Lata Medical Research
foundation, Nagpur
Operational Model of Cell phone
Counseling for Improving Exclusive
Breast Feeding–Process and Challenges
Authors:
Dr. A. Patel, Dr. L.Dhande,
Dr. Y. Pusdekar, Dr. P. Kuhite,
Dr. S Khan ,Ms. A. Puranik
Background
 Despite wide spread coverage, cell
phones are scarcely being used for
maternal and child health
 Cell phone counseling (CPC) is an
innovative health care intervention
 Cell phone can provide need based
counseling at home to improve health
care behavior such as improving exclusive
breast feeding (EBF).
Lata Medical Research Foundation, Nagpur
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Why We Chose Mobile Phones
 Rapid increase in usage of Mobile phones in Nagpur, India
 More time and cost-effective than in-person counseling
 Potential to implement in rural areas due to improved
network coverage
 Indian culture requires mothers not to leave the home for
first 5 weeks postpartum
 Number of nuclear families increasing
 Empowers women to obtain timely consultations from home
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Objectives & Methodology
 Objectives :To describe a Cell Phone Counseling (CPC)
operational model
 Methods: An operational model of using cell phone
counseling for improving EBF was developed to counsel 518
under privileged women of Nagpur city from 2 hospitals that
were enrolled in a trial to evaluate its effectiveness.
 Cell phones purchased with prepaid sim cards and
recharge vouchers were given to 273 mothers(out of
518) who did not had phones
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Lactational Counseling - Methodology
Data base of all mothers
Call transfer facility
Lactational Counselor
Daily 70-80 calls / 300-400
bulk SMS
Beneficiaries - Mother - Baby dyads
Speed dialing, call back
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Mobile Phones Were Used For





Weekly phone counseling
On-demand support
Appointment reminders
Sending SMSes
Recording Conversations of
beneficiaries with the LC
 Database was developed for
the following logs:
•
•
•
•
•
Weekly calls
Missed calls
Reminder calls
Recordings
SMS reports and templates
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Rates of Exclusive Breastfeeding on
Follow Up visits
Exclusive Breastfeeding (%)
120
80
97.6*
97.0*
100
80.9
73.7 74.3
78.1
97.3*
96.2*
70.7
60
48.5
40
20
0
Within 24 hours
after delivery
At 6th week
At 10th week
At 14th week
At 6th month
Visit time points
Control
Intervention
* - Represents p-value < 0.001
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Bottle Feeding Rates on Follow Up visits
– A comparison of Groups
25
21.6
Bottle feeding (%)
20
18.3
15
11.8
9.2
10
7.0*
5.7
5
0
0.8 0.2
Within 24
hours after
delivery
0.8*
0.6*
0.6*
1.2*
At 6th week At 10th week At 14th week At 6th month At one week
after 6th
month
Visit time points
Control
Intervention
* - Represents p-value < 0.001
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Introduction of Semi-Solid Feeds
120
P-value < 0.001
98.5
86.7
% of participants
90
60
P-value < 0.001
30
26.9
0.4
0
Incorrectly introduced semi solid food Timely introduction of semi solid food
before 6 months
Control
Intervention
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Outcomes in Neonates
45
P-value < 0.001
36.9
% of participants
36
27
23.6
P-value < 0.01
18
12.5
6.8
9
0
Timely initiation of breastfeeding
Control (N=513)
Baby Require hospitalization
Intervention (N=518)
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Baby Weights at Different Time Points
-A Comparison in Groups
Weight of the baby (in Kgs')
9
P-value < 0.05
8
P-value < 0.001
7
P-value < 0.001
6
P-value < 0.001
5
4
P-value > 0.05
3
2
Within 24 hours
after delivery
At 6th week
At 10th week
At 14th week
At one week after
6th month
Visit time points
Control
Intervention
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Comparison of Total Mean Cost
and Mean Effect
Control (n = 104)
Total Cost
Exclusive breastfeeding
rate (%)
Intervention (n = 105)
n
Mean ± SD
n
Mean ± SD
104
3145.4 ± 3598.3
105
7145.6 ± 11258.6
38/90
42.2
95/99
96.0
Variable
N
Mean
Std. Err.
ICER
100000
5812.0
7.24
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[95% Conf. Interval]
5797.8
5826.2
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Problems Faced During Counseling
2%
31%
37%
25%
5%
Phone switched off
Call rejected
Other problems
Call not received
Call received by relative
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Challenges
 Identification documents of beneficiaries for activation of
cell phones
 Unnecessary demands for assistance in other
than health problems or even crank calls
 Dedicated staff necessary to keep a track of
unanswered calls and make calls frequently
 Unavailability of developed operating systems
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Lessons Learnt
 Cell phone counseling at home showed an unprecedented
improvement in infant and young child feeding indicators in
this Indian study population
 Trained front line health workers (Auxiliary nurse midwives)
can successfully implement cell phone lactational counselling
- Programmatic implications
- Promise of scalability in the public as well as private health
systems.
 It helped the woman and her family by providing timely
intervention to avert emergencies and reducing unnecessary
hospital visits.
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Conclusion
Our model for CPC for improving EBF was found to be
highly effective and has potential to be scaled up to
public and private healthcare systems
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Acknowledgement
We would like to acknowledge the following Organization /
persons for their contribution & support Sponsors: World Bank, Alive & Thrive
 Partnered organizations : Indira Gandhi Govt.
 Medical College and Hospital
& other participating hospitals
 Project Manager: Dr. Y Pusdekar
 Lactational Counsellors: H Kadu, P Adware, S Khan
 Statistician: J Borkar
 Data entry operators: A Puranik, M Chikte
 Data Collectors: M Sebastian, S Bano, K Meshram,
P Gajbhiye, S Palaspagar, S Lonare
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