Effects of an mHealth voice message service (mMitra) on maternal health knowledge and practices of low-income women in India: findings from a pseudo-randomized controlled trial

Murthy, Nirmala; Chandrasekharan, Subhashini; Muthuperumal, Prakash; Ganju, Aakash; Peter, Joanne; Kaonga, Nadi Nina; Mechael, Patricia

doi:10.1186/s12889-020-08965-2

Cited by 33 publications

(48 citation statements)

References 14 publications

(18 reference statements)

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“…In the Wired Mothers study, the intervention group receiving SMS reminders had a significantly higher percentage of women delivering with skilled birth personnel (60%) compared to the control group (47%) ( 48 ). The use of apps in combination with SMS or voice reminders has also been proven to significantly increase supervised institutional deliveries in three studies ( 45 , 53 , 58 ).…”

Section: Resultsmentioning

confidence: 99%

mHealth interventions to reduce maternal and child mortality in Sub-Saharan Africa and Southern Asia: A systematic literature review

Bossman

Johansen

Zanaboni

2022

Front. Glob. Womens Health

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BackgroundReducing maternal mortality, neonatal mortality and under 5-year mortality are important targets addressed by the United Nations' Sustainable Development Goals. Despite studies reported an improvement in maternal and child health indicators, the progress achieved is not uniform across regions. Due to the increasing availability of mobile phones in low and middle-income countries, mHealth could impact considerably on reducing maternal and child mortality and maximizing women's access to quality care, from the antenatal stage to the post-natal period.MethodsA systematic literature review of mHealth interventions aimed at reducing maternal and child mortality in Sub-Saharan Africa and Southern Asia. Primary outcomes were maternal mortality, neonatal mortality, and under-five mortality. Secondary outcomes were skilled birth attendance, antenatal care (ANC) and post-natal care (PNC) attendance, and vaccination/immunization coverage. We searched for articles published from January 2010 to December 2020 in Embase, Medline and Web of Science. Quantitative comparative studies were included. The protocol was developed according to the PRISMA Checklist and published in PROSPERO [CRD42019109434]. The Quality Assessment Tool for Quantitative Studies was used to assess the quality of the eligible studies.Results23 studies were included in the review, 16 undertaken in Sub-Saharan Africa and 7 in Southern Asia. Most studies used SMS or voice message reminders for education purposes. Only two studies reported outcomes on neonatal mortality, with positive results. None of the studies reported results on maternal mortality or under-five mortality. Outcomes on skilled birth attendance, ANC attendance, PNC attendance, and vaccination coverage were reported in six, six, five, and eleven studies, respectively. Most of these studies showed a positive impact of mHealth interventions on the secondary outcomes.ConclusionSimple mHealth educational interventions based on SMS and voice message reminders are effective at supporting behavior change of pregnant women and training of health workers, thus improving ANC and PNC attendance, vaccination coverage and skilled birth attendance. Higher quality studies addressing the role of mHealth in reducing maternal and child mortality in resource-limited settings are needed, especially in Southern Asia.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019109434, identifier CRD42019109434.

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Section: Resultsmentioning

confidence: 99%

mHealth interventions to reduce maternal and child mortality in Sub-Saharan Africa and Southern Asia: A systematic literature review

Bossman

Johansen

Zanaboni

2022

Front. Glob. Womens Health

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“…The RCT presented here is part of a large mixed methods evaluation of Kilkari 17. Findings add to the limited evidence available on the effectiveness of large-scale health information messaging programmes4 7 12 and smaller scale initiatives in Malawi8 and Zanzibar 9–11. However, comparisons with other programmes are challenging given the fundamental differences in programme components, implementation partners, study contexts, scale of implementation and evaluation design.…”

Section: Discussionmentioning

confidence: 96%

“…Evidence linking scaled mHealth messaging programmes to changes in health outcomes is limited [7][8][9][10][11][12] ; a factor which may impede sustainability and further expansion. 13 The…”

Section: Introductionmentioning

confidence: 99%

“…Evidence linking scaled mHealth messaging programmes to changes in health outcomes is limited7–12; a factor which may impede sustainability and further expansion 13. The scant evidence available suggests varied impacts on a range of outcomes including improvements in birth weight7; infant feeding practices7 8; utilisation of early and complete antenatal care (ANC),8 9 facility-based skilled birth attendance,10 12 maternal and childhood immunisation services7; and reductions in perinatal mortality 11. However, efforts to compare and generalise these findings have been hampered by wide variations in study contexts and programme components including the content, modality, frequency of messages and supporting programmatic activities 14.…”

Section: Introductionmentioning

confidence: 99%

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The impact of a direct to beneficiary mobile communication program on reproductive and child health outcomes: a randomised controlled trial in India

et al. 2022

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BackgroundDirect-to-beneficiary communication mobile programmes are among the few examples of digital health programmes to have scaled widely in low-resource settings. Yet, evidence on their impact at scale is limited. This study aims to assess whether exposure to mobile health information calls during pregnancy and postpartum improved infant feeding and family planning practices.MethodsWe conducted an individually randomised controlled trial in four districts of Madhya Pradesh, India. Study participants included Hindi speaking women 4–7 months pregnant (n=5095) with access to a mobile phone and their husbands (n=3842). Women were randomised to either an intervention group where they received up to 72 Kilkari messages or a control group where they received none. Intention-to-treat (ITT) and instrumental variable (IV) analyses are presented.ResultsAn average of 65% of the 2695 women randomised to receive Kilkari listened to ≥50% of the cumulative content of calls answered. Kilkari was not observed to have a significant impact on the primary outcome of exclusive breast feeding (ITT, relative risk (RR): 1.04, 95% CI 0.88 to 1.23, p=0.64; IV, RR: 1.10, 95% CI 0.67 to 1.81, p=0.71). Across study arms, Kilkari was associated with a 3.7% higher use of modern reversible contraceptives (RR: 1.12, 95% CI 1.03 to 1.21, p=0.007), and a 2.0% lower proportion of men or women sterilised since the birth of the child (RR: 0.85, 95% CI 0.74 to 0.97, p=0.016). Higher reversible method use was driven by increases in condom use and greatest among those women exposed to Kilkari with any male child (9.9% increase), in the poorest socioeconomic strata (15.8% increase), and in disadvantaged castes (12.0% increase). Immunisation at 10 weeks was higher among the children of Kilkari listeners (2.8% higher; RR: 1.03, 95% CI 1.00 to 1.06, p=0.048). Significant differences were not observed for other maternal, newborn and child health outcomes assessed.ConclusionStudy findings provide evidence to date on the effectiveness of the largest mobile health messaging programme in the world.Trial registration numberTrial registration clinicaltrials.gov; ID 90075552, NCT03576157.

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“…8 There have been a few systematic reviews evaluating the role mHealth plays in improving the health care system especially in developing countries. Murthi et al 11 concluded that mobile voice messages provided suitable and appropriate information throughout pregnancy and helped improve uptake of maternal services geared towards improving maternal health outcomes. Free et al7 too found advantages related with mHealth interventions as it concerns utilization of health services especially in the area of appointment reminders and provision of related clinical support.…”

Section: Introductionmentioning

confidence: 99%

Mhealth and Utilization of Health Care Services in Lagos Southwest Nigeria- A Pilot Study

Osanyin

Oluwole

Odeseye

et al. 2021

Preprint

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Background: A third of pregnant women in Nigeria do not attend Antenatal care, hence this quasi-experimental study was carried out within 500 consenting pregnant women within the 5 administrative zones of Lagos to determine the association between Mhealth services and utilization of antenatal and skilled delivery services amongst pregnant women in Lagos, Southwest Nigeria.Methods: Participants were divided into an intervention (who received voice messages) and a control arm (did not receive voice messages). Ownership of a mobile phone and willingness to participate were the selection criteria. Data was collected using a structured interviewer administered questionnaire. Analysis was by descriptive statistics with 95% CI to identify factors associated with antenatal attendance.Results: Total respondents were 488 (response rate 97.6%). One hundred and fifty-nine (63.8%) of the intervention group found the messages useful. Using the WHO 2016 ANC model, women in the intervention group had a significantly higher frequency of antenatal care attendance than the control group (p < 0.0001). There was a statistically significant difference in antenatal attendance between the intervention and the controls (p < 0.0001). There was also a significantly lower likelihood of poorly supervised (unskilled) home deliveries within the intervention arm (p=0.011). Conclusion: Mhealth was associated with an increased antenatal attendance and skilled birth attendance at delivery. This has a significant impact in reducing morbidity and mortality indices.

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Effects of an mHealth voice message service (mMitra) on maternal health knowledge and practices of low-income women in India: findings from a pseudo-randomized controlled trial

Cited by 33 publications

References 14 publications

mHealth interventions to reduce maternal and child mortality in Sub-Saharan Africa and Southern Asia: A systematic literature review

mHealth interventions to reduce maternal and child mortality in Sub-Saharan Africa and Southern Asia: A systematic literature review

The impact of a direct to beneficiary mobile communication program on reproductive and child health outcomes: a randomised controlled trial in India

Mhealth and Utilization of Health Care Services in Lagos Southwest Nigeria- A Pilot Study

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