MoTeCH writeup on local ghana tech site

Someone on the Ghana Software Developers mailing list saw a job posting and description of MoTeCH I put up on the list, took it upon himself to learn more about the project, and wrote a nice write-up about it here:

http://www.233tech.com/2010/02/unwired/motech-using-mobiles-for-maternal-health/

Nice to see excitement about what we're doing here locally from individuals completely outside of the project!

Women & Mobile Phone Usage

Some interesting statistics regarding women’s mobile phone usage and access below. This presents a challenge to our immediate work, and an incredible opportunity for the future.

·         There are 300 million fewer female subscribers than male subscribers worldwide

·         A woman is 21% less likely to own a phone than a man in low and middle-income countries - 23% in Africa, 24% in the Middle East, and 37% in South Asia

·         Going forward, two thirds of potential new subscribers for mobile network operators will be women

·         Women in rural areas and lower income brackets stand to benefit the most from closing the gender gap

·         93% of women report feeling safer because of their mobile phone

·         85% of women report feeling more independent because of their mobile phone

·         41% of women report having increased income and professional opportunities once they own a phone

Source: www.cellular-news.com/story/41986.php?s=h

 

 

More Pregnancy Diaries

More fascinating questions from our pregnancy diary ladies. We managed to get some fathers involved this time – lots of varied questions from them. We’re continuing to learn from these diaries and using the questions asked to inform the final edits to Pregnant Parents’ app content.

 

A.      Faustina

1.       Why is it that a pregnant woman will vomit seriously in the labor ward even though she did not vomit during pregnancy?

2.       Sometimes after delivery, some babies vomit the same as the mother did?

3.       Why is it that a pregnant woman can easily get annoyed?

4.       Why is it that some pregnant women do not want the smell of petrol?

5.       If you are pregnant, and are about to give birth, your whole body will be hot. Why is it so?

6.       When you give birth, the baby’s body is always hot. Why is it so?

7.       What kinds of food will you give to the child to ensure a healthy growth?

8.       What kinds of food should a lactating mother eat to the make the child healthy?

9.       When you are a nursing mother, they tell you not to eat rice. What is the reason for that?

10.   When you give birth, they tell you not to drink cold water. Why is it so?

 

B.      Doris

1.       Why is it that when you are pregnant, you are not allowed to lie on your back?

2.       When a baby gets to eight months, you are not allowed to give him/her T.Z because they say it will make he/she not able to walk?

3.       Our mothers tell us not to eat mangoes when we give birth. Why is it so?

4.       Why does a child react or cry when you throw it up knowing that it doesn’t know anything. Is it that the child knows about fear or death?

 

C.      Abena

1.       Why is it that during the month of December, there is always a lot of wind and dust all the place?

2.       Why is it that there is a lot of cold during this period?

3.       I have noticed that during the month of December–April, a lot of people get disease like CSM, T.B and whooping cough and people end up losing their lives. Why is it so?

 

D.      Hellen

1.       What is the new Flu, what are the signs and how can one protect him/herself from getting it?

2.       What can I do so other people don’t get it?

3.       In our local communities, people say it not advisable for a pregnant woman to eat fresh      meat for the child will grow fat and will have to be operated upon during labor. Is this true or not in your own view and is it good for the pregnant woman to eat fresh meat and why?

4.       What is night blindness and what can one do so that I don’t get it?

5.       When a child is running diarrhea in my community, they tell us not to give the child water but the nurses tell us to give water. Why?

6.       When a child has measles in my community, they tell us not to allow the child to sleep and also not to bath the child but the nurses say it is advisable to bath the child and let it sleep. Why?

 

E.       Mavis

1.       Why would a pregnant woman have swollen face and legs?

2.       Why is it that when a woman is pregnant, she experience severe abdominal pains?

3.       My child had convulsion when I gave birth. Why is it so?

4.       My baby had sores in the tongue, and mouth but the drug given at the clinic did not work and I had to use local treatment (i.e. burn Neri, grind it apply it on the sores).

 

F.       Ruby

1.       What causes high fever? Is it a lot of thinking?

2.       Can you please explain why twins are now common because it was said that twins were inherited?

3.       May I know whether it is normal for a woman not to have her period in about six months or one to two years after giving birth and what is the cause?

 

G.     Monica

1.       There is a pregnant woman in my community who complains of joint pains and swollen legs. What is the cause of those pains?

2.       There is a nursing mother here who complains of her baby having hot body, malaria and stomach pains. Can you tell me the cause?

 

H.     Justice

1.       What causes elephantiasis?

2.       Has catarrh got a treatment?

3.       What causes high blood pressure?

4.       What are some of the food for one who has low sperm count?

5.       Is it true that a man can have intercourse with an HIV woman without getting the disease?

6.       People like taking paracetamol if they are to drink a lot of alcoholic drinks so as to reduce the effect of the alcohol. Is it right? What advice can you give?

7.       People say that there are no drugs for the treatment of jaundice. Is that true?

8.       How long does it take to show that one has HIV even if the person did not go for testing?  I mean what are the sign and symptoms of it?

 

I.        Oliver

1.       Why do children usually have convulsion and the locals give marks on the baby’s body and face to stop it?

2.       Why is it that when a child gets convulsion, a woman or the baby’s mother is not allowed to handle or hold the child?

3.       Why do babies cry and have stomach upsets?

4.       Why do pregnant women have loss of appetite and waist pains?

5.       Some pregnant women have itchy bodies such that they can’t even bath especially in the night. Why is it so?

6.       One woman has bodily pains in the third month of her pregnancy, what is the reason?

7.       Some women frequently come to buy drugs for diarrhea all the time for the same child and the same sickness. What is the cause?

8.       Some babies gain temperature in the night, coughs and cries a lot in the night. What is the reason?

9.       There is a child in Gaani here who is just one month and four days old but has dysentery, is always hot and does not sleep in the night. What is the cause of that?

Pregnant Parents' Content Pre Testing

The first of many pre-testing sessions to come, this taught us a lot about the importance of finding the right voice, reading speed, and dialect. It was also our first opportunity to really get pregnant parents’ ideas about how they think the service might be able to help them.

_____________________________________________

Pregnant Parents App Pre-Testing Focus Group I
Gowrie

23^rd January 2010.

 

Method

Translated Pregnant Parents’ app content was played in the local language (Nankam) to a group of approximately 20 people. Recordings were as follows:

1. Male voice, late 30s
2. Female voice, late 30s, fast and strong voice
3. Female voice, early 30s, slow and soft voice, background noise (pounding fufu, babies, etc)

 

Mobile Phone Ownership

• 4/11 participants owned a mobile phone
• 3/11 participants did not own a mobile phone but had access to one either within or outside the compound or household
• 4/11 participants had access to phone but not necessarily within the household

 

Feedback on Voice recordings

 

1. Male voice, late 30s

• The man’s recording was not clearly understood because he used the real indigenous language which is hard to understand because most pregnant women are intermarried from other communities and tribes
• Participants preferred an adult female voice since she has the experience of child birth and will talk about it more comfortably thus more educative.
• Men wanted to be able to listen to the messages together with their spouses so they both get informed and help each other interpret the messages. They said they would like it if some messages came from a male voice but they were also comfortable with a female voice.
• Some thought the language was too deep and too complex which makes it hard to bring the message out more clearly

 

2. Female voice, late 30s, fast and strong voice

• Very fast but women were able to pick the message
• A pregnant woman was able to interpret and explain the message from the recording

 

3. Female voice, early 30s, slow and soft voice, background noise (pounding fufu, babies, etc)

• Dialect more clear
• Background noise distractive to the listeners
• Slow speaking is boring to the pregnant women and it made them dose. It wasn't engaging and didn't sound natural. The lady sounded like she was reciting notes or just reading. She didn't sound experienced nor comfortable with what she was saying

 

Recorded song

• People were not able to pick the message out of the song because the words were not clear probably due to the rough recording.
• Preferred to get information using voice recordings as opposed to receiving information in a song. However the idea is welcome every once in a while.
• The sound of the song is familiar to the local setting
• Wanted to receive information on their radios in addition to the mobile phone because every household has access to one unlike the mobile phone.

 

Registration for PPA app

·         Want nurse to register them to help them establish due date etc. Comfortable revealing pregnancy to nurse, not to others in community.

·         Some say they would be comfortable giving information to CHVs. Comfortable revealing missed menses. Other said they would confide in health worker but not volunteer.

·         Sometimes worried about calling in even if told number is toll free.

·         Can flash and call.

·         Better to have the nurses register the patient because of confidentiality and trust.

• If the registration service is a free service for the woman, it would be easy for a woman to register herself with the call center.
• Calling the call center to get register is another confidential way to have women register on the service. Women liked the idea.
• Language used for registration: women want to be able to register themselves using their local languages. The languages vary according to where the patient comes from.

 

Preferred time to receive message

·         Saturday in the morning because everyone is at home then

·         8:30 in the night  - woman would have finished cooking

·         Someone said that her man has a phone and goes to work with it – he returns after she has left so no access to phone

·         6am – better time to move around than evening – for shared phones

 

Perceived benefits of receiving weekly messages

·         If message is listened together with husband, it will help them in the way they take care of their kids and pregnancy.

·         Educates you on what to do when pregnant. Certain things make you scared but messages tell you what to do, will encourage men to help you get to clinic to get help.

·         Process very educative – women learnt new things.

·         Will help ease arguments between woman and man.

·         Reminders about what to do and what not to do.

·         Listening to messages could encourage her to go to clinic about some of the things which make her scared.

• Messages will serve as reminders to her on certain things she might forget e.g. what to eat, when she should go for hospital visits.
• Said it would encourage them to go to a clinic especially if they see some of signs of danger pregnancy talked at in the messages.

 

Pregnant parents concerns and questions

·         Want nurses to receive same information so they can discuss at ANC.

·         Want a health worker to receive the call.

·         What language will call center operators speak – need local language.

·         Want information for child health as well as pregnancy.

·         Another asked if they can call helpline when sick before going to see nurse for medical help.

·         Its good to come back as MoTeCH team to interact with them from time to time

·         Preferred name for service: “Asungtaaba” (“let’s help each other”) or  “emaasum viisigu” “Health investigators”

 

Ghana's first CHPS nurse talks about MoTeCH

I posted a youtube video of Cecelia Adah, Ghana's First CHPS nurse, talking about how MoTeCH could be used to increase compliance of Intermittent preventive treatment (IPT) of malaria in pregnancy, using a drug called SP.

It is recommended that pregnant women living in areas of high malaria transmission take 3 doses of SP during their second and third trimesters of pregnancy to reduce the impacts of the malaria parasite on the mother and baby, resulting in a healthier pregnancy and healthier baby. In the Upper East, many women get their first dose of SP, but compliance drops off a lot for the second and third doses. With MoTeCH, we can proactively remind the nurses to follow up on pregnant women who are overdue for their next dose of SP, hopefully increasing the proportion of women who receive all 3 recommended doses.

Nurses' Phone Survey

A survey of nurses’ phones was conducted in order to ascertain the proportion of those with java-enabled phones. This information informs us as to the feasibility of nurses being able to use a java application on their phones. Data regarding telco operator use is also informative as a proxy indicator for network reliability in the area, pricing, and popularity. Information regarding handset manufacturer shows us something about which handsets nurses might easily and quickly adapt to, should new phones be introduced to them. Raw data is accessible here.

 

Main findings:

-          89% of nurses have MTN lines

-          60% of nurses have Nokia phones

-          20% of nurses have java-enabled phones

 

 

Full Report

 

Sample

95 nurses in KND and KNDW

 

Results

 

Java

For 76 of the nurses surveyed we were able to ascertain if their phone is java-enabled. Of those 76, 20% have java-enabled phones, 80% do not.

 

Lines

89%: MTN

7%: Vodafone

1%: Tigo

1%: Stolen

1%: No phone

 

Make

For 85 of the nurses surveyed we were able to ascertain phone make and model. 60% of the sample had Nokia phones, making it the most popular by far. The Vodafone promotion phone was the second most common make (11%). Breakdown of nurses phones by make are as follows:

 

Make	%
Nokia	60
Multimex (Vodafone promo)	11
Motorola	6
Acatel	4
Sony Ericsson	4
NEC	2
Blackberry	1
G-Tide	1
Hamer	1
Huawei	1
J-man	1
LG	1
Sagem	1
Samsung	1
Seimens	1
Tecno	1
Toshibo	1
ZTE A20	1

 

 

 

SMS Model Testing

We recently did a field testing to ascertain the appeal of using SMS for PP app messages. We hear time and again that the literacy issues in Ghana are such that sending messages by voice is crucial to the success of our work here. Yet, supporting SMS is cheaper and in some ways technically simpler than voice. Plus, literacy stats rarely give indication of level of proficiency in a language, or indications of local language literacy. This small field exercise aimed to shed some light on this. The exercise is by no means scientific but gives us some indications to work from.

 

Summary of findings:

-          50% of people approached could not read either English or local languages

-          86% of those who were literate chose to read English rather than local languages

-          Participants’ level of understanding of written messages was accurate in all cases, but often only the main message was deduced, with some details missing.

 

Implications:

-          Illiteracy is prevalent amongst our target demographic in UER so there is value in supporting IVR

-          Literacy mainly relates to English (local languages are oratory in origin and rarely written)

-          The level of understanding of written messages may be more rudimentary than for audio messages, although it is difficult to draw conclusions on this without a direct comparison with voice.

 

Full Report

The SMS model testing exercise took place on the 3^rd of December, 2009 in two local communities in UER, Pungu and Doba. The exercise intended to assess the accuracy of people’s understanding of written messages, in order to attempt to reach a decision regarding the value of investing in audio messages for users of the Pregnant Parents’ application in addition to making these available by SMS.

 

Respondents

-          Respondents were selected from all age categories

-          14 randomly selected participants (mostly over 40 years old) were approached but were unable to take part as they could not read in either English or local languages.

 

Language Preference

-          Kassim: 2 respondents chose to read messages written in Kassim and provide verbal explanations of their interpretations of the messages in Kassim

-          English: 12 respondents preferred to read messages written in English. 4 provided verbal interpretations of the meaning of the messages in Kassim or Nankam, the remainder provided their explanations in English.

-          Nankam: no one from the Nankam community could read Nankam

 

Comfortability Reading Messages

-          Most of the women could not fluently read text messages and missed out some words in some of the messages.

-          2 respondents needed us to display text on the PC instead of a phone because they did not have their reading glasses with them and so we had to increase the font size for them to be able to read the messages.

-          Many pregnant women were not able to take part in this exercise as they were not able to read any language.

 

Interpretations

Respondents who could read were mostly able to understand the main points in the messages. In several cases more in-depth information was missed. Those who read messages in Kassim seemed to have a more detailed understanding of the messages.

 

Message Shown

Regularly attend ANC even when you don’t feel sick because things can change without you knowing. No matter how busy you are, make time for it.  A minimum of 4 ANC visits is recommended. The first visit should take place as soon as you suspect you are pregnant and you should make three visits after quickening (first noted movement of the baby your womb.)  This will enable the midwife help detect and solve any problems that may arise as well as help you deliver a healthy baby.

 

1. Lady 23 years (read in Kassim)

This means it is good that when you are pregnant or realize that you are pregnant, you start attending ANC all the time and you should attend at least 4 times before you deliver. This will enable the nurses detect any problem in your pregnancy and help you and your baby be healthy so that you can deliver safely or deliver a healthy baby.

                Analysis: captured the main points accurately.

 

2. Lady 24 years

It’s like if you are pregnant, you should always be going to the ANC even whether you are sick or not.

Analysis: correct. Main point understood but lots of detail missing.

 

3. Pregnant lady about 20 years old

They are trying to tell me that even if I am not sick, I should attend antenatal.

Analysis: correct. Main point understood but lots of detail missing.

 

4. Young lady 28 years

I understand it as if you are pregnant, you should try as much as possible to attend antenatal clinics, and it can help you deliver safely. Secondly, when you give birth, it will help you look after the child well so that it will not be getting sick all the time.

Analysis: Main point understood.

 

 

Message Shown

It is good to feed well during pregnancy. Meat, fish and poultry give you essetral (essential) protein which makes the body grow. If you are vegeltations (vegetarian) or do not want to eat meat, eat a fistful of nuts every day. Foods like beans, nuts and peas are also good. Drink lots especially water and fruit juices e.g. coconut, oranges but do not drink too much of packaged fruit juice as it has a high sugar content.

 

5. Lady 50 years

It means the kind of food a pregnant woman should eat like I have red meat, fish and coconut that will make her healthy.

Analysis: correct. Main point understood but lots of detail missing.

 

6. Lady 35 years

Respondent could not explain the content or meaning of the message she read either Kassim or Nankam.

Analysis: no understanding

 

7. Lady 27 years

That it is good to feed well especially when you are pregnant. It helps you to grow and it helps the baby too. The vegetarians too don’t want to eat meat. Fish meat and fruits and it help you to grow.

Analysis: main points understood. Misunderstanding of some text.

 

8. Lady 18years

It is trying to tell us that if you are pregnant, we should eat protein foods like meat, Beans which can help the baby to grow well and have healthy heart to the pregnant woman. You can eat sugar but not too much because it can cause danger to the baby inside.

 

Message Shown

Missing your period is a sign of pregnancy but a test will be required in the clinic by the midwife /doctor to confirm. Your health and that of your baby is very important. To ensure that you are starting your pregnancy on a good note and to avoid possible complications during pregnancy, including miscarriage and stillbirth, consult a health care provider as soon as you are pregnant.

 

9. Lady 22 years

I will simply tell her to go to the hospital for a test. May she does not know she is pregnant and if she goes and confirms that she is pregnant, the she will go for ante natal care.

Analysis: main points understood

 

10. Nursing mother 36 years old (read in Kassim)

The message means that, if you miss your period, it means you are pregnant but you need to go for test at the clinic to confirm that you are really pregnant. If that is confirmed, you would have to go for ANC for regular check up to ensure a healthy pregnancy and keep your baby healthy. To me it’s trying to say that it’s a must to go for ANC when you realize you are pregnant for it is good for you and very good for the healthy growth of your unborn baby.

Analysis: good understanding of meaning

 

 

 

11. Lady 25 years

The message is saying that if you miss your period and don’t know what is happening, you go to the hospital so that the doctor will confirm.

Analysis: main point understood

 

12. Nursing Mother 19 years

Respondent says that, she would give it some one to explain the meaning of the message to her but she doesn’t know what it means.

Analysis: no understanding

 

13. Nursing mother 29 years

It is trying to explain that, if you miss your period, you may be pregnant but you can go and confirm that by a test at the clinic. It is also telling us what to do during the pregnancy to stay healthy.

Analysis: main point understood. Reporting of some information which is not given.

 

14. Lady 20 years

What I understand is that if you miss your period, it means you are pregnant but it’s better to see your doctor to confirm and if it is pregnancy, you have to ask the important things you will do for the pregnancy to stand well.

Analysis: good understanding