BackgroundThe Millennium Villages Project (MVP) implemented in Western Kenya a mobile Health tool that uses text messages to coordinate Community Health Worker (CHW) activities around antenatal care (ANC) and Prevention of Mother-to-Child Transmission of HIV (PMTCT), named the ANC/PMTCT Adherence System (APAS).MethodsEnd-user changes in health-seeking behavior in ANC and postnatal care (PNC) were investigated following registration of 800 women into APAS. These investigations employed interviews of pregnant women or new mothers (n = 67) and CHWs (n = 20). Ordinal logistic regressions and exact binomial tests were used in the routine data analyses (n = 650, health registers).ResultsAll CHWs interviewed agreed that APAS helped them track pregnant woman efficiently, compared to paper-based tracking forms. Women registered in APAS reported that CHWs reminded them of appointments more regularly than before its inception.The routine data analysis showed that among women who had their 1st ANC visit in the 2nd trimester, women who resided in the MVP cluster and were in APAS had:3 times the odds of going for more ANC visits compared to women who were not registered (but resided in the cluster), after adjusting for the mother’s HIV status in the multivariate model (Adjusted OR = 2.58, 95% CI [1.10-6.01]);twice the odds of going for more ANC visits compared to women who were not registered and resided outside the cluster (Adjusted OR = 2.37, 95% CI [0.99-5.67])Among women not registered, residence inside or outside the cluster did not affect the number of ANC visits made (Adjusted OR = 0.86, 95% CI [0.45-1.69]).The APAS also greatly increased the likelihood of women making the 6 recommended post-delivery baby follow-ups.For women registered in APAS, the MTCT rate at 18 months was significantly different from that of women not registered, and from the global rate of 30%. Women not registered had a 9% MTCT rate at 18 months regardless of residence, while women registered had a 0% transmission rate at both 9 and 18 months.ConclusionsThe incorporation of mHealth tools in CHW programs can improve adherence to ANC and PNC and enhance PMTCT efforts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1358-5) contains supplementary material, which is available to authorized users.

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Africa is set to become a key contributor to global energy demand. Urban growth and the energy use of city residents will drive much of the region’s changing energy picture. However, few studies have assessed residential energy use among African cities, and the heterogeneity in energy use at the sub-city scale. We use the case of Dar es Salaam, which is among Africa’s fastest-growing cities, and to our knowledge, present the first disaggregated estimates of residential energy use at the ward level. We show three main findings. First, we find a statistically significant difference in mean residential energy use among the surveyed wards, which group into four clusters representing distinct levels of household and transport-related energy use. These results show that mean residential energy use (the sum of household and transport-related energy use) is not always correlated with the socio-economic or spatial characteristics of wards—e.g. Msasani (high-income, formal ward) showed similar residential energy use as Keko (low-income, informal ward). Second, we show differences in energy use and fuel switching that occur between low-income and high-income wards: wood fuel (i.e. charcoal) is a majority contributor to residential energy use in low-income wards (Buguruni, Keko and Manzese), compared to gas, electricity and transport oils in high-income wards (Msasani and Kawe). Finally, regression models indicate that ward density has a statistically significant effect on transport-related energy use, while fuel stacking and proxies for household wealth have a statistically significant effect on household-related energy use. To conclude, we recommend that policymakers account for ward level differences in residential energy use when crafting energy sector strategies for Dar es Salaam (e.g. electrification, energy-efficient cooking, or public transportation initiatives). Policymakers may also anticipate possible convergence towards higher levels of energy use and a shift towards modern fuels, as wards develop socio-economically over time.

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