scientific and medical information (which was always our goal) to ensure women begin to have a more accurate and complete understanding of health issues in pregnancy.


Jess and Kirsten both pointed out the fact that this article also indicates a strong need to educate expecting families that maternal care is free in Ghana. This is something we can address with reminders in our content throughout the pregnancy that free services are available through delivery. This is clearly low-hanging-fruit which we can address and hopefully with this education, we will see an increase in the number of women seeking ANC at facilities.

Video of MoTeCH song

As promised, here's the video of local artists singing the MoTeCH song!

http://www.youtube.com/watch?v=fSV9Qo_InpA