Methods
Design :
This study was a pre/post descriptive study. We collected data from 20 RHFs and two district hospitals. We then merged the two data sets to examine the number of obstetric referrals from RHF to hospitals to identify common reasons for referrals, maternal and newborn outcomes, and time from RHF referral to hospital arrival. Inclusion criteria for RHFs included: staffed by providers who owned a smartphone capable of downloading WhatsApp and facility located two hours or less from the district hospital. The two district hospitals included in the study provide the vast majority of CEmONC services to residents of the county. Baseline data were collected six months prior to implementation of the MORES intervention (November 1, 2020 to April 30, 2021) and endline data were collected during the last six months of the intervention (August 1, 2022 to January 31, 2023).
Study setting :
Liberia is a West African country with a maternal mortality ratio of 661 deaths per 100,000 live births, ninth highest globally (2). Bong County is the third most populous county in Liberia, with a population of approximately 329,000 (12). To reduce maternal deaths, efforts have been made to increase facility delivery with skilled providers instead of home births, particularly in rural areas. The most recent Demographic and Health Survey of Liberia revealed 84% of women delivered with a skilled provider, up from 61% in 2013 (13). Bong County reports 88% of pregnant women receiving four or more antenatal care visits and 86.8% delivering with a skilled provider. In 2019, there were 15,231 facility births attended by a skilled provider in Bong County (13). Of these, 12,362 (81%) were delivered at a RHF with a midwife or nurse.