DOI: 10.5061/dryad.866t1g1nw
title: Randomized control trial of SMS for postpartum behaviors and family planning in Kiambu County, Kenya

description: Background It is estimated that one third of maternal deaths in Kenya in
 2014 could have been prevented by more timely care-seeking. Mobile health
 interventions are increasingly being recognized as tools for the delivery
 of health education and promotion. Many maternal deaths occur in the first
 few weeks after delivery and mothers who are given adequate care in the
 postpartum period have better health outcomes. Kiambu County, Kenya has a
 high level of literacy and phone ownership amongst mothers delivering in
 public hospitals and was chosen as a site for a postpartum short message
 service intervention. 
      
      Methods
       Women were recruited
 after delivery and randomized to receive a package of mobile messages or
 standard of care only. Messages covered danger signs, general postpartum
 topics, and family planning. Endline phone surveys were conducted at 8
 weeks postpartum to assess knowledge, care seeking behavior and family
 planning uptake. Analysis was conducted using Stata and is presented in
 odds ratios.      
      Results   Women who
 received the danger sign messages were 1.6 times more likely to be able to
 list at least 1 danger sign and 3.51 times more likely to seek treatment
 if they experienced postpartum danger signs. There was no significant
 difference in routine postpartum care seeking or care seeking behaviors
 concerning newborns. Women who received family planning messages were 1.85
 times more likely to uptake family planning services compared to controls
 and 2.1 times more likely to choose a longacting method. Conclusions
 Simple, low-cost mobile interventions can support women in the early
 postpartum period when the information is targeted to particular points in
 the postpartum continuum. Additional research is needed to understand the
 interplay between healthcare providers and mobile health interventions.
 Health policy makers should consider direct mobile interventions for women
 as an option for supporting positive maternal health outcomes in certain
 populations.
description: Enrollment took place over 5 months, beginning in November 2017
 and concluded in March 2018 at three public hospitals in Kiambu County,
 Kenya. Research assistants approached all eligible women on the day they
 would be discharged from the facility after giving birth and gave them
 information describing the study. If a woman consented to participate, she
 completed the in-person baseline survey administered by a research
 assistant at the hospital before discharge and was enrolled in the study.
 Endline survey data was collected 8 weeks after discharge through a phone
 survey. Endline data collection concluded in May 2018. All hospitals were
 enrolling simultaneously during the enrollment period. Survey data were
 recorded on a tablet using SurveyCTO software (2016 Dobility, Inc, 225
 Cambridge, MA). Calls were attempted 4 times before the participant was
 deemed unreachable. The dataset was processed so that
 the baseline and endline data is contained in the final dataset and linked
 by a unique identifier ("case_id"). The dataset was processed in
 STATA 13. 
description: We removed potentially identifiable information (such as age,
 residential location, hospital names, unique health issues, and
 comments) and added a small random number of days (less than 7) to all
 dates to further de-identify any care-seeking behavior, delivery dates,
 and survey dates. The variable names are used in the first Excel tab, and
 the labels (survey question) is provided in the 2nd tab
 ("Labels").