Primary studies included in this systematic review

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Primary study

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Giving cell phones to pregnant women and improving services may increase primary health facility utilization: a case-control study of a Nigerian project.

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Authors Oyeyemi SO , Wynn R
Journal Reproductive health
Year 2014
Links Pubmed DOI PubMed Central

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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BACKGROUND: Worldwide, about 287 000 women die each year from mostly preventable complications related to pregnancy and childbirth. A disproportionately high number of these deaths occur in sub-Saharan Africa. The Abiye ('Safe Motherhood') project in the Ifedore Local Government Area (LGA) of Ondo-State of Nigeria aimed at improving facility utilization and maternal health through the use of cell phones and generally improved health care services for pregnant women, including Health Rangers, renovated Health Centres, and improved means of transportation. METHODS: A one-year sample of retrospective data was collected from hospital records and patients' case files from Ifedore (the project area) and Idanre (control area) and was analyzed to determine healthcare facility utilization rates in each location. Semi-structured questionnaires were used to generate supplemental data. RESULTS: The total facility utilization rate of pregnant women was significantly higher in Ifedore than in Idanre. The facility utilization rate of the primary health care centres was significantly higher in Ifedore than in Idanre. The number of recorded cases of the five major causes of maternal death in the two LGAs was not significantly different, possibly because the project was new. CONCLUSIONS: Giving cell phones to pregnant women and generally improving services could increase their utilization of the primary healthcare system.

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Antenatal health promotion via short message service at a Midwife Obstetrics Unit in South Africa: a mixed methods study.

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Journal BMC pregnancy and childbirth
Year 2014
Links Pubmed DOI PubMed Central

This article is included in 5 Systematic reviews Systematic reviews (5 references)

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BACKGROUND: Adequate antenatal care is important to both the health of a pregnant woman and her unborn baby. Given South Africa's high rate of cellphone penetration, mobile health interventions have been touted as a potentially powerful means to disseminate health information. This study aimed to increase antenatal health knowledge and awareness by disseminating text messages about clinic procedures at antenatal visits, and how to be healthy during pregnancy. METHODS: Participants recruited were pregnant women attending a primary health care facility in Cape Town. A controlled clinical trial was carried out where the intervention group (n = 102) received text messages staggered according to the week of pregnancy at the time of recruitment. The control group (n = 104) received no text messages. These text messages contained antenatal health information, and were delivered in English, Xhosa or Afrikaans, according to the preference of each participant. A baseline knowledge questionnaire with nine questions was administered prior to the intervention. The same questionnaire was used with added health-related behaviour questions for the intervention group at exit. A modified intention-to-treat analysis was done. To compare the control and intervention group's knowledge, Fisher's exact tests and two-sample t-tests tests were carried out for binary and continuous outcomes, respectively. A focus group of seven participants from the intervention group was then conducted to gain more insight into how the text messages were perceived. RESULTS: There was substantial loss to follow-up during the study with only 57% of the participants retained at exit. No statistically significant difference was detected between the control and intervention group in any of the nine knowledge questions at exit (all p > 0.05). Responses from the focus group indicated that the text messages acted as a welcome reminder and a source of positive motivation, and were perceived as extended care from the health care provider. CONCLUSIONS: While the intervention failed to improve antenatal health knowledge, evidence from self-reported behaviour and the focus group suggests that text messages have the potential to motivate change in health-seeking behaviour. One should be mindful of loss to follow-up when rolling out mobile health interventions in developing country settings. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR201406000841188. Registered 3 June 2014.

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Mobile phones improve antenatal care attendance in Zanzibar: a cluster randomized controlled trial.

Journal BMC pregnancy and childbirth
Year 2014
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis Broad syntheses (1 reference) 8 Systematic reviews Systematic reviews (8 references)

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BACKGROUND: Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems. 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. We evaluated the association between a mobile phone intervention and antenatal care in a resource-limited setting. We aimed to assess antenatal care in a comprehensive way taking into consideration utilisation of antenatal care as well as content and timing of interventions during pregnancy. METHODS: This study was an open label pragmatic cluster-randomised controlled trial with primary healthcare facilities in Zanzibar as the unit of randomisation. 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary healthcare facilities were included at their first antenatal care visit and followed until 42 days after delivery. 24 primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text-message and voucher component. Primary outcome measure was four or more antenatal care visits during pregnancy. Secondary outcome measures were tetanus vaccination, preventive treatment for malaria, gestational age at last antenatal care visit, and antepartum referral. RESULTS: The mobile phone intervention was associated with an increase in antenatal care attendance. In the intervention group 44% of the women received four or more antenatal care visits versus 31% in the control group (OR, 2.39; 95% CI, 1.03-5.55). There was a trend towards improved timing and quality of antenatal care services across all secondary outcome measures although not statistically significant. CONCLUSIONS: The wired mothers' mobile phone intervention significantly increased the proportion of women receiving the recommended four antenatal care visits during pregnancy and there was a trend towards improved quality of care with more women receiving preventive health services, more women attending antenatal care late in pregnancy and more women with antepartum complications identified and referred. Mobile phone applications may contribute towards improved maternal and newborn health and should be considered by policy makers in resource-limited settings.

Primary study

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Mobile phone intervention reduces perinatal mortality in zanzibar: secondary outcomes of a cluster randomized controlled trial.

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Journal JMIR mHealth and uHealth
Year 2014
Links Pubmed DOI PubMed Central

This article is included in 6 Systematic reviews Systematic reviews (6 references)

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BACKGROUND: Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse. OBJECTIVE: We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. METHODS: This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as a proxy of neonatal mortality. RESULTS: Within the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births. The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74). CONCLUSIONS: Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT01821222; http://www.clinicaltrials.gov/ct2/show/NCT01821222 (Archived by WebCite at http://www.webcitation.org/6NqxnxYn0).

Primary study

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The effect of SMS messaging on the compliance with iron supplementation among pregnant women in Iran: a randomized controlled trial.

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Authors Khorshid MR , Afshari P , Abedi P
Journal Journal of telemedicine and telecare
Year 2014
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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We examined the effect of SMS text messages on compliance with iron supplementation among pregnant women. A randomized controlled trial was conducted on 116 pregnant women referred from public health centres in Ahvaz. Their gestational age was 14-16 weeks. The subjects were randomly assigned to a control group who received usual care, or to a 12-week intervention with SMS reminders in addition to usual care. Participants in both groups were provided with iron supplements and taught how to take iron tablets. Most women in the intervention group (94%) had high compliance with iron supplements compared to the control group (66%); this difference was significant (P = 0.003). Although haemoglobin, haematocrit and ferritin decreased significantly in each group, there was no significant difference between them. Using SMS reminders is an efficient way of improving compliance of women with iron supplementation during pregnancy. However, in the present study better compliance did not improve anaemia.

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A study to assess the feasibility of text messaging service in delivering maternal and child healthcare messages in a rural area of Tamil nadu, India

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Journal The Australasian medical journal
Year 2014
Links Pubmed DOI PubMed Central

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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Background Mobile text messaging is a potentially powerful tool for behaviour change because it is widely available, inexpensive, and instant. Aims To evaluate whether mobile Text Messaging Service is a feasible mode of raising knowledge regarding maternal and child health (MCH) and to explore issues related to mobile text messages as a mode of health education. Method A community-based intervention study was conducted from January to June 2013 in six randomly selected villages of Vellore district, Tamil Nadu. A multi-stage sampling technique was followed: 120 individuals from 120 households (30 clusters in six villages) were contacted. Data was collected using a pretested questionnaire by house-to-house visits in three phases: 1) baseline assessment of aptitude towards text messages; 2) intervention: sending MCH-related text messages; and 3) end-line assessment to evaluate the increase in knowledge level. Qualitative data regarding mobile text messages as a mode of health education was explored. Quantitative data was analysed using SPSS version 17.0 and qualitative data by Anthropac software. Results Of the individuals surveyed, 69.17 per cent and 52.5 per cent were "able to read" and "type and send" text messages, respectively. Seventy per cent of individuals were willing to receive health information via text messages, and 98.33 per cent believed text messages could effectively spread health messages. A significant increase in knowledge was observed following text messages. Male gender and subjects' ability to read text messages were significantly associated. Factors related to mobile phone use include minimum economic burden, easy availability, portability, and ease of use. Factors related to mobile text messages as a mode of health message delivery include direct receipt of information, mass reach, the absence of regional language font in many handsets, and illiterate individuals being unable to read messages. Conclusion In rural areas, mobile text messages have the potential to deliver health messages regarding MCH.

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Exploring the use of mobile phone technology for the enhancement of the prevention of mother-to-child transmission of HIV program in Nyanza, Kenya: a qualitative study.

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Journal BMC public health
Year 2013
Links Pubmed DOI PubMed Central

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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BACKGROUND: Community-based mobile phone programs can complement gaps in clinical services for prevention of mother-to-child transmission (PMTCT) of HIV in areas with poor infrastructure and personnel shortages. However, community and health worker perceptions on optimal mobile phone communication for PMTCT are underexplored. This study examined what specific content and forms of mobile communication are acceptable to support PMTCT. METHODS: Qualitative methods using focus groups and in-depth interviews were conducted in two district hospitals in Nyanza Province, Kenya. A total of 45 participants were purposefully selected, including HIV-positive women enrolled in PMTCT, their male partners, community health workers, and nurses. Semi-structured discussion guides were used to elicit participants' current mobile phone uses for PMTCT and their perceived benefits and challenges. We also examined participants' views on platform design and gender-tailored short message service (SMS) messages designed to improve PMTCT communication and male involvement. RESULTS: Most participants had access to a mobile phone and prior experience receiving and sending SMS, although phone sharing was common among couples. Mobile phones were used for several health-related purposes, primarily as voice calls rather than texts. The perceived benefits of mobile phones for PMTCT included linking with health workers, protecting confidentiality, and receiving information and reminders. Men and women considered the gender-tailored SMS as a catalyst for improving PMTCT male involvement and couples' communication. However, informative messaging relayed safely to the intended recipient was critical. In addition, health workers emphasized the continual need for in-person counseling coupled with, rather than replaced by, mobile phone reinforcement. For all participants, integrated and neutral text messaging provided antenatally and postnatally was most preferred, although not all topics or text formats were equally acceptable. CONCLUSIONS: Given the ubiquity of mobile phones in Kenya and current health-related uses of mobile phones, a PMTCT mobile communications platform holds considerable potential. This pre-intervention assessment of community and health worker preferences yielded valuable information on the complexities of design and implementation. An effective PMTCT mobile platform engaging men and women will need to address contexts of non-disclosure, phone sharing, and linkages with existing community and facility-based services.

Primary study

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Evaluation of the Information and Communications Technology for Maternal, Newborn and Child Health Project Known locally as ‘Chipatala Cha Pa Foni’(Health Center by Phone)

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Journal Balaka District, Malawi: Invest in Knowledge Initiative
Year 2013

This article is included in 1 Systematic review Systematic reviews (1 reference)

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Primary study

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Does telephone lactation counselling improve breastfeeding practices? A randomised controlled trial.

Authors Tahir NM , Al-Sadat N
Journal International journal of nursing studies
Year 2013
Links Pubmed DOI

This article is included in 8 Systematic reviews Systematic reviews (8 references)

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BACKGROUND: Exclusive breastfeeding rates in Malaysia remains low despite the implementation of the Baby Friendly Hospital Initiative (BFHI) policy in government hospitals. It has been suggested that any form of postnatal lactation support will lead to an increase in exclusive breastfeeding rates. OBJECTIVE: To study the effectiveness of telephone lactation counselling on breastfeeding practices. DESIGN: Single blinded, randomised controlled trial (RCT). SETTING: Maternity wards in a public hospital in Kuala Lumpur, Malaysia. PARTICIPANTS: 357 mothers, each of whom had delivered a full term, healthy infant via spontaneous vaginal delivery. METHODS: Mothers were followed up for 6 months. The intervention group (n=179) received lactation counselling via telephone twice monthly by certified lactation counsellors in addition to receiving the current conventional care of postnatal breastfeeding support. The control group (n=178) received the current conventional care of postnatal breastfeeding support. Definitions of breastfeeding practices were according to World Health Organization (WHO) definitions. Participants answered a self-administered questionnaire during recruitment and were later followed up at one, four and 6-month intervals during the postpartum period via a telephone-based questionnaire. RESULTS: At 1 month, a higher percentage of mothers in the intervention group practiced exclusive breastfeeding, compared to the control group (84.3% vs. 74.7%, OR 1.825 95%, p=0.042, CI=1.054, 3.157). At 4 and 6 months postpartum, similar percentages of mothers from the two groups practiced exclusive breastfeeding (41.98% vs. 38.99%; 12.50% vs. 12.02%, no significant differences, both p>0.05). Slightly higher numbers of mothers in the control group had completely stopped breastfeeding at the 1, 4 and 6 month marks, compared to the intervention group (7.4% vs. 5.4%; 12.6% vs. 9.9%; 13.9% vs. 9.4%; all p>0.05). The reason cited by most mothers who had completely stopped breastfeeding during the early postpartum period was a low breast milk supply, while returning to work was the main reason for stopping breastfeeding later in the postpartum period. CONCLUSIONS: Telephone lactation counselling provided by certified lactation counsellors from the nursing profession was effective in increasing the rate of exclusive breastfeeding for the first postpartum month but not during the 4 and 6month postpartum intervals.

Primary study

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The effect of telephone support on depressive symptoms among HIV-infected pregnant women in Thailand: an embedded mixed methods study.

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Journal The Journal of the Association of Nurses in AIDS Care : JANAC
Year 2013
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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Depressive symptoms negatively impact the lives of HIV-infected individuals and are correlated with faster progression to AIDS. Our embedded mixed methods study examined and described the effects of telephone support on depressive symptoms in a sample of HIV-infected pregnant Thai women. HIV-infected pregnant Thai women (n = 40) were randomly assigned to either the control or the intervention group. A registered nurse provided telephone support to the intervention group. Depressive symptoms were measured at three points in both groups. In-depth interviews were conducted at Time 2 and Time 3. Results show that depressive symptoms in the intervention group decreased over time. Qualitative results describe how telephone support can work, but also reveal that telephone support did not work for everyone. We recommend that a larger mixed methods study be conducted to examine the effects of telephone support on depressive symptoms among HIV-infected women, including the costs and benefits of such support.