# PANDA e-health system as a tool to increase antenatal contacts and improve perinatal outcomes in Tanzania: adaptation and feasibility study

## TL;DR

A mobile health system called PANDA was adapted and tested in Tanzania to improve antenatal care and perinatal outcomes by promoting respectful and systematic prenatal consultations.

## Contribution

The study adapted the PANDA e-health system to include respectful care prompts and demonstrated its feasibility in rural Tanzania.

## Key findings

- PANDA was successfully adapted and accepted by participants, with high recruitment and retention rates.
- PANDA enabled systematic and personalized antenatal care, and was associated with prolonged first consultation duration.
- Feedback from participants and stakeholders informed refinements for a future effectiveness trial.

## Abstract

Antenatal attendance is critical for pregnant women to receive the screening, health education and care plans that can optimise positive perinatal outcomes. In Tanzania, few women achieve the WHO-recommended 8 contacts with health workers, partly due to the limited screening and diagnosis services offered and health workers’ disrespectful attitudes. Mobile health solutions have potential to support the provision of comprehensive and respectful antenatal consultations, but these need to be rigorously assessed. The study aimed to adapt the Pregnancy and Newborn Diagnostic Assessment e-health system (PANDA), to incorporate respectful care prompts, and assess the feasibility of the new PANDA system to deliver prenatal care to women in rural Tanzania.

A prospective, pre- and post-cohort mixed-methods study over 12 months was carried out in two primary facilities and one linked referral hospital. One hundred and sixty pregnant women (1st or 2nd trimester) were recruited; 80 received usual prenatal care and 80 received care through PANDA. Feasibility outcomes comprised recruitment and retention of women into the study, acceptability of the intervention and research processes, intervention fidelity, feasibility of data collection, confirmation of trial outcome measure and quality of implementation.

Incorporation of respectful care prompts was achieved and considered acceptable. The study recruited to target (> 90%) in both groups and 100% of women were retained in the study. Fidelity of the PANDA package, including training, was confirmed through observations and clinical data. Two interlinked themes summarised the qualitative narratives: PANDA supports relational care, and PANDA enables systematic and personalised ANC provision. PANDA was considered a positive intervention, although its use prolonged the first consultation duration.

Acceptability of PANDA use and feasibility of study processes were demonstrated. Participants’ and stakeholders’ feedback have informed refinement of the PANDA package and its implementation strategy ahead of commencing a cluster trial to assess effectiveness.

The study was prospectively registered (ISRCTN34645009) on 21/10/2022.