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

Abstract

BackgroundApplying 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.MethodsThis 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.ResultsThe 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.ConclusionsThe 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.Trial registrationClinicalTrials.gov, NCT01821222.

Use of mobile phone for improvement in maternal health: a randomized control trial

“…8 Lund et al reported that the majority, 59%, of intervention women stated that receiving text messages influenced the number of times they attended antenatal care. 7 In addition, 71% felt that the educational messages helped them in various areas including learning about danger signs in pregnancy and feeling that the health system cared for them.…”

“…Lund et al reported that there was a trend towards favourable intervention association across all secondary outcome measures, although not statistically significant. 7 In the intervention group 72% of nullipara women received two doses of tetanus vaccination versus 56% in the control group (OR, 1.62; 95% CI, 0.81-3.26). The perinatal deaths are the deaths that occur during intrauterine life after 28 weeks of pregnancy till seven days after birth, thus it consists of intrauterine deaths (macerated still births), intrapartum deaths (fresh Still births) and early neonatal deaths.…”

“…Similar observations were noted by other authors in their studies. 7 Postnatal visit is also useful in providing contraceptive advice to woman or the couple. It is a good opportunity to counsel the couple about the importance of spacing between the issues and adoption of small family norms.…”

21st Century Patient Registries, Ebook Addendum to Registries for Evaluating Patient Outcomes: A User's Guide, 3rd Edition

“…33 Standards cover areas including formulating research questions, patient-centeredness and engagement, data integrity, statistical methods, and the design of registries and data networks. Specifically, for the design and features of registries, the PCORI Methodology Report provides standards for the following: the type, extent, and length of patient follow-up; transparency of data use agreements, informed consent agreements, and data security documentation for institutional review boards; data quality assurance via structured training of data abstractors, use of data quality checks, and procedures for data review and verification; documentation and explanation of any protocol modifications; consistent data collection with clear, operational definitions of data elements; systematic, unbiased patient enrollment; monitored and minimized loss to follow-up; and collection of data to address confounding.…”

“…Involving patients early on could have helped the sponsor identify these issues and determine whether to modify the delivery device or abandon development prior to outlay of significant resources. 33 While these examples come out of clinical trial development programs and not registries specifically, each illustrates the pitfalls of having inadequate patient input in scenarios that are germane to registry research. One example of patient input in registries is the PARTNERs PPRN 34 , which is evaluating the impact of patient involvement on the study consent process.…”