Effectiveness of an integrated community and hospital digital health information system for maternal and newborn healthcare in Northern Kenya: a nonrandomized before-after evaluation

BackgroundPoor access to antenatal care (ANC), skilled delivery, and postnatal checks within 48 h of delivery are linked to adverse pregnancy outcomes. In Kenya, unequal use of these services has caused significant regional disparities, with 15 out of 47 counties being high priority.ObjectivesTo evaluate the effectiveness of a digital health solution to improve maternal and newborn health (MNH) uptake.MethodsFrom July 2017 to March 2019, we implemented an integrated community and hospital digital health information system, in ten health facilities and four community health units in Turkana County, Northern Kenya. We used a non-randomized before-after household survey. We assessed the proportion of mothers attending at least four antenatal visits, receiving skilled delivery, and receiving postnatal checks within 48 h at baseline and 12 months post-intervention. Statistical comparisons included p-values and 95% confidence intervals, accounting for clustering at the CHU level. These findings were compared with data from the Kenya Health Information System for the study subcounty and Turkana County.ResultsAmong a catchment population of 4,300 women of reproductive age (WRA), 692 and 608 women were interviewed at baseline and endline, respectively. STONE-HMIS® led to 5%, 23%, and 16% improvements in 4th antenatal care visits, skilled delivery, and postnatal checks within 48 h, respectively. For the same period, subcounty and county data showed that 57.7% and 65.8% of WRA attended at least 4 ANC visits, 39.5% and 67.8% delivered with skilled assistance, and 23.5% and 24% had postnatal checks.ConclusionsIntegrating digital health systems at provider and community levels, aligned with health system priorities, showed marked improvements MNH indicators in an underserved, remote area.