Saving Newborns in Uganda With a Pediatrician in Your Phone

What is a midwife to do if there's no doctor and a baby's in trouble? The PRISMS app was designed to mimic a pediatrician and send diagnoses and care suggestions by SMS

South Sudanese refugees in Uganda, which is stressing medical availability even more.
Ben Curtis/AP

Impact Journalism Day: Today, 50 of the world's leading medias highlight positive innovations that are changing the world

The sight of midwives rushing about a maternity ward trying to attend to more mothers than they can handle is common in Ugandan hospitals. Between the scarcity of much-needed equipment and the shortage in staffing, including doctors, midwives find themselves having to make quick diagnoses on mothers and newborn babies alone, a daunting task.

Now a group of researchers at Uganda's Mbarara University of Science and Technology has developed technology to enable midwives and other health professionals to treat complications of newborns in the absence of a specialist. It’s called Protecting Remote Infants by SMS, or, PRISMS.

Common problems among newborns include difficulty breathing, fever, bleeding from the umbilical cord or the nose, sepsis, and jaundice, let alone the troubles of premature birth. PRISMS helps frontline health workers save newborns using the mobile app, which can help by providing timely diagnosis and healthcare suggestions.

Health workers input the assessments of the newborn’s data: weight, temperature, respiratory rate, heartbeat, skin and cord color – into the app. The software then processes the data and provides care management suggestions by SMS.

Once uploaded into the app, the data is sent to a server and stored securely in a database, where it can be accessed for real-time surveillance, disease monitoring and quality improvement.

One doctor and lucky at that

For now, PRISMS is only being used for newborns under 28 days of age. The first four weeks of life – the neonatal period – represent the most vulnerable time for a child’s survival, according to the World Health Organization: In 2016, 2.6 million deaths, or roughly 46 percent of all under-five deaths, occurred during this period across the world.

Dr. Data Santorino, the leading pediatrician in the group of researchers behind the app, believes this mortality rate is largely preventable.

“In environments with limited resources, most newborn healthcare decisions are made mainly by nurses or midwives with no specialized training. We developed PRISMS to mimic a pediatrician,” Santorino says.

Three midwives tested the app for a month in 2016 at the Bwizibwera Health Centre IV, in Kashari Mbarara, southwestern Uganda. Only one doctor works there, and apart from attending to patients, he has many managerial responsibilities. Up to 100 babies are delivered each month at this facility. About 10 percent suffer from complications and need to be referred to Mbarara Regional Referral Hospital, says Leonia Nanjovu, one of the midwives who participated in the trial.

“We are lucky to have one doctor. In Health Centre III there is none; there are only midwives, and they do everything. When you are alone you have to manage alone, you don’t have a doctor to consult,” she says. “Even when you have a doctor, he may not be very near. When you have PRISMS, you work on the patient very fast. And medicine is dynamic. This app helps you to know which medicine to give and the proper dosage."

During the trial, the midwives were able to manage all the newborn complication cases by themselves, without need to refer the babies to another facility.

Feed the examination results into the app and you can get a response on how to manage the case within five minutes, or suggest more tests, explains Nanjovu, adding that the app tells you to refer the child if it deems you cannot manage the case alone.

At first the team designed the app for basic mobile telephones, but the display screen was too small. So they decided to adapt it for smartphones, completing the final version in late 2015.

The PRISMS team is deploying the app in additional health facilities thanks to a partnership with the Ugandan Baylor Children’s Foundation, and hope to have it running in more than 15 by the end of 2018. They are currently training health workers in how to use the technology in Ntara Health Center IV, Rwamwanja HC III, Kibiito HC IV, Fort Portal Regional Referral Hospital and Rukunyu HC IV. “With the little resources we get, we train as many health workers as possible prior to deployment,” says Mukama, noting that instruction is very expensive.

The app was developed starting in 2013 by a multidisciplinary team including Dr. Santorino, Nanjovu, software developer Martin Mukama and Dr. Francis Bajunirwe, an epidemiologist. It is managed by E-Wall Technologies Company. The developers had PRISMs registered as an innovation by the newborn steering committee of Uganda’s Ministry of Health.