Wired Mothers - Use of Mobile Phones to Improve Maternal and Neonatal Health in Zanzibar

NCT01821222 | Completed DMC

• 1 other identifier: 09-086KU
• Study Type: interventional
• Target: 2,550
• Locations: 1 country
• Sites: 1

Brief 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.

Conditions

Pregnancy; Maternal Health; Newborn Death; Health Behavior; mHealth

Keywords

Maternal health; Neonatal health; mHealth; Mobile phones; Access to health services; Health behavior

Outcome Measures

Primary Outcomes (1)

• Skilled delivery attendance

  We used the WHO definition, whereby skilled delivery attendants are midwifes, doctors or nurses who have been educated and trained in the skills needed to manage pregnancies, childbirth and complications in women and newborns. We also included home deliveries assisted by skilled birth attendants, although international consensus has not been reached on this issue.

  From inclusion to 42 days after delivery. Asssessed at delivery and confirmed 42 days after delivery

Secondary Outcomes (2)

• Perinatal mortality

  From inclusion of the pregnant women until 7 days after delivery. Assessed at delivery and 7 days after delivery

• Antenatal care attendance

  From inclusion of the pregnant women until delivery

Other Outcomes (4)

• Anti tetanus vaccination

  From inclusion of the pregnant women until delivery

• Preventive malaria treatment

  From inclusion of the pregnant women until delivery

• Antepartum and intrapartum referrals

  From inclusion of the pregnant women until postpartum period

Study Arms (2)

Wired mothers intervention

EXPERIMENTAL

The wired mothers' intervention consisted of two components: an automated short messaging service (SMS) system providing wired mothers with unidirectional text messaging and a mobile phone voucher system providing the possibility of direct two-way communication between wired mothers and their primary health care providers. While only women with registered phone numbers received text messages, all women in the intervention group were given mobile phone vouchers to contact their local primary health care provider.

Device: Wired mothers

Control

NO INTERVENTION

The control group received standard care

Interventions

Wired mothers DEVICE

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.

Wired mothers intervention

Eligibility Criteria

• Age: 14 Years - 45 Years
• Sex: female
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Pregnant women attending antenatal care at one of 24 selected primary healthcare facilities

You may not qualify if:

• Missing end-of-study questionnaire

Sponsors & Collaborators

• University of Copenhagen: lead
• Ministry of Health and Social Welfare, Zanzibar: collaborator
• Danish International Development Cooperation: collaborator

Study Sites (1)

24 Primary Healthcare Facilities on the island on Unguja

Zanzibar, Tanzania

Location

Related Publications (3)

• Lund S, Hemed M, Nielsen BB, Said A, Said K, Makungu MH, Rasch V. Mobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: a cluster-randomised controlled trial. BJOG. 2012 Sep;119(10):1256-64. doi: 10.1111/j.1471-0528.2012.03413.x. Epub 2012 Jul 17.

  PMID: 22805598 RESULT

• Lund S, Rasch V, Hemed M, Boas IM, Said A, Said K, Makundu MH, Nielsen BB. Mobile phone intervention reduces perinatal mortality in zanzibar: secondary outcomes of a cluster randomized controlled trial. JMIR Mhealth Uhealth. 2014 Mar 26;2(1):e15. doi: 10.2196/mhealth.2941.

  PMID: 25098184 DERIVED

• Lund S, Nielsen BB, Hemed M, Boas IM, Said A, Said K, Makungu MH, Rasch V. Mobile phones improve antenatal care attendance in Zanzibar: a cluster randomized controlled trial. BMC Pregnancy Childbirth. 2014 Jan 17;14:29. doi: 10.1186/1471-2393-14-29.

  PMID: 24438517 DERIVED

MeSH Terms

Conditions

Perinatal Death; Health Behavior

Condition Hierarchy (Ancestors)

Pregnancy Complications; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Death; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Behavior

Study Officials

• Stine Lund, MD, PhD

  University of Copenhagen

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD, PhD fellow

Study Record Dates

• First Submitted: March 26, 2013
• First Posted: March 29, 2013
• Study Start: February 1, 2009
• Primary Completion: April 1, 2010
• Study Completion: April 1, 2010
• Last Updated: March 29, 2013

Record last verified: 2013-03

Locations

TA (1)