Effect of enhanced reminders on postnatal clinic attendance in Addis Ababa, Ethiopia: a cluster randomized controlled trial

Abstract

Background: Failure to attend maternal health services is an intractable challenge for the health-care system in low-and middle-income countries. The use of technology for reminding patients about their appointments has been demonstrated to be an effective (future) tool toward increased health care services utilization in developing countries, such as Ethiopia. Objective: We aimed to investigate the effect of enhanced reminders on postnatal care attendance versus usual care (notification of an appointment at discharge). Methods: The study was a cluster randomized controlled trial: out of eligible 86 health centers, 16 health centers in Addis Ababa (AA) were randomized to either the intervention (8) or the control (8) groups; with a total of 350 mothers equally randomized into each arm. Mothers in the intervention group received the SMS (short message service) or a voice call reminder at 48 and 24 hours before the due postnatal appointment, whereas the control group received only the usual notification of appointments provided by health professionals at discharge from the ward following delivery. We recruited participants on wards after delivery at discharge and followed them up to 6 weeks. This study's primary outcome was postnatal visit compliance. Our assessment consisted of a two-level bivariate and a multivariate ordinal logistic regression analysis. Results: The majority (97.7%) of the participants completed the study; 173(98.9%) of women in the intervention group and 169 (96.5%) of women in the control group. There was a statistically significant difference in postnatal care (PNC) compliance among women who were in the intervention versus the control group (p-value = 0.005). Higher odds of postnatal compliance was observed among the intervention group (AOR:2.98, 95% CI 1.51-5.8). Conclusions: Mobile phone reminders were effective in terms of enhancing adherence to PNC appointments. This indicates integration of mobile phone reminders in postnatal care could improve postnatal appointment compliance.

Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia

“…Our findings were consistent with those reported in studies from Bangladesh [ 66 ], Nigeria [ 68 ], and Côte d'Ivoire [ 71 ], which reported that SMS text reminders improved childhood vaccination coverage. Our findings were also in line with those of other studies that observed that mobile phone–based reminders significantly improved attendance to different health service appointments [ 61 , 75 , 99 - 101 ]. On the contrary, community-based studies from Ethiopia [ 75 ], Kenya [ 67 ], and South Africa [ 76 ] reported that the effect of SMS-based mobile phone interventions on full vaccination coverage was not statistically significant at 5% significance level.…”

Impact of mHealth interventions on antenatal and postnatal care utilization in low and middle-income countries: A Systematic Review and Meta-Analysis

“…The characteristics of the included studies were shown in table 1. Mudey, 2015 [12] , Fedha, 2014 [13] , Kebede, 2019 [15] , Bangal, 2017 [16] and Adanikin, 2013 [17] included an intervention as SMS reminders and Lund, 2014 [14] included intervention as an automated short messaging service (SMS) system and a mobile phone Voucher system. All studies had comparators as standard care.…”

“…All studies had comparators as standard care. Lund, 2014 [14] and Kebede, 2019 [15] were the cluster randomized controlled trials, and the sample size has been recalculated for the actual sample size considering the study’s design effect. We have performed sensitivity analysis and excluded studies due to methodological issues and different target populations.…”

“…[4,6] Although studies have shown the effectiveness of mHealth intervention towards maternal and child health outcomes. [12][13][14][15][16][17] In the present metaanalysis, we have pooled the data of selected studies in low-and middle-income countries to create or strengthen the evidence for mHealth's effectiveness towards antenatal and postnatal care utilization. This meta-analysis detected that m-health has the potential to increase antenatal and postnatal attendance compared to the standard approach, although the level of evidence was moderate.…”

“…[11] We have reviewed relevant studies that have evaluated mobile technology's effectiveness in promoting maternal and child health by measuring maternal satisfaction, their attitude and behavior towards available maternal and child health services, their antenatal and postnatal attendance, and maternal and perinatal health as well. [12][13][14][15][16][17] However, it remains inconclusive due to the limited sample size; hence, it is required to integrate and analyze these studies' findings with a systematic review of all available relevant literature and meta-analysis. This study evaluated mHealth interventions' effectiveness in antenatal and postnatal care utilization in low and middle-income countries.…”