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Mobile health (mHealth) has gained considerable interest recently due to its potential to improve health outcomes in developing countries with high outreach yet low costs. Several studies have explored the use of short message service (SMS) reminders to improve antiretroviral (ARV) retention and adherence, with mixed results. The majority of these studies has a quantitative nature and employs randomized designs, which do not provide further qualitative insights about other possible impacts of the messages. Based on the qualitative assessment of an SMS intervention in Burkina Faso, which complemented a (quantitative) Randomized Controlled Trial (RCT), we show that beyond the functional role of improving ARV retention and adherence, SMS messages can also play important symbolic roles in offering psychosocial support to people living with HIV (PLHIV) and improving their perception of life. Concomitantly, we show that sufficient (ICT) literacy skills cannot be taken for granted in resource-poor settings. Yet, regardless of (ICT) literacy skills, the symbolism of care was perceived. Furthermore, we highlight the importance of complementing quantitative evidence of mHealth interventions with qualitative assessments.

Background: A home-based record (HBR) is a document used to record the history of health services and key health information of an individual and through which health education messages can be shared. The record is kept by the individual or their parent/caregiver at home, and is intended to compliment the records kept at the health facility. The great majority of these HBRs are paper-based, although many countries have future plans for digitalizing them for improved access and use, as well as higher rates of recording. In some middle- and high income countries, electronic HBRs are already being used in order to promote information sharing between providers to improve the integration in care, as well as reduce the risk of data loss. There is a need to better understand what efforts have already been undertaken in terms of the digitalization of HBRs and what lessons can be learned moving forward. Objective: The main objective of this scoping review is to map the peer-reviewed and grey literature available on the digitalization of HBRs for MNCH. The following review question is guiding the exercise towards this objective: What efforts have already been undertaken for the digitalization of home-based records for maternal, newborn and child health (MNCH)? Methods: The scoping review will include the following steps: 1) a search strategy to identify relevant materials, 2) inclusion and exclusion criteria for the selection of relevant materials, 3) data extraction from the relevant materials, 4) synthesizing the results

Hospital-based studies suggest that late presentation at tertiary level is a driving factor for mortality from severe febrile illness in resource-poor contexts. Recent research into health seeking pathways in Malawi identified primary level barriers linked to service provision and misdiagnoses. In Malawi an Emergency Triage, Assessment and Treatment (ETAT) package, approved by the World Health Organisation (WHO) has been introduced at tertiary level and is being rolled out to district and primary clinics. mHealth technologies are likely to sustain quality in implementing clinical protocols, particularly when community-based health providers with limited formal training are increasingly working to offset primary level staff shortages. We aimed to develop and evaluate feasibility and acceptability of a prototype primary care level intervention to improve triage, assessment and referral of children with severe illness in Blantyre and to investigate whether this facilitates systematic and timely recognition and response to severe illness. All paediatric cases within five primary clinics in urban Blantyre were triaged and assigned Red for Emergency, Amber for Priority and Green for Queue using the mHealth triage algorithm. Phones were assigned to triage, to clinicians and the A&E department within the local tertiary, referral hospital (Queen Elizabeth Central Hospital (QECH)) for monitoring patient referrals. We conducted a rigorous evaluation using a combination of quantitative and qualitative approaches, both pre- and post and, using the phone as a monitoring tool, in parallel to the intervention. Seventy-four healthcare staff were trained across five urban primary clinics. A total of 41,358 patients were assessed using the mHealth triage algorithm from December 2012 to May 2013, of whom 1.56% were referred to QECH. Rates of concordance between triage and clinician assessment showed a good level of agreement above chance (Kappa value = 0.71). Pre- and post-Patient Journey Modelling tools identified positive changes in patient flows. Overall patient and health worker satisfaction was high with indirect impact on quality of clinical assessment amongst health workers based at intervention clinics but not directly involved in the intervention. This study has shown that mHealth technologies have the potential to improve primary level health services in resource-poor contexts with high patient numbers and overburdened health staff. Working in collaboration with the Ministry of Health the data we present will inform the development of a cluster-randomised trial to rigorously evaluate the role of mHealth in the implementation of ETAT. This will aid policy decisions around ETAT implementation at primary health level.