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

Abstract

ObjectiveTo evaluate the effectiveness of mHealth interventions on antenatal and postnatal care utilization in low and middle-income countries.DesignSystematic review and meta-analysisSettingStudies from low and middle-income countries were included for analysis.ParticipantsWe searched the literature through major electronic databases such as PubMed, MEDLINE, Embase, Cochrane, Scopus, CINAHL, Clinical key, Google Scholar, Ovid databases with selected keywords, and explored the reference list of articles. Meta-analysis was performed in RevMan 5.4 software; p-value < 0.05 was considered statistically significant. The effect of variables was measured in the Odds ratio with a fixed-effect model. Six published interventional studies were selected as per the eligibility and PICO framed for the systematic review and meta-analysis. Search restricted to articles in the English language, online published, and preprint articles till September 2020.Primary and secondary outcome measuresWe evaluated the effectiveness of mHealth intervention on antenatal care utilization, including four antenatal check-ups, iron-folic acid supplementation, two tetanus toxoid immunizations, and postnatal care utilization, which includes postnatal check-ups of delivered mothers.ResultsResults have been presented in the form of a forest plot. Findings of this meta-analysis depicted the significant increase in four or more antenatal care attendance (OR=1.89, 95% CI-1.49-2.19), TT immunization (OR=1.63 (95% CI-1.17-2.27), compliance to iron supplementation (OR=1.88, 95% CI-1.18-3.00) and postnatal care attendance (OR=2.54 (95% CI-2.15-2.99) among those pregnant mothers who received mHealth intervention compared to control group.ConclusionThis meta-analysis concluded that m-health has the potential to increase the utilization of full antenatal care and postnatal care compared to standard care, although the level of evidence is moderate.Trial registrationCRD42020204618, PROSPERO, International prospective register of systematic reviewsArticle SummaryStrengths and limitations of this studyThis meta-analysis creates an evidence for the effectiveness of mHealth with pooled data of interventional studies with limited sample sizes.Technology is changing, but even with limited support like SMS, there was an improvement in antenatal and postnatal service utilization.Sensitivity analysis identified possible reasons for heterogeneity among studies.Studies included from LMICs so results can be generalized for the respective population.mHealth as an intervention is a broad term that created heterogeneity also.

Effectiveness of mHealth Interventions for Monitoring Antenatal Care among Pregnant Women in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

“…In the present study, we found that antenatal mothers who used mobile health interventions had an approximately two times higher chance of receiving ANC check-ups than women who did not use any mobile health applications or did not receive any short message services, which is higher than in another systematic review conducted in a population of LMICs in the time frame from 2008-2020 (OR = 1.89, 95% CI: 1.49-2.19) [30]. Despite the fact that most people exhibit techno-skepticism (i.e., a skeptical attitude toward technology), this meta-analysis revealed that mHealth has the potential to increase antenatal attendance when compared to conventional approaches.…”

Efficacy of mHealth Interventions for Improving Maternal and Neonatal Outcomes Among Pregnant Women With Hypertensive Disorders: Protocol for a Systematic Review

“…mHealth interventions are implemented and researched extensively. Evidence from systematic reviews shows that mHealth interventions are effective in increasing the use of antenatal and postnatal care, including attendance at antenatal and postnatal care check-ups, facility-based deliveries, and skilled attendance at birth and vaccination rates [ 22 ]. Conversely, another systematic review and meta-analysis concluded that most studies conducted in low- and middle-income countries are of poor methodological quality, and few have evaluated impacts on patient outcomes [ 23 ].…”

Uptake, Engagement and Acceptance, Barriers and Facilitators of a Text Messaging Intervention for Postnatal Care of Mother and Child in India—A Mixed Methods Feasibility Study

“…Studies on testing mHealth interventions for postnatal care in India is limited [ 34 , 35 ]. And our study results indicate that new mothers who used the service found that the intervention to be informative, timely and empowering.…”

“…On the other hand, in India, studies on testing mHealth interventions for postnatal care are limited [ 34 , 35 ]. To address the above issues, an innovative solution to provide ongoing follow-up service to new mothers at discharge was designed.…”