GestDate Team 14 December 2016 GestDate: A mobile application to estimate gestational age and support clinical decision making GestDate Team 14 December 2016

Gestational age (GA) assessment is an integral part of antenatal care (ANC) Recommended by WHO Time-sensitive interventions depend on capacity to estimate GA Antenatal corticosteroids (ACS) IPTp-SP for malaria prophylaxis Induction of labor Team readiness for pre-term infant Photo credit: HNN/SNL

Current practice may fall short Knowledge gaps and confidence issues impact provider performance for GA estimation

Very few tools help providers address what they should do when various individual data sources (e.g., history, physical, and/or ultrasound results) point to discrepant estimates for GA and EDD

Objectives To develop a mobile application to assist in calculation of GA and support clinical decision making To gain knowledge about the usability, acceptability and feasibility of the mobile application

Design Meeting January 14, 2016 One-day meeting to design application and evaluation Convened experts in mHealth, maternal health, obstetric ultrasound, implementation, monitoring & evaluation

The GestDate App Provider decision support tool Collects relevant data (last menstrual period, uterine size in cm or weeks, ultrasound results) Optimizes GA calculation, including scenarios with multiple inputs Guides health worker to recommended interventions based on inputs Algorithm based on ACOG/AIUM guidance for GA estimation

Key Features of GestDate Automated calculations Data validation Automated “skip” or “go-to” logic Input of multiple types of data Screenshot from GestDate

Input: Availability of Ultrasound

Inputs: LNMP

Inputs: Uterine Exam

Field Test: April 2016 Jaipur, Rajasthan Supported by Jhpiego Baltimore/DC and Jhpiego India Two clinical sites – both level 3 health centers Intrapartum and antenatal care settings

Results Overall positive feedback Highlights Report EDD as well as current GA Consider reporting an EDD for each type of data entered (LMP vs. ultrasound vs. physical exam) Suggest GA window-specific interventions Do not make application smaller, e.g., phone size Feedback shared with Baltimore/DC team

Post-test Modifications Field Test Result Modification Patients hand-carried ultrasound results with a wide range of GA Additional scenarios that incorporate a wider variety of ultrasound results Providers interested in an application that reports both GA and EDD Addition of EDD calculation to programming (in progress) Add suggested interventions following GA calculation Pending further modifications

GestDate in Action

Next Steps GestDate available to download onto compatible devices for additional field testing Further refinement may be undertaken to incorporate additional clinical scenarios May be used by Jhpiego sites within suite of mHealth tools for maternal health

Acknowledgments Jhpiego New Frontiers Award Sarah Searle and Jennifer Snyder Gbaike Ajayi Dr. Yashpal Jain and Dr. Ashutosh Sarwa Jhpiego India Team CommCare/Dimagi For inquiries, please contact Dr. Lisa Noguchi (lisa.Noguchi@jhpiego.org)