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.