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

Lund, Stine; Nielsen, Birgitte B; Hemed, Maryam; Boas, Ida M; Said, Azzah; Said, Khadija; Makungu, Mkoko H; Rasch, Vibeke

doi:10.1186/1471-2393-14-29

Cited by 301Mobile Health and mHealth ApplicationsGlobal Maternal and Child HealthICT in Developing Communities

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

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Lund, Stine, Nielsen, Birgitte B, Hemed, Maryam, Boas, Ida M, Said, Azzah, Said, Khadija, Makungu, Mkoko H, Rasch, Vibeke·2014·BMC Pregnancy and Childbirth

DOI 10.1186/1471-2393-14-29PMC PMC3898378

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Abstract

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.

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Most SMS-based interventions are pilot tested (stage 3) or at large scale implementation stage (stage 4).
“most SMS based interventions are pilot tested (stage 3) [31,34,37,38,42,71] or at large scale implementation stage (stage 4) [28 -30,32,35].”
From Current evidence on the use of mHealth approaches in Sub-Saharan Africa: A scoping review (2023) · cites this paper as [29]
The Methods describe an SMS intervention evaluated in a cluster-randomized trial across 24 Zanzibar health facilities, supporting its use as an example of a tested intervention. The paper does not classify that intervention as a stage 3 pilot test or assess whether most SMS interventions are at stage 3 or 4; its Discussion also questions whether its voucher system would be feasible at a larger scale. No page numbers are available in our copy. (LLM, conf=0.79)
Experimental — accuracy not yet measured
Maternal health was the most prevalent health outcome, with a frequency of 9 out of 30 articles (30%).
“Among the articles analyzed, maternal health was the most prevalent health outcome with a frequency of 9 out of the 30 articles (30%) [27-35].”
From Barriers to the Use of Mobile Health in Improving Health Outcomes in Developing Countries: Systematic Review (2019) · cites this paper as [31]
The use of SMS only was mentioned in 16 of 26 interventions (62%).
“The use of SMS only was mentioned in 16 of 26 interventions (62%) [28-31,35,37,38,40-43,45-47,50,52].”
From Barriers to the Use of Mobile Health in Improving Health Outcomes in Developing Countries: Systematic Review (2019) · cites this paper as [31]
In the same trial, antenatal care improved with 44% of the intervention arm receiving the recommended four antenatal visits compared to 31% in the control group.
“Antenatal care improved with 44% of the intervention arm receiving the recommended four antenatal visits compared to 31% in the control group (38).”
From Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work? (2014) · cites this paper as [38]
Less evidence is available regarding end users' and decision makers' acceptance of and engagement with digital health technology.
“Less evidence is available regarding end users’ and decision makers’ acceptance of and engagement with digital health technology.”
From Operability, Acceptability, and Usefulness of a Mobile App to Track Routine Immunization Performance in Rural Pakistan: Interview Study Among Vaccinators and Key Informants (2020) · cites this paper as [12]

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Authors: Lund, S., Nielsen, B. B., Hemed, M., Boas, I. M., Said, A., Said, K., Makungu, M. H., & Rasch, V.
Affiliations: University of Copenhagen (DK)
Aarhus University Hospital (DK)
Corresponding author: Lund, Stine
ORCID: Lund, Stine
Said, Khadija
Rasch, Vibeke
Venue: BMC Pregnancy and Childbirth
Publisher: Springer Science and Business Media LLC
Published: 2014-01-17
Volume: 14
Issue: 1
Pages: 29-29
ISSN: 1471-2393 (ISSN-L)
DOI: 10.1186/1471-2393-14-29
PMC: PMC3898378
OpenAlex: W2095109714
Cited by: 301
References: 36
Citations by year: 2026: 11 · 2025: 22 · 2024: 22 · 2023: 20 · 2022: 33 · 2021: 27 · 2020: 35 · 2019: 36 · 2018: 30 · 2017: 29 · 2016: 16 · 2015: 10 · 2014: 9 · 2013: 1
FWCI: 38.62
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
www.springer.com/tdm (unspecified)
Locations: BMC Pregnancy and Childbirth (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
Topics: Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
Keywords: mobile devices, antenatal care attendance, text messaging, voucher incentives, tetanus vaccination, malaria prevention, maternal health, newborn health, resource-limited settings, Zanzibar
MeSH terms: Adult, Developing Countries, Female, Gestational Age, Humans, Malaria, Patient Acceptance of Health Care, Patient Education as Topic, Pregnancy, Prenatal Care, Tanzania, Tetanus Toxoid, Reminder Systems, Young Adult, Text Messaging

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

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