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Preventing Infant Deaths: Health Expert Exports Telemedicine Program to Cameroon

Professor Adapts Alabama System to Improve Health of Mothers, Infants

Baby and mom in Cameroon
The rollout of a new mobile phone hotline that connects physicians to rural clinics in Cameroon may improve the health of pregnant women and newborns.


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A hotline credited with preventing infant deaths in Alabama is being adapted to help rural providers curb infant mortality and improve the health of mothers in central Africa.

Comfort Enah, a UMass Lowell associate professor of nursing, is working with colleagues in Cameroon and the University of Alabama Birmingham to test the system designed to improve maternal and newborn health.

The system being deployed in the central African republic of more than 27 million people uses mobile phones to allow rural clinicians to seek advice from a 24-hour call center. Experts in neonatal care and obstetrics are available when needed.

“The model of landline and mobile phone clinical support for pregnant women and deliveries works in other locations, so now we’ll be able to evaluate the health of moms and babies in Cameroon,” said Enah, the Donna Manning Endowed Chair in UMass Lowell’s Solomont School of Nursing. 

Cameroon’s infant mortality rate of 48 per 1,000 live births nearly doubles the global rate (27 per 1,000 live births), according to the World Bank. The U.S. infant mortality rate is 5 per 1,000 births.

Alabama’s rate of 6.99 per 1,000 births remains among the highest in the country, according to the U.S. Centers for Disease Control and Prevention. However, it is the lowest rate ever recorded in the state, according to the Alabama Department of Public Health.

Since its launch in 1969, the MIST system (Medical Information Service via Telephone) has connected providers in rural Alabama to clinicians at major medical centers. While many large health care centers in the U.S. have adopted the system during the past 50 years, it is only now spreading to less-developed countries, following the expansion of mobile infrastructure and personal cell phone use.

These advances allowed Enah and her research partners to adapt a pilot system for Cameroon, using funding from the U.S. National Institutes of Health. The research team published results in the International Journal of Women’s Health in April 2022 showing that a treat-in-place system was the best solution in a country challenged by violence, poor roads and lack of transportation.

So far, results in Cameroon have shown a positive impact on mothers and their babies, according to Enah. A $515,000 grant from the National Institute for Child Health and Human Development will allow the team to assess maternal and neonatal outcomes of the system as it rolls out in other areas of the country. 

The system is also beneficial because it helps nurses in rural clinics learn skills from the experts on the other end of the line, said Enah, whose other work in reducing health disparities has included research in preventing HIV infections among Black teenagers in Alabama.

“After this new study, we should have the evidence to support an expansion to more countries that will improve pregnancy care, thereby reducing maternal and fetal deaths,” she said.

UMass Lowell is a national research university located on a high-energy campus in the heart of a global community. The university offers its students bachelor’s, master’s and doctoral degrees in business, education, engineering, fine arts, health, humanities, sciences and social sciences. UMass Lowell delivers high-quality educational programs, vigorous hands-on learning and personal attention from leading faculty and staff, all of which prepare graduates to be leaders in their communities and around the globe.