1. WawaRed: “Getting connected for a better maternal and child health in Peru”
José Enrique Pérez Lu MD MSc PhD (c)
Universidad Peruana Cayetano Heredia

2. Introduction
Maternal and child care is one of the Millennium Development Goals
Information and communication technologies (ICT) are an opportunity to improve health:
Electronic Health Records
Use of cell phones

3. WawaRed
“Wawa” means baby in Quechua, and “Red” means network in Spanish
Includes:
Text messages (SMS)
Advice about pregnancy, appointment reminders, prevention and motivational messages.
Electronic health record for maternal care
Interactive voice response (IVR) system:
Messages about danger signs during pregnancy.
The main objective is to improve maternal and child care
We designed a RCT to evaluate the impact

4. Electronic Health Record
Phone calls
Personalized SMS
SMS Platform
IVR Central
Electronic Health Record
Secure Database
WawaRed Portal
Data collection

5. Developing the SMS: First step - Needs assessment
Focus groups with pregnant women for knowing their preferences about the type of text messages that they want to receive
Second step – Assess program acceptability
Focus group with pregnant women for validate the messages that we had done
Third step - Assess technological feasibility
Pilot with 92 pregnant women for test the system
The 93% were "very satisfied " to receive SMS

6. Type of SMS
Motivational
Education (Nutritional, Pregnancy Warning Signs)
Appointment Reminders (2 days before each visit)
Specific (Hyperemesis, Obesity, Malnutrition, Anemia, hypertension, diabetes, Urinary infection, Syphilis, HIV, fever, TB, Alcohol, Drugs, etc)
We sent the SMS on Monday, Wednesday and Saturday at 9:00 am each week

7. "Mommy rejoice and go to your clinic visit"
“Going to your ANC visit is not losing all morning, it is gaining health for your baby”
“Consume iron to have energy and prevent anemia, it can be found in foods like : liver, spleen, and red meat”
"Mommy rejoice and go to your clinic visit"
“Keep going, you're in the middle of your pregnancy, and your baby is getting bigger and stronger”

8. Randomized clinical trial of the impact of the SMS
Sample size: 1300
Power: 80%
Principal outcome: Percent of pregnant women attending at least 6 ANC visits
Difference between 60% - 68%
Secondary outcomes:
Median of n of ANC visits
Delta of blood hemoglobin
Percent of women with vomiting that go to ER
Percent of women with difficulty seeing that go to ER
Average weight of infants

9. Results:
Women receiving the SMS messages compared to women who didn’t showed:
10% higher number of antenatal care visits according to schedule
The average number of women with 6 ANC visits is 5% higher in the intervention group than in the control group
7% higher women with 9 or more ANC visits in the intervention group compare with the control group.

10. Results: SMS were more effective among :
Women with secondary or higher education
13% higher number of ANC visits on time
Increase their vitamin adherence during:
The last week of pregnancy by five percentage points
The last month of pregnancy by three percentage points
Increase APGAR score (1 minute) by 0.14
Women who live closer to the health center:
Increased vitamin intake compliance during the last month of pregnancy by three percentage points
A positive effect on newborn birth weight equivalent to grams

11. Results:
Intervention was more effective within the group of women with at least secondary school and who live closer to the health center
Improved the total number of ANC visits attended by visits
Total number of ANC visits on time increased by 0.58
Vitamin intake during the last week and month of pregnancy was also increased by 12 %
Increase the weight of newborns by grams
Increase APGAR score (1 minute) by 0.16 point

12. WawaRed Rural: Better health in maternal care in Rural Areas
Voice messages in Spanish and Quechua in rural areas:
Advice about pregnancy, appointment reminders, prevention and motivational messages

13. Developing voice messages:
First step - Need assessment
Focus groups with pregnant women
Not want SMS
Prefer voice messages in Spanish and Quechua
They wanted their partners also receive messages
Second step – Assess program acceptability
Focus group with pregnant women for validate the messages that we had done
Third step - Assess technological feasibility
Pilot with 10 pregnant women for test the system

14. Evaluation of the program:
Randomized clinical trial of the impact of voice messages with 208 pregnant women
In deep interviews with 10 pregnant women

15. In deep interviews:
“It helped (the voice messages) to remind myself to take my iron with orange juice”
“When WawaRed called me, I felt it was as if my mother was calling me and giving advice”
“The messages taught me what I have to do for a successful pregnancy. And now I'm teaching my sister who is pregnant”
“With the messages I learned to eat well, so my baby is chubby”
“With the messages I learned what the warning signs in pregnancy are. If I felt any discomfort I should go to the health center”

16. Conclusions:
SMS increased the number of ANC visits, vitamin adherence, APGAR score and newborn birth weight
SMS were more effective within the group of women with at least secondary school and who live closer to the health center
In rural areas pregnant women prefer voice messages over SMS
They feel that the messages help to educate them on how to have a good pregnancy

17. Thanks