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

BMC Pregnancy and Childbirth

Vibeke Rasch²  Mkoko H Makungu³  Khadija Said³  Azzah Said³  Ida M Boas⁴  Maryam Hemed³  Birgitte B Nielsen¹  Stine Lund⁴ 

[1] Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark;Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark;Ministry of Health, Revolutionary Government of Zanzibar, Stonetown, Zanzibar, Tanzania;Department of International Health, Immunology and Microbiology, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark

关键词: Zanzibar;    mHealth;    Mobile phones;    Neonatal health;    Maternal health;    Antenatal care;   

Others  :  1131733
DOI  :  10.1186/1471-2393-14-29

 received in 2013-04-08, accepted in 2014-01-07,  发布年份 2014

【 摘 要 】

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.

Trial registration

ClinicalTrials.gov, NCT01821222.

【 授权许可】

   
2014 Lund et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]GSMA: African Mobile Observatory 2011. London: Groupe Spéciale Mobile Association; 2011.
• [2]Howitt P, Darzi A, Yang GZ, Ashrafian H, Atun R, Barlow J, et al.: Technologies for global health. Lancet 2012, 380:507-535.
• [3]Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al.: Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012, 379:2151-2161.
• [4]Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, et al.: Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet 2011, 378:1139-1165.
• [5]Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, et al.: Stillbirths: Where? When? Why? How to make the data count? Lancet 2011, 377:1448-1463.
• [6]Carroli G, Rooney C, Villar J: How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol 2001, 15(Suppl 1):1-42.
• [7]Campbell OM, Graham WJ: Strategies for reducing maternal mortality: getting on with what works. Lancet 2006, 368:1284-1299.
• [8]Mpembeni RN, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D, et al.: Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets. BMC Pregnancy Childbirth 2007, 7:29. BioMed Central Full Text
• [9]Villar J, Ba'aqeel H, Piaggio G, Lumbiganon P, Miguel BJ, Farnot U, et al.: WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet 2001, 357:1551-1564.
• [10]Conrad P, De AM, Moses A, Larsson EC, Neuhann F, Muller O, et al.: Compliance with focused antenatal care services: do health workers in rural Burkina Faso, Uganda and Tanzania perform all ANC procedures? Trop Med Int Health 2012, 17(3):300-307.
• [11]UN: The Millenium Development Goals Report. 2012. http://www.un.org/millenniumgoals/pdf/MDG%20Report%202012.pdf webcite (accessed January 15th 2014)
• [12]Lund S, Hemed M, Nielsen B, Said A, Said K, Makungu M, et al.: Mobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: a cluster-randomised controlled trial. BJOG 2012, 119(10):1256-1264.
• [13]Ministry of Health: Zanzibar Reproductive and Child Health Strategy 2006-2010. Stonetown: Revolutionary Government of Zanzibar; 2006.
• [14]Raatikainen K, Heiskanen N, Heinonen S: Under-attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health 2007, 7:268. BioMed Central Full Text
• [15]WHO, UNICEF: Countdown to 2015 Decade Report (2000-2010): Taking Stock of Maternal, Newborn and Child Survival. Geneva: World Health Organization; 2010.
• [16]Kyie NN, Chansa C: Gabrysch. Quality of antenatal care in Zambia: a national assessment. BMC Pregnancy Childbirth 2012, 12:151. BioMed Central Full Text
• [17]Nyamtema AS, Bartsch-de JA, Urassa DP, Hagen JP, Roosmalen JV: The quality of antenatal care in rural Tanzania: what is behind the number of visits? BMC Pregnancy Childbirth 2012, 12(1):70. BioMed Central Full Text
• [18]Beeckman K, Louckx F, Masuy-Stroobant G, Downe S, Putman K: The development and application of a new tool to assess the adequacy of the content and timing of antenatal care. BMC Health Serv Res 2011, 11:213. BioMed Central Full Text
• [19]Zanconato G, Msolomba R, Guarenti L, Franchi M: Antenatal care in developing countries: the need for a tailored model. Semin Fetal Neonatal Med 2006, 11(1):15-20.
• [20]Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P, et al.: The effectiveness of mobile-Health Technology-Based Health Behaviour Change or Disease Managenment Interventions for Health Care consumers: A systematic Review. PLoS Med 2013, 10:1.
• [21]Car J, Gurol-Urganci I, De JT, Vodopivec-Jamsek V, Atun R: Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev 2012, 7:CD007458.
• [22]Guy R, Hocking J, Wand H, Stott S, Ali H, Kaldor J: How effective are short message service reminders at increasing clinic attendance? A meta-analysis and systematic review. Health Serv Res 2012, 47(2):614-632.
• [23]Deglise C, Suggs LS, Odermatt P: SMS for disease control in developing countries: a systematic review of mobile health applications. J Telemed Telecare 2012, 18:273-281.
• [24]Deglise C, Suggs LS, Odermatt P: Short message service (SMS) applications for disease prevention in developing countries. J Med Internet Res 2012, 14(1):e3.
• [25]Tamrat T, Kachnowski S: Special Delivery: An Analysis of mHealth in Maternal and Newborn Health Programs and Their Outcomes Around the World. Matern Child Health J 2012, 16:1092-1101.
• [26]Noordam AC, Kuepper BM, Stekelenburg J, Milen A: Improvement of maternal health services through the use of mobile phones. Trop Med Int Health 2011, 16(5):622-626.
• [27]L’engle KL, Vahdat HL, Ndakidemi E, Lasway C, Zan T: Evaluating, feasibility, reach and potential impact of a text message family planning information service in Tanzania. Contraception 2013, 87:251-56.
• [28]Cormick G, Kim NA, Rodgers A, Gibbons L, Buekens PM, Belizan JM, et al.: Interest of pregnant women in the use of SMS (short message service) text messages for the improvement of perinatal and postnatal care. Reprod Health 2012, 9:9. BioMed Central Full Text
• [29]Jones CO, Wasunna B, Sudoi R, Githinji S, Snow RW, Zurovac D: “Even if you know everything you can forget”: health worker perceptions of mobile phone text-messaging to improve malaria case-management in Kenya. PLoS One 2012, 7:e38636.
• [30]Jareethum R, Titapant V, Chantra T, Sommai V, Chuenwattana P, Jirawan C: Satisfaction of healthy pregnant women receiving short message service via mobile phone for prenatal support: a randomized controlled trial. J Med Assoc Thai 2008, 91(4):458-463.
• [31]John Koku A-W, Bruce ML, James P, Stone AE, Aliya W: The architecture of a software system for supporting community-based primary health care with mobile technology: the Mobile Technology for Community Health (MoTeCH) iInitiative in Ghana. Online J Public Health Inform 2012, 4:1.
• [32]Majoko F, Munjanja SP, Nystrom L, Mason E, Lindmark G: Randomised controlled trial of two antenatal care models in rural Zimbabwe. BJOG 2007, 114(7):802-811.
• [33]Wesolowski A, Eagle N, Noor AM, Snow RW, Buckee CO: Heterogeneous mobile phone ownership and usage patterns in Kenya. PLoS One 2012, 7(4):e35319.
• [34]Gisore P, Shipala E, Otieno K, Rono B, Marete I, Tenge C, et al.: Community based weighing of newborns and use of mobile phones by village elders in rural settings in Kenya: a decentralised approach to health care provision. BMC Pregnancy Childbirth 2012, 12:15. BioMed Central Full Text