SMARThealth Pregnancy: Improving women’s life-long health in rural India
Every year, millions of women die from heart disease, stroke and complications of diabetes, with the greatest number of deaths occurring in low-resource settings, such as parts of rural India. Prof Jane Hirst and Dr D Praveen (the George Institute for Global Health) lead the SMARThealth Pregnancy programme, which aims to help community health workers identify women at risk during pregnancy and manage their healthcare in order to reduce improve pregnancy outcomes and prevent future health complications.
Click here to read more about the SMARThealth Pregnancy project page on The George Institute’s website.
Identifying women at risk
Both type 2 diabetes and high blood pressure are directly linked to heart disease, but many women in rural India are unaware of this and never seek treatment.
Some of those at greatest risk are women who develop diabetes and high blood pressure during pregnancy. Women with high blood pressure in pregnancy are up to four times more likely to develop long-term high blood pressure. Women who have diabetes in pregnancy are seven times more likely to develop type 2 diabetes; up to 75% of Indian women with diabetes in pregnancy will develop high blood-sugar levels or type 2 diabetes within five years of giving birth. In addition, around 50% of pregnant women are anaemic, a leading contributor to maternal mortality and morbidity.
Although these are well-known complications of pregnancy, women in rural India who experience them may not always be identified, due to a lack of access to healthcare, shortages of health workers, and uneven health services in rural communities. This means women at risk are unable to access postnatal preventive therapies or make positive lifestyle changes.
Using smartphone technology
Antenatal care presents an opportunity to engage with women who might otherwise fall through the gaps; check whether they have conditions such as anaemia, diabetes and high blood pressure, and put in place measures that can help prevent this. The George Institute in India and Oxford have developed a smartphone-based system to help community health workers do just that.
Mobile technologies have the potential to revolutionise the delivery of essential healthcare, especially in rural populations where the majority of antenatal and postnatal care is delivered by low-skilled, community health workers. SMARThealth Pregnancy is a low-cost, tablet-based system that supports clinical decision-making with affordable point of care diagnostics and electronic clinical decision support based on local guidelines.
Integrating care to promote life-long health
Recognising the importance of pregnancy as a key life stage for women’s health, and identifying and managing the risk factors for heart disease and stroke early, could help to reduce the complications associated with high blood pressure and diabetes during pregnancy, for both mothers and their babies. It could also improve pregnancy outcomes, with improved detection and management of high-risk pregnancy conditions
Traditionally, postnatal care has focused on reproductive health and care of the baby. A new, life-course approach to women’s health, which integrates the prevention of non-communicable diseases with existing maternal and primary healthcare, may reduce the transmission of disease risk from one generation to the next; lead to earlier and improved uptake of preventive treatment; and promote life-long health in women.
In time, SMARThealth Pregnancy could be scaled up within India, and implemented in many other countries which face similar healthcare challenges.
From 2019-2020, Dr Shobhana Nagraj led a pilot cluster randomised trial to assess feasibility and acceptability of SMART Health Pregnancy. The pilot study involved 4 primary health centres and 200 pregnant women in Andhra Pradesh and Haryana and demonstrated that this approach was acceptable for community health workers, primary care doctors and women. https://clinicaltrials.gov/ct2/show/NCT03968952.
Building on the success of the pilot trial, Prof Jane Hirst, is leading a large 4-year cluster randomised trial SMARThealth Pregnancy 2, across one district in Telangana and two districts in Haryana funded by UKRI. We aim to answer whether a SMART Health Pregnancy approach can reduce anaemia in the first year after birth and identify women at the highest risk of longer-term cardiovascular complications.
ClinicalTrials.gov Identifier: NCT05752955
Alongside this trial, we are developing a low-cost tool to support women’s mental health throughout pregnancy and the first postnatal year (the PRAMH study led by Dr Nicole Votruba).