Leah Kyalo, with her finely braided hair and doll-like face, sits on the brown sofa in her kitchen/living room. She holds her six-week-old daughter, Oliva, in her arms, wrapped in a sky-blue blanket patterned with white rabbits. It's a quiet afternoon in this high-rise apartment building in Wote, the central town of Makueni County in southern Kenya. In a soft voice, the 23-year-old says, "As a new mother, I'm reassured by the messages about my ability to raise a baby, because I've never done it before." The messages in question are those that Jacaranda Health, a non-profit organization, sends regularly to her telephone to advise her on her eating and physical habits and ease her worries at this special time in her life.
Without the text support she will receive until her daughter's first birthday, she would not have known, for example, that eating a lot of beans could explain the bouts of constipation of her breastfed baby.
When she was just two weeks pregnant, Leah Kyalo was "enrolled" by nurses at Wote referral hospital in a program called PROMPTS, which stands for Promoting Mothers through Pregnancy and Postpartum. She received practical information, appointment reminders and messages about worrying signs that can arise during pregnancy.
She can also ask any health-related question: an answer arrives in less than five minutes. She turned to her phone when she was vomiting every time she took her iron supplements (the program advised her to continue), and when she woke up with blood in her sheets, PROMPTS sent her to the nearest hospital.
The aim of the program, which was set up in 2017, is to provide information to young expectant mothers in order to reduce maternal mortality indirectly. In Kenya, despite significant progress in health care, maternal mortality has, unfortunately, remained high since the 1990s. The country of 50 million people on the Indian Ocean coast in East Africa recorded 530 maternal deaths per 100,000 live births in 2020, in line with the continent’s average. The World Health Organization (WHO) estimates that this rate has actually worsened since 2017, rising by 55%; the 2014 national census put it at 362 deaths a year. This is a far cry from the UN's Sustainable Development Goal, which aims to bring the global average to fewer than 70 maternal deaths per 100,000 births by 2030 (in Canada, it's fewer than 20).
Kenya’s vast, mainly rural territory is not well covered by the inadequate road infrastructure. Among the factors influencing maternal mortality are the lack of resources, both human and material, within health facilities, as well as the long distances to travel and the lack of transportation.
This context is conducive to what specialists call the three delays: delay in the decision to seek care, delay in accessing a health facility, and delay in receiving care in the health facility. In this complex equation, PROMPTS is tackling the first factor (which is involved in a third of the deaths), to ensure that women get to a hospital as early as possible when necessary.
Answering all their questions
"I ask a lot of questions," Leah admits with a laugh. "I'm afraid the system already knows me by name!" And indeed, at the other end of the line, some 140 kilometres away, Melody Muyula can sometimes recognize patients’ styles, although their names and contact details are hidden from her. From Jacaranda Health's offices in Nairobi, the support worker analyzes hundreds of messages a day through her square-rimmed glasses. Questions arrive in English or Kiswahili on her interface: "I'm three months pregnant, but I'm still menstruating, what could be the problem?" "When it's too hot, especially at night, how do you make sure your baby is neither too warm nor too cold?" "My daughter has watery diarrhea", or “It's like they didn't sew me up properly down there, I need your help.”
Every day, between 4,000 and 15,000 messages arrive from various Kenyan counties, and in 2024, 650,000 mothers were registered on the platform.
Jacaranda Health started small as a simple maternity clinic, founded in 2011 on the initiative of American Nick Pearson, with the idea of commercially developing high-quality maternity care in Nairobi's peri-urban areas. Soon after, the team launched an SMS-based appointment reminder and satisfaction survey service, but a simple error caused the project to evolve, recounts Jay Patel, the company's director of technology. "We wanted to launch a one-way service, but, accidentally, we set up a two-way service and didn't realize it until mothers started texting us. We had to get our helpdesk up and running very quickly and figure out how to answer their questions." From his brightly lit offices in Nairobi, he recalls how the volume of messages increased, quickly reaching over 1,000 a day. Then the team said stop.
To help it cope, an initial artificial intelligence (AI) program was integrated in 2019, making it possible to send pre-written replies, but, above all, to sort text messages according to the urgency of the patient's situation.
The new version, completed in 2024 thanks to a grant from the Google foundation on digital health initiatives and funding from the International Development Research Centre, is on a different scale. Jacaranda Health has built the world's first large language model (LLM) for health in Kiswahili, called UlizaLlama. An LLM is a machine-learning program capable of recognizing human language and generating text.
When Leah asks a question about nutrition, for example, the system recognizes certain words and responds automatically, taking into account the stage of pregnancy or the baby's age. If the mother is not satisfied with the response, a human takes over — Jacaranda Health estimates that the program still makes errors in 30% of cases. However, if danger signs are spotted in a text message (7% of cases), a call is automatically scheduled with one of the 13 members of the team, which includes nurses, nutritionists and other health-care professionals, to check on the patient's condition and refer her to emergency services if necessary. Bleeding, reduced fetal movement, fever and jaundice in infants are the most frequent alerts received by Melody Muyula. Although the majority of women react in time on their own, there are times when the intervention of a support worker is crucial. Melody Muyula remembers a woman who was seven months pregnant. She had recently enrolled in the program and had been losing a lot of blood for three days, without worrying at all. “During the call, she said to me, innocently, 'I thought it was normal!' We realized that this mother-to-be knew nothing of the danger signs to watch out for during pregnancy.”
Sensitive situations like these require understanding and empathy, which is why technology is not left alone at the helm. "Having worked with the system and seen it improve over time, I can say that the AI's accuracy has really increased, as has its transparency, accountability and complementarity," points out Melody Muyula, a nutritionist who joined the company four years ago.
AI means data
What makes PROMPTS so reliable is the fact that the algorithm has been trained on local health data. On the African continent, the absence of a common health information system, along with problems of quality, uniformity and timeliness of data recording, make it difficult to build a specialized LLM; large-scale initiatives are rare. The thousands of messages received every day by PROMPTS present a perfect flow in the supply. The messages have been used to train and enrich UlizaLlama, an open source program available for anyone wishing to use or adapt the model. "I think AI will be able to bring care to populations that don't usually have access to it and enable health-care systems to serve their patients a little better," says Jay Patel. The program also works with Hausa and Yoruba from Nigeria, and Xhosa and Zulu from South Africa, and has been rolled out in Eswatini (2021), Ghana (2022), Nigeria and Nepal (2024).
The results are encouraging. According to a study published in BMC Pregnancy and Childbirth in 2024 and involving over 700 Kenyan women, mothers enrolled in the program were twice as likely to make postnatal visits than mothers who were not enrolled, for example. Another study, published in PLOS in 2025 and involving over 6,000 pregnant women, found that the program enabled them to improve their knowledge, preparation for childbirth, newborn care and vigilance in the face of worrying symptoms.
Barriers to health-care use
In Kenya, PROMPTS is available in 23 of the 47 counties, but not yet in the semi-arid northern regions, which are most vulnerable to problems regarding access to health care. In Garissa, Mandera and Wajir, the number of women who visited the hospital at least four times during their pregnancy — an indicator of awareness of the importance of care — is only 31%, 40% and 45%, respectively, compared with a national average of 66%. Mortality among children under one year of age, the period during which the program is still supervising mothers, is also higher on average than in the rest of the country.
In Kenya, 89% of the population has access to a cell phone
The Jacaranda Health team is aware of the area's needs but faces challenges: “There are operational problems involved in expanding into the large northern counties. One of them is that the majority of the population is nomadic, which makes initial enrolment with PROMPTS difficult. Another is that the program refers mothers to institutional care, and this is much harder to do without the kind of network of health facilities that exists in southern Kenya.”
Even with good indicators, Makueni County, where Leah lives and where only four gynecologists practise, faces its share of challenges, such as food insecurity and a hilly topography, which causes some homes to become isolated during the rainy season, sometimes for a week or two. But the factors are not always geographical or economic, points out Christine Muteria, head of maternity at the Wote referral hospital.
"Some women have a fear of coming to the hospital, a mixture of superstition and culture. They don't want to bring bad luck to their pregnancy. This delays care-seeking and the start of prenatal visits," she asserts in a room full of notebooks, binders and statistical tables in the hospital's administrative wing. She explains in a confident voice that, nonetheless, the situation has improved and that interventions like PROMPTS have helped reassure mothers about medical monitoring. The county's maternal mortality rate has fallen sharply, from 96 deaths per 100,000 births in 2014 to 53 per 100,000 in 2024.
Christine Muteria taps away on her telephone and computer in search of the latest patient reviews. The telemedicine program systematically asks mothers for feedback on their visits, and their responses inform hospital management of areas for improvement. Jacaranda Health works in close partnership with county governments and can report incidents involving health staff, such as disrespectful behaviour (if the mother agrees), but also local health trends. Through the questions, the organization noticed, for example, that mothers in Mombasa, on the Kenyan coast, were particularly interested in getting massages. After consultation with the authorities, an information campaign on the risks and precautions to be taken in relation to massages was rolled out across the county.
For Christine Muteria, this education of mothers has changed the game in the nurses' day-to-day work and improved care: "The lines are long and there's a shortage of nurses, so sometimes we can be working almost on autopilot. When the patient is aware of the tests and services she should be receiving at this stage, it mobilizes the nurses." And everyone wins.
The program described in this article and production of this report were made possible by support from Canada's International Development Research Centre.
This article was originally published in the April-May 2025 issue of Québec Science magazine.