Article Text

Original research
Use of mHealth tools to register birth outcomes in low-income and middle-income countries: a scoping review
  1. Lottie Grace Cansdale1,
  2. Gabriella Kelly1,
  3. Ali Khashan2,3,
  4. Address Malata4,
  5. Fannie Kachale5,
  6. David Lissauer6,7,
  7. Simeon Yosefe8,
  8. James Roberts9,
  9. Simon Woodworth3,10,
  10. Blandina Mmbaga11,
  11. Christopher Redman12,
  12. Jane Elizabeth Hirst12
  1. 1University of Oxford Medical Sciences Division, Oxford, UK
  2. 2University College Cork School of Public Health, Cork, Ireland
  3. 3INFANT Research Centre, University College Cork, Cork, Ireland
  4. 4Malawi University of Science and Technology, Limbe, Malawi
  5. 5Malawi Ministry of Health, Lilongwe, Malawi
  6. 6Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
  7. 7Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
  8. 8Central Monitoring and Evaluation Division, Malawi Ministry of Health, Lilongwe, Malawi
  9. 9Magee-Women's Research Institute, Pittsburgh, Pennsylvania, USA
  10. 10University College Cork Business School, Cork, Ireland
  11. 11Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
  12. 12Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, UK
  1. Correspondence to Mrs Lottie Grace Cansdale; lottie.cansdale{at}


Objective Accurate reporting of birth outcomes in low-income and middle-income countries (LMICs) is essential. Mobile health (mHealth) tools have been proposed as a replacement for conventional paper-based registers. mHealth could provide timely data for individual facilities and health departments, as well as capture deliveries outside facilities. This scoping review evaluates which mHealth tools have been reported to birth outcomes in the delivering room in LMICs and documents their reported advantages and drawbacks.

Design A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Joanna Briggs Institute guidelines for scoping reviews and the mHealth evidence reporting and assessment checklist for evaluating mHealth interventions.

Data sources PubMed, CINAHL and Global Health were searched for records until 3 February 2022 with no earliest date limit.

Eligibility criteria Studies were included where healthcare workers used mHealth tools in LMICs to record birth outcomes. Exclusion criteria included mHealth not being used at the point of delivery, non-peer reviewed literature and studies not written in English.

Data extraction and synthesis Two independent reviewers screened studies and extracted data. Common themes among studies were identified.

Results 640 records were screened, 21 of which met the inclusion criteria, describing 15 different mHealth tools. We identified six themes: (1) digital tools for labour monitoring (8 studies); (2) digital data collection of specific birth outcomes (3 studies); (3) digital technologies used in community settings (6 studies); (4) attitudes of healthcare workers (10 studies); (5) paper versus electronic data collection (3 studies) and (6) infrastructure, interoperability and sustainability (8 studies).

Conclusion Several mHealth technologies are reported to have the capability to record birth outcomes at delivery, but none were identified that were designed solely for that purpose. Use of digital delivery registers appears feasible and acceptable to healthcare workers, but definitive evaluations are lacking. Further assessment of the sustainability of technologies and their ability to integrate with existing health information systems is needed.

  • obstetrics
  • information technology
  • health informatics

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors JEH, CR, AK, AM, DL, FK conceived the review idea. LGC carried out the search and LGC and GK screened and selected articles. LGC wrote the manuscript with input from GK, AK, AM, FK, DL, SY, JR, SW, BM, CR, JEH. All authors approved the manuscript prior to submission. JEH is the guarantor.

  • Funding There was no specific funding for this project. JEH is funded by a UKRI Future Leaders Fellowship.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Author note The original concept for this systematic review was co-developed equally by the authors from high-income country (HIC) and low-income country (LIC) settings to address an identified priority from the authors from Tanzania and Malawi. The protocol was jointly developed and the search strategy and data extraction were performed by HIC researchers, with support from LIC researchers. The LIC researchers contributed to interpretation of themes and ensuring contextual relevance. All authors read and approved the final version of the manuscript. The first (LGC) and last author (JEH) are both HIC authors, as the first author is a student who has been supervised by the senior author.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.