“Help, the Mother Is Bleeding!” An Interactive Voice-Controlled Virtual Mentor to Support Birth Attendants in Resource-Constrained Settings

Preterm Birth Initiative East Africa
Organization Location: 
San Francisco, California, USA

There is a well-documented shortage of skilled birth attendants in low- and middle-income countries, and their workload has increased dramatically with the recent and rapid increase of facility births. Most birth attendants receive basic emergency obstetric and neonatal care (BEmONC) training, but post-training support to ensure use of emergency guidelines and protocols is usually lacking. Several post-training performance improvement strategies are currently in use, including supportive supervision and clinical mentoring, checklists and other decision aids, and mHealth tools, but these approaches require either the presence of an additional person providing guidance or manual manipulation of the tool or guide. This technological solution aims to combine existing performance improvement strategies—mobile prompts, in-person clinical mentoring, and checklist-style decision aids—into one hands-free tool: a “Virtual Mentor” that, when triggered by a spoken command, interacts audibly with the birth attendant during a postpartum hemorrhage (PPH) event to increase adherence to established management algorithms and timeliness of interventions. This project will use an “off-the-shelf” package to rapidly and inexpensively develop the prototype for a PPH VM—the Amazon Alexa device, open-source software, and event-driven serverless computing platform. The project has a completed data set that reflects birth attendant behaviors during highly-realistic PPH simulations completed in Kenya in 2016. This VM prototype will be co-developed with Kenyan birth attendants and engineers and will be tested using the same highly-realistic PPH simulation cases in two Kenyan maternity hospitals. Indicators of the VM's functionality will be acceptability, feasibility, and impact on birth attendant behaviors including calls for help, administration of IV oxytocin and isotonic crystalloid fluid replacement, assessment for signs of shock, assessment for the cause of PPH, and communication with patient and companion.

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