Simple SMS system keeps a close watch on Rwanda’s babies

Using an old cellphone, health worker Floride Uwinkesha logs the latest pregnancy in isolated rural areas of Rwanda.

She works for a monitoring programme that aims to improve maternal health and has already helped cut infant and maternal mortality rates.

Marceline Mwubahamana (31) is three months pregnant and doesn’t have to leave her home to have her details logged into the health ministry’s national database.

Uwinkesha, the local officer in charge of maternal health in the rural Nyarukombe district of eastern Rwanda, sends through simple codes on a basic cellphone.

The database, known as RapidSMS, was set up in 2009 with the backing of the United Nation’s children’s agency Unicef and underpins a medical monitoring programme for pregnancies and babies aged up to two years.

Uwinkesha is one of 45 000 volunteers helping to track health in the remotest parts of the rolling hills of Rwanda. They are elected by the people of their village and given basic training by the government.

“PRE,” she taps, giving a code that means that the pregnancy was confirmed by a health centre. “NP,” she adds, meaning “no problem”.

Once Mwubahamana’s details are recorded in the database, the software generates a date for her next prenatal visit.

“I also send basic information, such as their identity number,” Uwinkesha said. A reminder text message will be sent before Mwubahamana’s next appointment.

This pregnancy is going well but should there be health concerns or an emergency, the healthworker sends a “red alert” test message to the nearest medical facility.

Alerts help to flag women registered in the system and who may be in danger.

“We can easily find the names of women who have high-risk pregnancies, like those who have had repeated miscarriages or have had gynaecological surgery,” said Francois Hakizimana, who runs the Murambi medical centre, a short drive from the capital, Kigali.

Hakizimana demonstrates how the system works as he scrolling down the screen to show dozens of names of pregnant women who live in villages.

“We can tell them to go to the nearest health facility as soon as we see that there is any problem,” Hakizimana said.

Those involved in the text message programme say it has helped save many lives, but no exact figures are available because it is difficult to measure the precise effect of the programme.

In any event, Rwanda has registered huge progress in maternal health, according to World Bank data.

The infant mortality ratio for babies aged under one year was 31 deaths per 1 000 births in 2015, just below the world average of 31.7, which is a significant advance from 2009, when Rwanda’s rate was 47 per 1 000.

Over the same period, the maternal mortality rate was cut by almost a third, from 411 to 290 deaths per 100 000 births.

Uwinkesha will keep checking on Mwubahamana and her baby for up to 28 days after birth. After that, a healthworker specialised in infant care will take over.

Each village has two trained carers, often a man and a woman, who will perform at least three home visits in two years to verify the health of the child and record data such as its weight and normal breathing rate.

“The main risks at birth are infections, malnutrition, diarrhoea and respiratory diseases,” said Joseph Nkinzingabo, who co-ordinates 1 422 healthworkers spread out over an area that has 14 health centres.

Nkinzingabo has just received a red alert: a woman who is about to give birth at home.

Calling the cellphone of her healthworker, he checks that all is well. The mother was able to reach a health centre and delivered safely. “No need to send an ambulance,” he said. – AFP

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