(208) Pilot Implementation of Nurse-Physician Phone Support Intervention for Maternity Health Workers: Global Health Translational Research

Objective:
Pilot test a maternal health systems provider-to-provider phone-intervention adapted for local contexts and evaluate its acceptability in the Ndop health district of Cameroon.

Study Design:
Translational adaptation of 24/7 provider support system Medical Information Service via Telephone (MIST) into a mobile system (mMIST). Prior to full-scale stepped wedge cluster randomized implementation, we conducted a pilot assessment in one health district, (1) capturing call volume over a 12-month period, and (2) evaluating maternal outcomes pre- and during the intervention period by analyzing administrative data from the regional health authority. From the administrative data, a preliminary effectiveness outcomes included maternal deaths.

Results:
From 03/2022-02/2023, 106 providers were trained to provide mMIST consults (n=30 nurses, midwives, OB/GYNs, and pediatricians) and utilize mMIST (n=76 peripheral providers, including nurses and lay practitioners). Average monthly volume was 14 calls into the mMIST system; ~30% required expert consultation, indicating adequate demand and acceptability. Most frequent reasons for maternal calls were abnormal labor (23%), hemorrhage (12%), infections (7%), hypertensive disorders (7%), and fetal malpresentation (6%). There were 8 maternal deaths in the pre-intervention period compared to 1 during the intervention period. Select secondary outcomes increased during the pilot. For example, prolonged/obstructed labor increased to 3.8% vs. 2.5% and uterine rupture was 0.6% vs. 0.1%.

Conclusion:
During the pilot, civil unrest increased in the region, increasing the need for maternal health support for remote providers and communities. Even so, the mMIST intervention was feasible and acceptable demonstrating potential for translating a multilevel, provider‑focused maternal health intervention for high-need resource-limited settings. Ongoing assessment will guide scalable deployment strategies to strengthen maternal care systems in Cameroon.