Newswise — A collaborative research group comprising members from Tanzania and Japan developed a mobile app and carried out a preliminary investigation to assess its potential in enhancing the knowledge and capabilities of midwives in Tanzania. The study concentrated on examining the app's impact on the educational achievements of midwives and the preparedness of expectant mothers for childbirth in Tanzania.

"According to Yoko Shimpuku, a professor in the Graduate School of Biomedical and Health Sciences at Hiroshima University, the mobile app designed for midwives exhibited notable advancements in their educational achievements, resulting in improved birth preparations for pregnant women in Tanzania. This research emphasizes the potential of utilizing technology to enhance midwife training, ultimately making a significant contribution to maternal health and tackling the persistently high rates of maternal and child mortality."

In sub-Saharan Africa, pregnant women face limited healthcare accessibility. In Tanzania specifically, just 51% of expectant mothers attend a minimum of four antenatal care visits, despite the World Health Organization's recommendation of at least eight visits throughout pregnancy. Given Tanzania's elevated maternal mortality ratio, it becomes imperative to enhance women's healthcare accessibility. Achieving this goal necessitates an improvement in the quality of antenatal care services provided to women.

The research team employed a mixed-methods approach to introduce an educational app for midwives in the intervention group. They collected data on the consistent usage of the app and assessed the learning outcomes of the midwives. Subsequently, the team conducted focus group discussions to gauge the app's usability and distributed surveys among pregnant women in both the intervention and control groups to evaluate the adequacy of information provided by the midwives regarding birth preparedness. The control group, comprising pregnant women, received standard antenatal care and completed the same survey.

The study involved the participation of 23 midwives, who were involved in the testing phase and provided data on their learning outcomes. The results revealed that 87.5% of the midwives continued their app-based studies even two months after the intervention. Additionally, the study included 207 pregnant women, with a subset assigned to the intervention group where the app was utilized, while the remaining formed the control group where the app was not employed. The pregnant women in the intervention group exhibited significantly higher knowledge scores and home-based value scores compared to those in the control group. The home-based value score indicates that a higher score signifies a greater preference among women for giving birth at a healthcare facility rather than at home.

Based on prior research, the research team was aware of the widespread smartphone usage in Tanzania, particularly among the younger population. Taking this into account, the team developed an app that offered up-to-date information on World Health Organization guidelines and practical recommendations for midwives to utilize during antenatal care visits for health education purposes. The study was carried out in two healthcare facilities located in Dar es Salaam, which is Tanzania's largest city. The research was conducted between October 2019 and March 2021.

The midwives who utilized the app underwent training sessions to familiarize themselves with its usage. To ensure that the cost of mobile data usage did not pose a barrier to using the app, the midwives were reimbursed for the expenses incurred. The app itself utilized an online education platform known as Goocus. It provided a wealth of information, including the World Health Organization's recommendations on antenatal and intrapartum care for pregnant women. Additionally, the research team developed locally adapted content featuring illustrations that explained the significance of preventive behaviors and early treatment. The content also demonstrated how midwives could effectively convey these concepts during antenatal care. The app's videos were narrated in Kiswahili, a language that was more comprehensible to the local women than English.

As the research team looks to the future, their next objective is to enhance and broaden the app for wider implementation, with a specific focus on reducing maternal and child mortality rates in developing nations, beginning with Tanzania. Yoko Shimpuku expresses that the ultimate aim is to create supplementary apps tailored for pregnant women and their families, all while accumulating substantial evidence through further research to evaluate the app's long-term effects and effectiveness. This comprehensive approach seeks to enhance knowledge and raise awareness regarding care throughout the entire pregnancy to postpartum period, ultimately leading to improvements in maternal health outcomes.

The research team comprises individuals from various institutions. Yoko Shimpuku and Naoki Hirose represent Hiroshima University in Japan. Beatrice Mwilike and Dorkasi Mwakawanga are affiliated with Muhimbili University of Health and Allied Sciences in Tanzania. Keiko Ito represents Kyoto University Hospital in Japan, while Kazumi Kubota is associated with The University of Tokyo Hospital, also in Japan.

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

About Hiroshima University

Since its foundation in 1949, Hiroshima University has striven to become one of the most prominent and comprehensive universities in Japan for the promotion and development of scholarship and education. Consisting of 12 schools for undergraduate level and 5 graduate schools, ranging from natural sciences to humanities and social sciences, the university has grown into one of the most distinguished comprehensive research universities in Japan. English website:

Journal Link: PLoS ONE