Field photographic and cartoon approach testing

Overview

We tested both approaches with 11 women and 9 men at Wagliga CHPS compound and Chaina health centre. These were divided in 2 separate groups to enable both genders share their views more comfortably. In general, men seemed to interprete the pictures more accurately as opposed to the women. Men also seemed more literate and could read a few words unlike their female counterparts.

Cartoon Vs Photos

Photos were preferred to the cartoons and these were interpreted more accurately. Photograph (d) below, “Helping baby grow” was most loved. Coincidentally both sexes chose it as their best. While women liked it because they admired the healthy, smiling babies while men liked it because they learn from the picture what they need to provide for their own babies to look like them. Men also mentioned that the children in the picture are well taken care of by their parents by the way they look. Women wanted their children to be like them.

Most disliked by the women was the 080 020 6001 picture because they were seeing people making their own phone calls. Men disliked the 6001 picture most because to them all the people in it looked sick!

Documented below are responses got to each picture. Male responses in italics.

Cartoon approach

080 020 6001

• Not Ghanaians from the dress code
•  See people holding their phones
• Don’t know why they are calling and who it is
• They see a number to call in case of an emergency e.g. fire, ambulance
• A boy standing holding his ears
• People are standing in a queue
•  Pregnant woman making a call
•  A man is sneaking into a man’s phone call
• There are 2 young unmarried ladies

6001

• They see a pregnant woman, a doctor, 2 friends and a mother
• These are people at an outreach
• Didn’t seem to get the whole picture of people Smsing
• Mother talking to her baby
• Mother going for ANC
• Mother calling for help because she is labour
• They are reading a text message
• They look like modern Ghanaians
•  One of the girls feels shy to say something they want to say

Hotline

• Breastfeeding woman and mother trying to make a phone call
• “Here most women don’t have phones,” said one of the women
•  Calling someone but they are not sure who. It could be a doctor or a nurse
• Pregnant woman is in labour
• Mother with child is taking her child for immunization
• "May be they are calling their husbands,” said one of the men present

Photographic approach

a.      Breast milk

 

 

• They see a breast feeding mother
•  A woman who wants to fight
• A woman waving bye
•  Didn’t see the water bottle
•  Woman with baby looks happy
•  Woman waves hand to reject a message
• Woman looks like she wants to take some water

 

 

b.      Start breast feeding baby

 

·         Mother lying down for a baby to suck

·         Why is the mother lying down while sucking? She is supposed to sit.

·         Baby is too old for a new born

·         They didn’t see/notice the nurse in the picture nor the watch

-          Mother and child sleeping

-          Child has breastfed and slept

-          Woman’s breast look heavy indicating that baby was not born long before

-          Baby appears to be troublesome and mother has to breastfeed while sleeping

-          Looks like there is a person supporting or examining mother’s breast

c.       The best protection

 ·         Kind of food to give the baby

·         2 healthy babies

·         All this food is not available here

·         "Poverty can’t let us buy this food but it’s good to know in case we get the money we can buy,” said a pregnant woman.

·         These look like Ghanaian babies

-          One baby breastfeeding and the other eating because he is older

-          Breastfeeding child is healthier that’s why the other mother is giving the baby food so he becomes like the breastfeeding one

-          Mother is feeding older child with other healthy foods

d.      Helping baby grow

 

 

·         Very nice healthy babies

·         Babies playing together

·         Babies are fat because they eat healthy foods

·         “Our babies are not as healthy because of poverty” lamented an old woman

·         “We have no time to buy these foods” said another.

·         They can see fish, eggs, black tea, groundnuts, beans, palm oil

-          Children are playing happily with their toys

-          There are different foods infront of the children

-          The children are satisfied and happy

-          It means the children are eating well

-          “It means we should give and healthy food to our children,” said one of the men.

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