Venkateswaran M, Ghanem B, Abbas E, Khader KA, Ward IA, Awwad T, Baniode M, Frost MJ, Hijaz T, Isbeih M, Mørkrid K, Rose CJ, & Frøen JF. (2022). A digital health registry with clinical decision support for improving quality of antenatal care in Palestine (eRegQual): a pragmatic, cluster-randomised, controlled, superiority trial. The Lancet. Digital Health, 4(2), e126–e136. https://doi.org/10.1016/S2589-7500(21)00269-7
The public health system in Palestine implemented a digital maternal and child health eRegistry with clinical decision support. Researchers compared the quality of antenatal care between primary care clinics with eRegistry and those with paper-based records. The study is a cluster-randomized controlled trial in primary health care clinics that provide antenatal care in the West Bank, Palestine. Fifty-nine clusters were randomly assigned to the control (paper-based records) group and 60 clusters to the intervention (eRegistry with clinical decision support) group. Researchers looked at the effectiveness of the eRegistry system in improving the provision of timely and appropriate screening and management in routine antenatal care, and health outcomes at delivery for mothers and newborns. Between January to September 2017, 3217 pregnant women and 3148 pregnant women received care in the intervention and control clinics respectively. The results found women were more often screened for risk factors and referred to high-risk clinics in intervention clinics (17.6%) compared to control clinics (12.6%). Compared to the control group, pregnant women were more often screened and managed for anemia, gestational diabetes, and hypertension in the intervention group than in the control group (adjusted ORs from 1.45 to 1.88). Only 9.4% of pregnant women attended the full schedule of routine antenatal care across both groups. There were no differences in fetal growth monitoring, antenatal care attendance, or adverse outcomes at delivery in the control and intervention groups. Overall, the improvements in most process outcomes strengthen the evidence of digital client tracking in lower-middle income settings and digital interventions can facilitate better coverage of antenatal care.