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The ‘AI-Powered Midwife’ Helping Pregnant Nigerian Women and Newborns Stay Healthy

By Innocent Eteng (Lead Writer)

Five years ago, when pregnancy related complications threatened the life of Abisola Oladapo’s new-born baby, she experienced a ‘eureka’ moment. “Unknown to me, my water had broken but I didn’t tell my doctor during my appointment because I thought I’d wet myself and I didn’t want to be judged,” she explained. Experts say the longer it takes for a baby to be delivered after the amniotic sac ruptures, the greater the risk for mother and baby.

I later went to the hospital and casually mentioned it to the nurse. When she checked, with a litmus paper, she discovered that I was in fact in labour and had been the entire time”, she said. At the same time, her family friend lost a baby to pregnancy-related complications.

These two experiences prompted Oladapo, a medical technology expert, to research the connection between pregnancy complications and neonatal deaths. She discovered that most complications are preventable with adequate antenatal education and delivery by a trained medical professional at a medical facility. She then teamed up with two colleagues, Michelle Ijomah, another health technology expert and Noel Abotti, a financial technology professional to create ‘Sister Agnes’.

So far, Agnes has reached 1,300 pregnant women across 60 communities in Lagos and Ogun State since 2020, including Ibeju-Lekki and Epe communities in Lagos State and Ajileke and Oke Odan communities in Ogun State. Photo credit to Mumspring.

Sister Agnes is an artificial intelligence-powered (AI) system created to deliver stage-specific pregnancy health information to pregnant women to help them understand their bodies’ evolution throughout pregnancy. The AI-powered system delivers daily and weekly antenatal information in some local Nigerian languages — pidgin English, Igbo, Hausa, and Yoruba.

‘Sister Agnes’
Temitope Adeyeri was 32 years old when she got married in 2018. Her first pregnancy unfortunately resulted in a miscarriage. When she became pregnant again in May 2020, unable to shake the fear that something would go wrong with her second pregnancy, she registered for antenatal care early enough at Ikorodu Primary Healthcare Centre (PHC), Lagos State. Still, the fear persisted.

One morning in November, her phone rang and before she could say a word, the voice on the other end speaking in pidgin English said: “Hello mama, my name na Sista Agnes. You don reach your 18th week. Your baby don big like orange [fruit]. E go dey kick you. No worry, na normal thing.” Soon after the call ended, she received a text message from the same number, reminding her to take her vitamins and keep healthy.

The solution is called Agnes because “it means ‘pure’ and embodies the person we want Agnes to be to the women she serves”, the team behind the application said. Agnes’ health tips come mostly as pre-recorded calls and programmed text messages delivered to pregnant women’s phones in all the local languages. The team now includes midwives who record voice notes tailored to the specific needs of women at different pregnancy stages — from week one to 40. These audio recordings are then fed into the AI-powered system that synchronises with the women’s details, inputted into the same system, enabling it to send the recordings as calls.

Adeyeri and her baby. Photo by Innocent Eteng.

According to Noel Abotti, “With each update, we want her more informed and aware of all that is happening in her body and to know what to do.” After a mother delivers, 15 months into her child’s life, she continues to get the text messages. But the calls change to reminders for her to take her child for immunisation, etc.

The Agnes line is toll-free for onboarded women to call for support. Its midwifery team handles the 24/7 toll-free helpline and provides periodic checks on the women. “Each midwife is assigned a specific group of women whom she monitors to ensure that they [women] continually hear from the same midwife,” the team said. “The information was very helpful to me,” Adeyeri acknowledges. When I was in my ninth month, I was very big. I could not recognise myself again. [But], Sister Agnes called and told me it was normal, that I should not listen to anybody except my midwife and doctor. It was that call that lifted my mood because I was like, ‘when is this thing coming out?’”

Image credit: Nigeria Health Watch

Reaching more through partnerships
So far, Agnes has reached 1,300 pregnant women across 60 communities in Lagos and Ogun State since 2020, including Ibeju-Lekki and Epe communities in Lagos State and Ajileke and Oke Odan communities in Ogun State. In December 2020, they partnered with the Lagos State government to onboard pregnant women as part of the state’s Mother, Infant and Child (MICH) initiative that aimed to promote nutrition among pregnant women. Through some PHCs in Lagos, women who had registered for antenatal care at the centres were contacted and asked if they wanted to be part of Agnes. The contacts of those who consented were then shared with the organisation.

According to the team’s internal survey, 79% of women who use Agnes deliver in health centers with medically trained attendants. This is 139% higher than the national rate. As a result, the women are four times most likely to survive pregnancy, and the survival rate of their children is 33% higher than the national average.

Image credit: Nigeria Health Watch

A low-tech solution
Agnes is one more addition to several other solutions addressing the issue of maternal and child mortality in Nigeria. HelpMum, trains traditional birth attendants and equips them with tablets laden with superior information to help pregnant women. It also improves child vaccination rates through a centralised digital vaccination tracker, and it has registered 60,000 children already. The OMOMi app, enables mothers to interact with live doctors, gives access to life-saving materials, and creates a virtual community where mothers share experiences. MomCare supports expectant mothers throughout their pregnancy journey. They combine a care bundle and quality improvement method under one umbrella to ensure that mothers are empowered to access the care they can trust.

The Agnes team considers their solution a critical addition to this group as it is low-tech in its simplicity. A woman with any functional phone — a smartphone is unnecessary — can receive the calls and messages in their local language, cutting off the barriers of illiteracy and lack of access to the internet. Use of mobile applications and sophisticated phones are sometimes considered “high technology” (high-tech) because it requires some level of literacy and internet connectivity to access the solution.

Yet even the low-tech nature of Agnes is not devoid of barriers. Agnes only deals with pregnant women, without connecting with their relatives for privacy’s sake. It means that if a woman cannot charge her phone due to a power outage, her phone is stolen, or it breaks; she cannot access the service. The team acknowledges this as a limitation and aims to start collecting relatives’ contacts as an alternative.

Meanwhile, some women say they now use the Agnes-imparted knowledge to help others. “My neighbour is six months pregnant. The other day, she woke up with swollen eyes. When I saw her, I laughed and asked, ‘have you taken your drugs?’ she said ‘yes’ and I said, ‘go and get watermelon and eat.’ I also helped her to do some exercises. By evening, the swelling had gone”, explained Edijana Richard, a 38-year-old mother of two.

Statistics represent real people
Nigeria’s neonatal death rate is 38 per 1000 live births. The number swells to 132 deaths per 1000 live births for under-five children. Across Sub-Saharan Africa, 1.1 million neonatal deaths occur every year — 45.8% of the global 2.4 million yearly cases. For maternal health, it is reported that in Nigeria, 39% of women deliver at health facilities, while 512 deaths occur for every 100,000 live births.

Image credit: Nigeria Health Watch

Testimonies like those of Richard’s and Adeyeri’s keep the Agnes team motivated. The team would like to “deepen our technology further” to reach more women but had to slow down due to the limited resources at their disposal. Still, because no region is exempt from the sad occurrence of maternal and neonatal deaths, Michelle Ijomah, one of the founders, said that the team is planning to scale Agnes to the South-South region this first quarter of 2022.

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