Effect of Antenatal Digital Risk Assessment on Women's Perceptions of Maternal Referral System Functionality in Siaya County, Kenya: A Randomized Controlled Trial
DOI:
https://doi.org/10.47604/jhmn.3706Keywords:
Functionality, Maternal, Referral System, Digital Health, Risk Stratification, Antenatal CareAbstract
Purpose: Over the past two decades, global maternal mortality has decreased by 34%, from 339 to 223 deaths per 100,000 live births. However, the rate of decline has slowed, and remains insufficient to achieve the Sustainable Development Goal (SDG) 3.1. This study aims to evaluate the effectiveness of a digital antenatal risk stratification tool in improving the functionality of maternal referral systems in selected healthcare facilities, with the goal of enhancing maternal and neonatal health outcomes.
Methodology: A randomized controlled trial (RCT) was conducted in level 4 healthcare facilities. Eligible pregnant women were randomized into an intervention group or a standard of care group with an equal sample size of 175 in each group. Modified Coopland’s Scoring System was employed to categorize maternal risk levels. Descriptive and inferential statistical analysis to summarize the data. Multivariable logistic regression was employed to evaluate the impact of the intervention on the functionality of a referral system controlling sociodemographic outcomes and mode of delivery.
Findings: The median age was 26 years (IQR:23-31) in the controls and 25 (22-29) in the intervention group (p-value=0.039). SVD was the most common mode of delivery in both groups. Significant higher proportion of participants reported adequate human resource support during referral in intervention group as compared to the standard of care group (p-value < 0.001). Overall, 27.7% reported the system as function, all of whom were in the intervention group. Functionality of the referral system was associated with assignment to the intervention group, household monthly income of KES 10,000-50,0000 and delivery through caesarean section.
Unique Contribution to Theory, Practice and Policy: Digital interventions can strengthen maternal referral systems by facilitating timely and appropriate referral of high-risk pregnancies, which suggest that establishing a national digital referral coordination framework to enable real-time tracking and accountability and integrating risk stratification tools into routine antenatal care protocols could improve perceived quality of the referral system within Siaya county.
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