Maternal and Child Health | Moana Digital Health

Overview

Maternal and child mortality remain among the most preventable indicators of health system performance, and among the most persistently difficult to reduce without integrated, longitudinal digital health infrastructure. The data needed to track and improve these outcomes, antenatal visit coverage, skilled birth attendance, neonatal mortality rates, stunting prevalence, immunisation coverage, exists in clinical facilities. The problem is that it is fragmented across paper registers, ANC cards that mothers carry and sometimes lose, ward admission books, vaccination booklets, and growth monitoring charts that are maintained separately, stored in different departments, and never connected to each other.

The Maternal and Child Health module integrates this entire continuum into one connected system. The pregnancy registered at a woman's first ANC visit and the growth chart maintained for her child two years later are part of the same longitudinal record. The birth circumstances documented at delivery, the NICU admission that followed, the neonatal death that occurred six hours after birth, and the stillbirth registered three months earlier for the same mother are all linked and visible together, providing the complete clinical picture that quality-of-care review requires.

All MCH data flows automatically into the national surveillance programme, providing Ministry of Health teams with real-time population-level indicators: ANC coverage, skilled birth attendance rate, neonatal mortality rate, maternal mortality ratio, stunting and wasting prevalence, and immunisation coverage by antigen, by facility, by district, and nationally. These are the indicators that governments report to WHO, UNICEF, and development partners. They should come from systems, not from manual collation exercises.

The indicator framework aligns directly with national health plan targets and SDG reporting requirements.

Core Capabilities

Antenatal Care and Pregnancy Tracking

When a pregnancy is confirmed, a Pregnancy record is created capturing the gestational age, estimated delivery date, gravida (total number of pregnancies), and parity (number of completed births). A structured risk factor profile is completed: previous caesarean section, age over 35, previous stillbirth, history of hypertension, gestational diabetes, and other clinically defined risk factors are documented explicitly as a flagged list rather than buried in free text. High-risk pregnancies are visually flagged on the patient record, alerting any clinician accessing the record to the elevated risk status.

Each ANC visit creates an ANC Visit record against the active pregnancy. Visit data captures the visit number, date, attending clinician, blood pressure, weight, fundal height, foetal heart rate, examination findings, and structured screening results: HIV status, syphilis serology, anaemia haemoglobin, and urine dipstick. Advice given to the mother is documented so the next visit's clinician can see exactly what was discussed in the previous visit. Next visit date is recorded and generates an appointment and a recall alert if the mother does not present within the expected window.

The surveillance layer calculates ANC indicator rates automatically from this data. ANC1 coverage, the percentage of pregnant women receiving at least one antenatal visit, and ANC4+ coverage, the percentage receiving the WHO-recommended minimum of four visits, are computed in real time at facility, district, and national level. These are among the most widely tracked maternal health indicators globally.

Delivery, Birth Registration, and Civil Documentation

When a woman delivers at a Moana facility, the birth is registered at the same moment it is clinically documented. There is no separate paper birth registration process. The delivery record captures delivery mode, birth weight, APGAR scores at one minute and five minutes, and outcome classification. If the baby is born alive, a permanent patient record is created automatically, linked to the mother's record, the pregnancy record, and the delivering clinician. The baby is immediately ready for first vaccinations and growth monitoring without any additional registration steps.

Back-dated birth registrations are supported for home births, births at non-Moana facilities, and facility transfers, with mandatory reason codes that maintain data quality while accommodating real-world registration patterns. Birth certificates are generated directly from the birth registry record, idempotently, without requiring a separate registration process.

Stillbirth Registration

Stillbirth is managed as a distinct clinical and administrative workflow, separate from live birth and neonatal death. The stillbirth record captures gestational age at delivery, cause of foetal death where clinically determined, the attending clinician, the facility, and a direct link to the mother's pregnancy record and ANC history. Cause of stillbirth is recorded in both plain language and ICD-10 code. Stillbirth data flows directly into the national surveillance programme for population-level stillbirth rate tracking, which is a required indicator under most national health plans and WHO reporting frameworks.

Death Registration

Death registration is completed within the clinical workflow at the point of discharge processing, eliminating the delay between clinical death documentation and administrative registration. The record captures date and time of death, place of death, cause of death in plain language and ICD-10 code, and the certifying clinician's identity. The patient record is updated to deceased status, preserving all clinical history intact for medico-legal review and population health analysis. Death certificates are generated directly from the death registry record.

Neonatal deaths receive specific handling that reflects their clinical and epidemiological significance. A neonatal death is flagged with the isNeonatal marker. Age at death is captured in hours rather than days: a death at six hours and a death at twenty-five days have fundamentally different implications for the assessment of intrapartum care quality and neonatal service performance. Every neonatal death links automatically to the corresponding birth registry record, showing birth weight, mode of delivery, and APGAR scores, and to the NICU admission record if one exists, showing the full course of care before death. This three-way linkage provides the complete clinical picture required for case review, quality improvement, and national neonatal mortality reporting.

Neonatal Intensive Care Unit (NICU)

NICU admissions are recorded with admission date, admission reason, birth weight, gestational age at admission, and admitting clinician. Admission reasons include prematurity, birth asphyxia, low birth weight, neonatal jaundice, neonatal sepsis, and respiratory distress. A continuous vital log records per-shift or per-event measurements of heart rate, oxygen saturation, respiratory rate, temperature, and feeding details including feeding type (NPO, nasogastric, breast, or formula) and volume in millilitres. Discharge outcomes are classified as discharged home, transferred to another facility, or deceased, with the corresponding record links populated at discharge.

Paediatric Growth Monitoring with WHO Z-Scores

At every well-child visit, the clinician records weight, height or length for infants under 24 months, head circumference, and mid-upper arm circumference. Moana calculates WHO Child Growth Standards z-scores automatically from the WHO LMS reference data embedded in the module: weight-for-age (WAZ), height-for-age (HAZ), weight-for-height (WHZ), and BMI-for-age (BMIZ). Four automatic flags are set based on the calculated z-scores: isStunted when HAZ falls below minus two standard deviations, isSeverelyStunted when HAZ falls below minus three, isWasted when WHZ falls below minus two, and isSeverelyWasted when WHZ falls below minus three. An underweight flag is set when WAZ falls below minus two.

Z-score flags at the minus two threshold trigger a clinical alert to the attending clinician at the point of the visit. Flags at the minus three threshold trigger a severe malnutrition alert with escalation to the facility supervisor. Growth charts are plotted automatically over time, showing the child's trajectory on the WHO reference curves. At the population level, stunting and wasting data from growth monitoring feeds the national MCH surveillance programme for national nutrition indicator reporting, which is a directly tracked SDG indicator under Goal 2.

Immunisation Programme Management

National immunisation schedules are configured in the system per country or per programme, mapping each antigen to its recommended doses, intervals, and eligible age ranges. Every vaccination administered is recorded against the patient's immunisation record with the vaccine name, antigen, dose number, batch number, lot expiry date, administration site, and the administering clinician. Adverse events following immunisation (AEFI) are captured and reported. Vaccine inventory is tracked at the facility level with the same batch and expiry management as the pharmacy module. When a child is overdue for a scheduled dose, a recall alert is generated. The surveillance layer calculates immunisation coverage rates by antigen, by age group, by facility, and by geography for national programme reporting.

Who Uses This Module

Midwives and Obstetric Nursing Staff

Register pregnancies, complete ANC visit documentation, manage delivery records, and register births. Primary users of the antenatal and delivery workflows.

NICU Nursing and Medical Staff

Create and manage NICU admissions, record vital logs per shift, document feeding records, and process NICU discharges and outcomes.

Paediatric and Primary Care Clinicians

Record growth measurements at well-child visits, review z-score calculations and growth chart trajectories, respond to malnutrition alerts, and administer and document vaccinations.

Ministry of Health Programme Officers

Access national MCH indicator dashboards including ANC coverage, skilled birth attendance, neonatal mortality rate, maternal mortality ratio, stunting and wasting prevalence, and immunisation coverage rates without accessing individual patient records.

How This Connects to the Rest of Moana

The MCH module is deeply integrated across the platform. Pregnancy records link to ANC visits in the same module. Delivery records link to birth registrations in Patient Management and to the Civil Registration surveillance programme. NICU admissions link to birth records and, in adverse outcomes, to death registrations. Growth monitoring records link to the patient's longitudinal paediatric history. Immunisation records integrate with the pharmacy module for vaccine stock tracking. All MCH events feed the Public Health Surveillance System for national programme indicator reporting.

Standards and Interoperability

ANC and delivery records are structured to FHIR R4 Patient, Observation, and Encounter resources. Civil registration outputs are compatible with national statistics office reporting formats. Immunisation records align with FHIR R4 Immunization and ImmunizationRecommendation resources. Growth measurements align with FHIR R4 Observation resources using LOINC codes for the relevant measurements. All MCH data feeds the moana-surveillance layer, where indicator definitions map directly to national health plan frameworks, WHO reporting standards, and SDG Goal 2 and Goal 3 indicator sets.