A 3 arm randomized cluster trial of mMitra and Arogya Sakhi home-based care projects in 250 villages of rural Maharashtra funded by DFID, UK

 

In January 2013, we began a 3 year randomized cluster trial of mMitra and Arogya Sakhi home-based care, with our partners, Swayam Sikshan Prayog (SSP) and iPartner India, in 250 villages in three districts of rural Maharashtra.

 

Aim: To determine whether improved access to preventive information during pregnancy and first year of child’s life through a mobile phone voice messaging and animated film service (mMitra) combined with improved access to after work-hours home based investigation and care during the antenatal period and infancy through trained health friends (Arogya Sakhis, also called Maitrins) leads to improved health outcomes among rural underprivileged pregnant women and infants.

 

Study Design: 3 Arm Randomized Cluster trial over three years.

 

Study population: Rural pregnant women and mothers with infants.

 

Study area: 250 villages in 3 rural districts [Osmanabad (100 villages), Washim (50 villages) and Solapur (100 villages)] of Maharashtra, India.

 

The three cluster arms (randomization unit: one village panchayat) are as follows:

 

Group A: Control group: 84 villages

 

Group B: Improved access to preventive information: mMitra group (voice messages and animations): 83 villages

 

Group C: Improved access to both preventive information (through mMitra) and after work    hours home based investigation and care (through the  Arogya Sakhis): mMitra and Arogya Sakhi intervention group: 83 villages.

 

 

Steps accomplished until May 2014:

 

  1. Preliminary needs assessment and baseline data collection in 500 randomly sampled women with children under age one in months 2-5 (2 respondents from each village).
     
  2.  Simultaneous Preliminary Qualitative Research in 40 villages (35 in - depth interviews of village elders, women, health workers) and 4 focus groups of pregnant women and mothers) to further understand the current behaviours and attitudes of the population to create messages tailored to the contextual needs of the village women. 
     
  3.  Randomization of 250 villages in the three districts into three arms
     
  4. Creation of training modules: 10 training modules (2 days each) for provision of home based antenatal care and postnatal care for the mother and care during infancy have been created. The antenatal training modules are on typical antenatal visit, haemoglobin test, urine test for sugar, proteins and infection, blood pressure measurement, blood sugar testing, abdominal examination of a pregnant woman to monitor growth of the fetus and fetal heart rate monitoring, recognition of danger signs and prompt referral. The infant training modules are on typical infancy visit, correct breastfeeding technique, detection and treatment of neonatal jaundice, treatment of diarrhoea and respiratory conditions, recognition of danger signs and prompt referral.
     
  5. Training of Arogya Sakhis: 83 Arogya Sakhis from group C have undergone in house 20 day training to provide home-based antenatal and postnatal care including investigations and currently undergoing onsite training.
     
    An Arogya Sakhi learning to perform to perform blood sugar test
    Arogya Sakhis in training
  6.  Mobile phone enrolment forms and antenatal, postnatal and infancy cards have been created on the SANA platform. The field supervisors will enrol women into mMitra through the mobile phone enrolment forms. The antenatal cards encoded into the mobile phone with the Arogya Sakhi will prompt the Sakhi regarding the signs and symptoms to be looked into, examination to be done and diagnostic investigations to be performed in the visit for that particular month. The sakhi will input her findings into the mobile phone form and she will receive prompts when referral is required. The investigation reports will also get transmitted from the mobile phone through the backend to the doctor of the project. The doctor will be sent alerts when any test for a patient is abnormal so that she can ensure that the Arogya Sakhi has discharged her duties properly and the woman has been properly referred.
     
    Data sent to the doctor including alerts
  7.  The technology of mMitra has been created based on Asterix telecommunication system, a LAMP server and PRI card system
     
  8. The voice messages have been created in Hindi and Marathi.
     
  9. Enrolment of women into the RCT has begun.
     
  10. Home based care is being provided to the enrolled women in Group C and mMitra voice calls are being sent to enrolled women in Groups B and C.