TELEHEALTH PLATFORMS AND THEIR ROLE IN IMPROVING MATERNAL AND CHILD HEALTH OUTCOMES IN NIGERIA

CHAPTER ONE

INTRODUCTION

Background of the study

The utilization of telehealth has significantly surged in response to the COVID-19 pandemic, as telemedicine offers a method to connect with medical professionals without the need for direct physical interaction. This is a significant benefit, given the manner of transmission of the SARS-CoV-2 virus (Kante et al., 2022).  Nevertheless, the acceptability and application rates of this technology remain low in several African nations, including Nigeria (Muri, 2023).  Despite the successful implementation of several significant telemedicine initiatives in Nigeria recently, both individuals and medical professionals remain sceptical about the effectiveness of telehealth and are hesitant to embrace it (Aina, 2022).

Telehealth refers to the provision of healthcare services from a remote location, as stated by Xue et al. (2021). It offers a method to give healthcare services and share information regarding healthcare, regardless of geographical, temporal, or cultural obstacles (Denis, 2020). An illustrative instance of Telehealth applications is its utilisation by an individual with diabetes. An individual can utilise a mobile application to calculate the body's insulin requirements based on the intensity of physical exercise. In addition, individuals have the option to arrange doctor's appointments using an internet-based health portal, or receive notifications through text messages or emails on the designated time for foot examinations (Xue et al., 2021). Additional options involve use a smartphone to capture retinal images, which can then be transmitted electronically to a professional. Alternatively, a mobile phone can be used to upload vital signs to a nurse who can provide electronic responses (Sander, 2023).

Mobile Health (mHealth) is a specific category within the broader field of telehealth. Mobile health technologies are often advocated as instruments to reduce mother and child mortality globally. mHealth refers to the utilisation of mobile technologies and wireless communication methods to enhance health and achieve better health outcomes (Jack et al., 2024). The mobile technologies mentioned encompass a range of devices, including mobile phones, personal digital assistants, smartphones, portable media players, handheld computers, and ultra-portable computers like tablet PCs (Shane, 2024). The software installed on these devices facilitate communication through many means such as text messages, images and videos, telephone and internet connectivity, and multimedia playback (Reed, 2023). The widespread presence of mobile communication and its user-friendly nature have led to the adoption of mobile applications for illness management and the promotion of healthy behaviours.

Telehealth technologies are utilised to promote mother and child health. These tools are utilised inside communities to give prenatal, birth, and postnatal care (Andy et al., 2022). Abundant research indicates that telemedicine interventions can effectively enhance the provision of community-based maternity, neonatal, and child health services in situations when there is a scarcity of healthcare professionals (Shane, 2024). A comprehensive analysis of existing literature examined the application of telehealth in maternal health interventions. Multiple studies conducted in low and middle-income countries provided evidence in favour of utilising telehealth for various purposes such as data collection, appointment reminders, health promotion, and communication between healthcare providers (Arinze et al., 2023). Another study examining the use of telehealth for child health in low- and middle-income countries utilised text message interventions to improve patient medication adherence, increase demand for healthcare services, ensure compliance with healthcare appointments, and enhance maternal education and behaviours (James et al., 2020).

Current data indicates that telehealth apps have the potential to enhance maternal, neonatal, and child health outcomes. This includes improving attendance for antenatal care, utilisation of healthcare facilities, competent attendance during childbirth, postnatal care attendance, and immunisation rates (Andy et al., 2022). A study conducted in Rwanda found that the implementation of an SMS-based system among community health workers led to a 27% rise in the number of deliveries in health care facilities over a span of 12 months (Ashipu et al., 2020). Mobile phone interventions in Zanzibar had a substantial impact on improving the rate of competent delivery attendance in primary healthcare facilities, as demonstrated by the study conducted by Ashiye et al. in 2022. Telehealth efforts in India, as reported by Abdul et al. (2021), have expanded the availability of services such as providing vitamins to pregnant mothers and doing postnatal home visits. One comprehensive analysis found that providing SMS assistance throughout pregnancy reduced the incidence of perinatal death in children of mothers who received the intervention, when compared to conventional prenatal care. A meta-analysis conducted by Lee et al (2024) shown enhanced breastfeeding rates with the utilisation of SMS/cell phone interventions.

1.2 Statement of the Problem

Nigeria's maternal and child health sector is confronted with significant obstacles, as the country grapples with some of the highest rates of maternal and infant mortality on a global scale. Nse (2023) argued that Nigeria has a maternal mortality ratio of 512 per 100,000 live births as of 2018, which is responsible for about 20% of global maternal deaths, according to the World Health Organization (WHO, 2023). Moreover, the United Nations Children's Fund (UNICEF, 2020) has reported a distressingly high infant death rate of 67 per 1,000 live births in 2019. These statistics emphasize the immediate necessity for successful interventions aimed at enhancing health outcomes for women and children in the nation. Hence, the necessity for doing this investigation

Although telehealth has the potential to enhance healthcare access and quality, its implementation in primary healthcare facilities in Nigeria is still below the recommended level (Anjola, 2023). Multiple factors contribute to this difficulty, necessitating a thorough and methodical examination and resolution in order to fully exploit the capabilities of telehealth. Inadequate financial resources allocated to healthcare is a persistent issue faced by countries in sub-Saharan Africa, such as Nigeria. Many public healthcare facilities in these countries heavily rely on government funding (Peace, 2023). Patients residing in rural or low-income regions may lack access to telehealth devices due to budgetary limitations, as observed by Odinta (2021). According to Solomon (2024), the implementation of telehealth systems necessitates substantial financial commitment. Primary healthcare facilities sometimes have financial constraints, which pose difficulties in allocating funds for telehealth infrastructure and training.

Despite the global development and implementation of Telehealth programmes to enhance mother and child health, their adoption and implementation in Nigeria have been limited (Preye, 2022). Health care professionals in low-resource areas have not placed sufficient emphasis on studying the adoption of Telehealth in the delivery of mother and child health services (Igere et al., 2023). The limited number of studies that concentrate on providers’ highlight difficulties such as technological issues, internet connectivity, power supply, and telephone upkeep (Abiola, 2022). Additional research has demonstrated that the adoption of technology among healthcare professionals is influenced by factors such as user-friendliness, cost, time efficiency, privacy and security concerns, familiarity with the technology, and assessments of potential risks and benefits (Ali et al., 2022).

Furthermore, the acceptance and utilisation of Telehealth in delivering mother and child health services are influenced by the knowledge and attitudes of primary healthcare (PHC) practitioners, as indicated by Uchenna et al. (2023). Nevertheless, there is a scarcity of research investigating the impact of knowledge and attitudes on the utilisation of Telehealth technology among primary healthcare (PHC) clinicians in resource-limited settings. Existing research on health care provider knowledge and attitudes has mostly examined their knowledge and attitudes about the utilisation of computers and information technology (Akinola, 2022). The relationship between knowledge, attitudes, and the acceptance or usage of Telehealth among primary health care practitioners is yet uncertain. Therefore, the necessity for this investigation arises.

Objectives of the study

The primary objective of this study is to critically explore telehealth platforms and their role in improving maternal and child health outcomes in Nigeria. Specific objectives of this study are to:

To assess the extent of Nigerians' knowledge on telehealth.

To evaluate the existing telehealth platforms available in Nigeria.

To determine the effectiveness of telehealth interventions in improving maternal and child health outcomes.

To Identify the challenges faced in implementing telehealth platforms in Nigeria.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What is the extent of Nigerians' knowledge on telehealth?

Are there any existing telehealth platforms available in Nigeria?

How effective are telehealth interventions in improving maternal and child health outcomes?

What is the challenges faced in implementing telehealth platforms in Nigeria?

1.5 Research Hypotheses

Ho: There is no significant effect of telehealth interventions in improving maternal and child health outcomes

Ha: There is n significant effect of telehealth interventions in improving maternal and child health outcomes

1.6 Significance of the study

The project seeks to offer significant insights that can guide policies, practices, and investments in healthcare infrastructure and technology with the goal of enhancing health outcomes for vulnerable groups. The study will provide a fundamental reference point for the general public, health professionals, policy officials, students, and scholars.

Telehealth platforms can extend their reach to distant and underserved regions of Nigeria, where access to healthcare services is restricted, thus enhancing health outcomes for women and children. Telehealth platforms can help decrease maternal death rates in Nigeria by allowing for early diagnosis of pregnancy issues and providing prompt medical care. Additionally, Telehealth simplifies the process of monitoring child growth and development, expedites the administration of timely vaccines, and allows parents the opportunity to seek guidance from specialists, ultimately resulting in enhanced child health outcomes. 

Moreover, these discoveries can offer useful insights to policymakers and healthcare practitioners regarding the most efficient strategies and ways to enhance the adoption of telehealth, so ensuring the realisation of the complete benefits of telehealth. The study's findings can provide valuable insights for healthcare policies and strategies that aim to incorporate telehealth into Nigeria's national healthcare system. This has the potential to impact healthcare delivery models throughout the entire area.

Furthermore, future scholars will utilise it as a thorough examination of the current body of literature. Consequently, other students with an interest in studying this subject will have the opportunity to utilise this work as preexisting information that can be exposed to critical evaluation. This study adds to the scholarly discussion on telehealth platforms and their impact on enhancing mother and child health outcomes in Nigeria. 

1.7 Scope of the study

Broadly, this study focuses to critically explore telehealth platforms and their role in improving maternal and child health outcomes in Nigeria. Specifically, this study seeks to assess the extent of Nigerians' knowledge on telehealth, evaluate the existing telehealth platforms available in Nigeria and determine the effectiveness of telehealth interventions in improving maternal and child health outcomes.  Further, this study will focus on identifying the challenges faced in implementing telehealth platforms in Nigeria and it also seeks to provide recommendations to overcome barriers and promote effective telehealth adoption in Nigeria’s primary healthcare system.

1.8 Limitations of the study

As is customary in any human endeavour, the researchers encountered modest constraints during the investigation. The primary constraint was the scarcity of comprehensive literature on the topic, stemming from the restricted accessibility of data on telehealth platforms and their impact on enhancing mother and child health outcomes in Nigeria. Therefore, a substantial allocation of time and exertion was required to identify suitable resources, publications, or information and collect data.

 Furthermore, this study is limited by its limited sample size and restricted geographic reach, namely concentrating exclusively on Nigeria. Hence, the generalizability of the findings in this study is limited, necessitating additional research. In addition, the researcher encountered a time limitation as a result of the necessity to do this research while simultaneously completing the responsibilities of attending lectures and engaging in other educational endeavors.

1.9 Definition of terms

Telehealth: Telehealth involves the delivery of healthcare services using digital technologies and telecommunications.

Primary Healthcare: PHC is a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people's needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative 

Maternal: Maternal is used to describe feelings or actions which are typical of those of a kind mother toward her child.