Targeted Mobile Phone Intervention Utilization in Antenatal Care and its Effects on Postnatal Outcomes among Pregnant Women in a Pastoralist Community in Narok County, Kenya

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