By Karen Angelo
A new study led by Assoc. Prof. Comfort Enah is evaluating whether a system that was designed to improve maternal and newborn health in rural America decades ago can bring similar benefits to Cameroon in central Africa.
Since its launch in 1969 in Alabama, a 24-hour hotline that connects health care providers in rural areas to clinicians at major medical centers has helped prevent infant deaths and improve the health of mothers, who might not otherwise have access to expert care.
Enah received a $515,000 grant from the National Institute for Child Health and Human Development to measure maternal and neonatal outcomes of the telemedicine system, which will roll out in several areas of Cameroon.
Cameroon has a relatively high infant mortality ratio of 48 per 1,000 live births, compared with the global infant mortality rate of 27 per 1,000 live births, according to the World Bank.
“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,” says Enah, who also serves as the Donna Manning Endowed Chair in the Solomont School of Nursing.
While many large health care centers in the U.S. have adopted the system, called MIST (Medical Information Service via Telephone), the expansion to less developed countries has just begun as mobile infrastructure has improved and personal cell phone ownership has increased.
These improvements allowed Enah and her research partners at the University of Alabama to adapt a pilot system for Cameroon, which was funded by an earlier grant from the National Institutes of Health. The results of that pilot study were published in the International Journal of Women’s Health in April 2022.
To design the pilot system, the research team collected feedback from health care institutions and clinics, midwives, phone companies, government entities and other experts. Challenges such as violence, poor roads and lack of transportation dictated that a treat-in-place system was the best solution.
Using mobile phones that work even if the internet or power goes out, the system allows a clinician in a rural health care clinic to call the 24-hour call center for help with a complicated delivery. If more advice is needed, a pool of experts in neonatal and obstetrics joins the call to provide additional support. The call center documents the exchanges and outcomes.
So far, the results of the pilot system show a positive impact on mothers and their babies, Enah says.
“It’s encouraging that providers in Cameroon are reporting that the phone system support improves care,” she says. “We believe it also increases the capacity for nurses, who acquire new skills as they stay on the line with experts. 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.”
Enah conducts other research to reduce health disparities, including the design of a video game to help prevent HIV infections among Black teenagers in Alabama.