Abstract:
Introduction Worldwide, complications that occur in pregnancy, at childbirth, and
in the immediate postnatal period (puerperium) are the leading causes of mortality
and morbidity among Women of Reproductive Age (WRA). Most women die
because of complications occurring during and following pregnancy. This study was
carried out to examine the effects of a mobile intervention use in antenatal care and
the postnatal outcomes. Methods The study was conducted in four busy public
hospitals in Narok County. A Randomized Controlled Trial (RCT) was conducted to
determine the effect of a targeted mobile phone intervention on antenatal and
postnatal clinic attendance, level of skilled attendant delivery, and the resultant
postnatal outcomes. Two hundred and eighty mothers (280) were recruited. The
intervention was bi-component, consisting of a standardized Short-message Service
(SMS) sent fortnightly and a phone call reminder made one week (7 days) before the
date the study mother had been booked to attend the ANC clinic. All study mothers
were followed up from recruitment to 42 days post-delivery. Data were analyzed
with Stata v14 using descriptive and inferential statistics. Ethical approval was
obtained from SERU at KEMRI. Results Two hundred and sixty-two mothers
completed the study giving a 93.6% completion rate. The mean age at enrolment of
the study participants was 23.87 years (SD 5.22, 95% CI 23.23-24.50). ANC
Attendance The intervention was associated with improved antenatal care clinic
attendance amongst the study population with the mean number of antenatal visits
being 4.099 visits for the 131 study participants in the intervention group while it
was 2.843 visits for the 128 study participants in the non-intervention study arm
giving a difference in means of 1.256 visits (95% CI 1.044-1.467, p-value < 0.0001).
Skilled Care deliveries The intervention was associated with improvement in skilled
care deliveries. The null hypothesis of there being no difference in the likelihood of a
study mother being assisted to deliver by a healthcare worker by the study group,
was rejected (X2 16.810, p-value < 0.0001) indicating that the study mothers in the
intervention study arm were more likely to be assisted by a healthcare worker to
deliver than those in the non-intervention study arm. Maternal Postnatal Outcomes
The intervention was associated with fewer maternal complications during and after
delivery. The difference in proportion between the study participants who had a
complication at birth was 17.23% (95% CI 6.51-27.94, p-value = 0.002) between the
intervention (19.70%) and the non-intervention (36.92%) study arm which was
statistically significant. Neonatal Outcomes A targeted mobile phone intervention
was associated with fewer neonatal mortalities. The difference in proportion between
the study participants who had neonatal mortality at birth was 9.32% (95% CI 1.91
16.74, p-value = 0.015) between the intervention (6.06%) and the non-intervention
(15.38%) study arm which was statistically significant.
In conclusion, a targeted
mobile intervention used in antenatal care was associated with improved ANC and
PNC attendance and better maternal and postnatal outcomes. We recommend
utilization of this interven
