Wired mothers – use of mobile phones to improve maternal and neonatal health in Zanzibar

Project summary

The study aims to examine the beneficial impact of use of mobile phones for health care on maternal and neonatal morbidity and mortality, and to seek innovative ways to ensure access to skilled attendance at delivery through an intervention called “wired mothers”. Wired mothers are pregnant women linked to a primary health care unit through use of mobile phones receiving standard sms reminders for care appointments and who can call the primary provider in case of acute or non acute problems. It is also the aim to study the health system’s response in relation to obstetric emergencies when using mobile phones to strengthen communication between different levels (from TBA to referral hospital). Specific objectives are: 1.To investigate attendance to routine primary health care appointments amongst wired and non wired women. 2. To investigate the level of facility based deliveries amongst wired and non-wired women. 3.To investigate the morbidity amongst wired and non-wired women. 4. To investigate the quality of services provided to wired and non-wired women. 5. To investigate neonatal morbidity and mortality amongst children born by wired and non-wired mothers.

Outputs

Project Completion Report:

Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems in Sub-Saharan Africa. We evaluated the association between a mobile phone intervention and use of essential maternal health care services and perinatal health. The study was an pragmatic cluster-randomised controlled trial with primary health care facilities in Zanzibar as the unit of randomisation. The study included 2550 pregnant women attending care in 24 primary health care facilities in six districts. Women in the intervention clusters received Short Message Service (SMS) messages with health education and appointment reminders for antenatal care, and a small mobile phone credit provided an opportunity to call their local midwife. Results showed that 44% of the women in the intervention group versus 31% in the control group received the recommended four antenatal care visit during pregnancy (OR 2.39, CI 1.03-5.55). The intervention had a significant increase in skilled delivery attendance amongst urban women (OR 5.73, 95% CI 1.51-21.81). The overall perinatal mortality rate in the study was 27 per 1000 total births and perinatal mortality was significantly reduced with an odds ratio of 0.50 (95% CI, 0.27-0.93).  In conclusion, the Wired Mothers intervention improved use of essential maternal health services and reduced perinatal mortality. Policy makers should consider use of mobile phone interventions in healthcare systems in resource-limited settings.