Health Behavior, Maternal Health, mHealth, Newborn Death, Pregnancy
Conditions
Keywords
Maternal health, Neonatal health, mHealth, Mobile phones, Access to health services, Health behavior
Brief summary
Reducing maternal and newborn mortality remains a global challenge. Because obstetric complications cannot be predicted, skilled attendance at the time of delivery and access to emergency obstetric care remain the most effective strategies to reduce mortality. Antenatal care has the potential to reduce maternal morbidity and improve newborns survival but this benefit may not be realized in sub-Saharan Africa where the attendance and quality of care is declining. There is a rapidly expanding number of mobile phone users in developing countries and due to the potential to strengthen health system the use of mobile phones is health care is emerging. The investigators assessed a mobile phone intervention named wired mothers aimed to improve maternal and newborn health. The hypothesis of the study was that the wired mothers mobile phone intervention would increase attendance to essential reproductive health services such as antenatal care and skilled delivery attendance and reduce severe adverse pregnancy outcomes for women and newborn. The objective of the study was to examine the effect of the wired mothers intervention on antenatal care, skilled delivery attendance, access to emergency obstetric care and perinatal mortality. The study was a pragmatic cluster randomized controlled trial with the primary health care facility as the unit of randomization. The study took place in 2009-2010 on the island of Unguja in Zanzibar. 2550 pregnant women who attended antenatal care at one of 24 selected facilities were included at their first visit and followed until 42 days after delivery. Facilities were allocated by simple randomization to either mobile phone intervention (n=12) or standard care (n=12). The intervention consisted of a SMS and mobile phone voucher component. The perspectives of the study are that mobile phones may contribute to saving the lives of women and their newborns and achievement of MDGs 4 and 5. Evidence is needed to guide maternal and child health policy makers in developing countries.
Interventions
DEVICEWired mothers
The wired mothers SMS component provided health education and appointment reminders to encourage attendance at routine antenatal care, skilled delivery attendance and postnatal care. A specially-designed software automatically generated and sent text messages throughout the pregnancy until six weeks after delivery. The frequency and content of the messages varied according to the women's gestational age. Mobile phone vouchers allowed all wired mothers to communicate directly with primary health care providers. Primary health care facilities randomised for intervention and hospitals were provided with a mobile phone with sufficient credit, while wired mothers were given a phone voucher with modest credit and a card with the phone number of her local primary health care provider.
Sponsors
Ministry of Health and Social Welfare, Zanzibar
Danish International Development Cooperation
University of Copenhagen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
14 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
* Pregnant women attending antenatal care at one of 24 selected primary healthcare facilities
Exclusion criteria
* Missing end-of-study questionnaire
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Skilled delivery attendance | From inclusion to 42 days after delivery. Asssessed at delivery and confirmed 42 days after delivery | We used the WHO definition, whereby skilled delivery attendants are midwifes, doctors or nurses who have been educated and trained in the skills needed to manage pregnancies, childbirth and complications in women and newborns. We also included home deliveries assisted by skilled birth attendants, although international consensus has not been reached on this issue. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Perinatal mortality | From inclusion of the pregnant women until 7 days after delivery. Assessed at delivery and 7 days after delivery | Calculated as a composite of stillbirths and early neonatal deaths |
| Antenatal care attendance | From inclusion of the pregnant women until delivery | — |
Other
| Measure | Time frame |
|---|---|
| Anti tetanus vaccination | From inclusion of the pregnant women until delivery |
| Number of calls between women and midwifes | From inclusion of the pregnant women until 42 days after delivery |
| Preventive malaria treatment | From inclusion of the pregnant women until delivery |
| Antepartum and intrapartum referrals | From inclusion of the pregnant women until postpartum period |
Countries
Tanzania
Outcome results
None listed