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

2. 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

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

4. 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

5. 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

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

7. 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

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

9. Input: Availability of Ultrasound

10. Inputs: LNMP

11. Inputs: Uterine Exam

12. 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

13. 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

14. 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

15. GestDate in Action

16. 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

17. 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