Wired Mothers - Use of Mobile Phones to Improve Maternal and Neonatal Health in Zanzibar
Condition: Pregnancy; Maternal Health; Newborn Death; Health Behavior; mHealth
Study type: Interventional

Summary: 
      Reducing maternal and newborn mortality remains a global challenge. Because obstetric
      complications cannot be predicted, skilled attendance at the time of delivery and access to
      emergency obstetric care remain the most effective strategies to reduce mortality. 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. There is a rapidly expanding number of mobile phone users in developing countries
      and due to the potential to strengthen health system the use of mobile phones is health care
      is emerging. The investigators assessed a mobile phone intervention named "wired mothers"
      aimed to improve maternal and newborn health.

      The hypothesis of the study was that the wired mothers mobile phone intervention would
      increase attendance to essential reproductive health services such as antenatal care and
      skilled delivery attendance and reduce severe adverse pregnancy outcomes for women and
      newborn.

      The objective of the study was to examine the effect of the wired mothers intervention on
      antenatal care, skilled delivery attendance, access to emergency obstetric care and perinatal
      mortality.

      The study was a pragmatic cluster randomized controlled trial with the primary health care
      facility as the unit of randomization. The study took place in 2009-2010 on the island of
      Unguja in Zanzibar. 2550 pregnant women who attended antenatal care at one of 24 selected
      facilities were included at their first visit and followed until 42 days after delivery.
      Facilities were allocated by simple randomization to either mobile phone intervention (n=12)
      or standard care (n=12). The intervention consisted of a SMS and mobile phone voucher
      component.

      The perspectives of the study are that mobile phones may contribute to saving the lives of
      women and their newborns and achievement of MDGs 4 and 5. Evidence is needed to guide
      maternal and child health policy makers in developing countries.
    


Intervention name(s): Wired mothers
Intervention type(s): Device
Intervention description(s): The wired mothers SMS component provided health education and appointment reminders to encourage attendance at routine antenatal care, skilled delivery attendance and postnatal care. A specially-designed software automatically generated and sent text messages throughout the pregnancy until six weeks after delivery. The frequency and content of the messages varied according to the women's gestational age.
Mobile phone vouchers allowed all wired mothers to communicate directly with primary health care providers. Primary health care facilities randomised for intervention and hospitals were provided with a mobile phone with sufficient credit, while wired mothers were given a phone voucher with modest credit and a card with the phone number of her local primary health care provider.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Maternal health; Neonatal health; mHealth; Mobile phones; Access to health services; Health behavior