The team developed a smartphone app to improve midwifery care in Tanzania

An international research team from Tanzania and Japan developed a smartphone application and conducted a pilot study on how the application could be used to enhance the knowledge and skills of midwives in Tanzania. Their study focused on the potential effects of the app on midwifery learning outcomes and birth readiness of pregnant women in Tanzania.

The team’s work is published in a journal PLOS ONE on March 31, 2023.

“Smartphone apps for midwives show a significant improvement in their learning outcomes, leading to better birth preparation for expectant mothers in Tanzania. This study highlights the potential of using technology to improve midwifery education, which in turn contributes to maternal health and addressing high maternal and child mortality rates,” said Yoko Shimpuku, a professor at the Graduate School of Biomedical and Health Sciences, Hiroshima University.

Pregnant women in sub-Saharan Africa have low access to healthcare. In Tanzania, only 51% of pregnant women have four or more antenatal care visits, while the World Health Organization recommends at least eight visits during pregnancy. Due to the high maternal mortality ratio in Tanzania, it is very important to increase women’s access to health services. To increase women’s access, the quality of antenatal care needs to be improved.

The team used a mixed methods study to provide educational applications for midwives in the intervention group. They obtained data on the continuous use of the app and measured midwives’ learning outcomes. Their next steps were to conduct focus group discussions on the usefulness of the app and a survey among pregnant women on labor readiness in the intervention and control groups to evaluate whether midwives had provided them with the right information. The control group of pregnant women received regular antenatal care and answered the same survey.

This study involved 23 midwives who took the test and provided learning outcome data. The results show that 87.5% of midwives continued to study with the application two months after the intervention. There were 207 pregnant women who were included in this study. The intervention group of pregnant women had significantly higher home-based knowledge and values ​​scores than women in the control group, in which the app was not used. This home-based score indicates that the higher the score, the more mothers tend to choose to give birth in a health facility rather than at home.

From previous research, the research team knows that there is widespread smartphone use in Tanzania, especially among the young population. The app the team developed provides up-to-date information on World Health Organization guidelines and practical suggestions for midwives to use in health education at antenatal care visits. They conducted the study at two health facilities in Dar es Salaam, Tanzania’s largest city, between October 2019 and March 2021.

Midwives who use the app receive training on how to use it. They also get reimbursed for the cost of the mobile data they use with the app, so that the cost doesn’t deter them from using the app. This application uses an online education platform called Goocus. The information in the app includes World Health Organization recommendations on antenatal and intrapartum care for pregnant women. The team also created content with locally adapted illustrations explaining why preventive or early treatment behaviors are important and showing midwives how to demonstrate these concepts in their antenatal care. The videos on the app are narrated in Kiswahili, a language most local women understand better than English.

Going forward, the team’s next step will be to refine and expand the application for larger-scale implementation, with a focus on reducing maternal and child mortality in developing countries, starting with Tanzania. “The ultimate goal is to develop additional apps targeting pregnant women and their families, while gathering strong evidence of the long-term effects and effectiveness of the apps through further research. This aims to increase overall understanding and awareness about care from pregnancy to postpartum, which ultimately improves maternal health,” said Shimpuku.

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The research team consisted of Yoko Shimpuku and Naoki Hirose from Hiroshima University, Japan; Beatrice Mwilike and Dorkasi Mwakawanga from Muhimbili University of Health and Allied Sciences, Tanzania; Keiko Ito from Kyoto University Hospital, Japan; and Kazumi Kubota from The University of Tokyo Hospital, Japan.

This research was funded by the Japan Society for the Promotion of Science, Kyoto University, and the Japan Agency for Medical Research and Development.

About Hiroshima University

Since its establishment in 1949, Hiroshima University has strived to become one of the leading and most comprehensive universities in Japan for the promotion and development of scholarship and education. Comprising 12 undergraduate schools and 5 graduate schools, ranging from natural sciences to humanities and social sciences, the university has grown to become one of Japan’s leading comprehensive research universities. English website: https://www.hiroshima-u.ac.jp/en