Smartphone Solution to Infant Mortality Awarded Gates Grant

A doctoral candidate at the School of Public Health is part of an international team of researchers that has been awarded a $250,000 grant from the Bill & Melinda Gates Foundation for a project that uses smartphones to reduce infant and maternal mortality in Kenya.

Louis Fazen, who is currently in his sixth year of the M.D./Ph.D. program at Yale and a student in the division of Epidemiology of Microbial Diseases, is part of a research group based in the east African nation that was recently awarded a Grand Challenges grant for their “Saving Lives at Birth” project.

Fazen and colleagues will work with The Academic Model Providing Access to Healthcare, a government program to combat HIV, and the Kenya Ministry of Health to train and support Community Health Workers (CHWs) to address the rising level of maternal and infant mortality. The grant funds the development of an information technology system that utilizes cutting-edge technology to foster rapid communications and feedback between mothers, their communities and their health care providers.

This Mother-Baby Health Network will use the phones to facilitate home and group-based care through CHWs and to improve collective advocacy. It will rely on an electronic medical record system that can be sent directly to CHWs using Android smartphones, allowing women and their newborns to be correctly triaged for care.

“Addressing these health needs requires a rapid and efficient information management system that extends from health facilities to individual households, crossing over geographic and socioeconomic divisions,” said Fazen, who currently lives in Eldoret, Kenya. It will, he said, provide communities with the information and communication tools they need to ensure that every mother and child has access to essential care at time of delivery and within the first 48 hours of birth.

Integrated with text messaging, the Mother-Baby Health Network will also be capable of notifying health care providers, alerting nearby GPS-tracked Mother-Baby Taxis in an emergency transport system and activating a personalized community of Mother-Baby Advocates to mobilize local resources. The Mother-Baby Health Network seeks to strengthen dialogue between communities and facilities to create a sustainable, community-driven demand for accountable maternal and newborn care at all levels of care.

Infant and maternal mortality remain serious public health issues in Kenya, Fazen said. The World Health Organization estimates that 77 percent of all maternal deaths occur within the first 48 hours of delivery, and the most recent Kenya Demographic and Health Survey indicates half of the mortality under 5 years of age now occurs in the first week of life. In the Rift Valley less than half of women receive a postnatal check-up and only 15 percent receive a postnatal check-up from a health provider within 48 hours of delivery. Moreover, the proportion of both facility deliveries and attendance by skilled providers in this region has continued to decline since 1989, while women increasingly deliver in their homes in the presence of a friend, relative or simply alone.

As a result of these trends, maternal mortality remains the leading cause of death among women of child-bearing age in Kenya. United Nations interagency figures indicate that maternal deaths have steadily increased from 380 to 530 per 100,000 live births, marking Kenya with one of the highest rates of increase (38 percent) between 1990 and 2008.

“Louis has designed a great project with both a randomized controlled trial and a qualitative component,” said Elizabeth Bradley, a professor at the School of Public Health, director of Yale’s Global Health Leadership Institute and Fazen’s adviser. “If the mobile phone intervention works, he will also find out a lot about implementation too—hopefully contributing to the development of best practices in this emerging field.”

The other members of the research team are Astrid Christoffersen-Deb, M.D, of the University of Toronto; Laura Ruhl, M.D., of Indiana University; and Julia Songok, M.D., of Moi University in Kenya

The Grand Challenges grants are highly competitive. From over 600 applicants, 75 finalists were selected to complete the final stage of the Saving Lives at Birth program, and 19 were selected as award recipients. Applications are received from across the globe – including from non-profits, faith-based organizations, universities and private enterprises.