Background Aponjon (meaning “near and dear ones”), a mobile phone-based mHealth service, customized voice messages for expectant (6–42 weeks pregnancy) and new mothers (1–52 weeks after delivery) for promotion of recommended healthcare practices. The Aponjon system sent two voice messages per week to subscribers, tailored to the timing during pregnancy or post-partum. The current study is an external evaluation of the effect of Aponjon use on knowledge and behaviors related to maternal and newborn health (MNH) care. Methods We implemented an observational study of Aponjon users with propensity score matched non-users in Bangladesh. Subscribers with at least 3 months exposure to Aponjon and non-users were interviewed retrospectively on knowledge and practices surrounding MNH. The sample included women with infants ≤6 months (243 users; 369 non-user) for maternal health knowledge and practice indicators and women with infants > 6 to 12 months old (332 users; 454 non-user) for neonatal health knowledge and practice indicators. Data were analyzed using principal component analysis and categorized as ‘high’ and ‘low’ at the median of principal component scores. Interactions between duration of use of Aponjon services and self-reported patterns of receiving and listening to messages were examined to assess the effect on knowledge and practices for MNH. Results Women reporting at least 6 months of using Aponjon were approximately 3 times as likely as the non-users to score high on both maternal healthcare knowledge questions and related practices. Similarly women with at least 6 months of Aponjon exposure were 1.5 times as likely as the non-users to score high on knowledge questions on newborn health. Reporting a good-pattern of Aponjon use (i.e. receiving a minimum of 3 messages per month and listening to all of them) had an even stronger association with knowledge and practices related to MNH care. However, a shorter exposure to Aponjon service (i.e. 3–5 months), despite having a good-pattern of use, did not have an effect on the related outcomes. Conclusions The use of Aponjon services for at least 6 months, with a good-pattern of receiving and listening to the messages, was associated with improved knowledge and practices related to MNH care. Electronic supplementary material The online version of this article (10.1186/s12911-019-0903-z) contains supplementary material, which is available to authorized users.

Background The third-generation oral contraceptive pill (3G-OCP) has improved side-effect profile compared to the second-generation (2G-OCP). In Bangladesh, comparative data on these two generations of OCPs is nonexistent. This study aimed to compare acceptability, side-effects and discontinuation rates between 3G- and 2G-OCPs. Methods This quasi-experimental study was conducted from October 2017 to June 2018 in two unions of one sub-district in Bangladesh. From each intervention and control unions, 1400 women were enrolled after screening for selection criteria. All the women in the intervention union received 3G-OCP while those in the control union had 2G-OCP. Women from both the groups were provided six cycles of OCPs, two at enrollment, and two each at two subsequent home-visits at 2-months apart by the health workers. Data was collected thrice: immediately after enrolment, and two subsequent follow-up visits at 2-months interval by the study interviewers. Life table analysis was done to compare cumulative discontinuation rates and Hazard Ratio (HR) was estimated for likelihood of discontinuation of 3G-OCP as compared to 2G-OCP due to side-effects. Results After 24-weeks of enrollment, 69.1% (n=967) of the women from the intervention and 58.0% (n=812) from the control group continued with the method. The major reason for discontinuation was pill use-related side-effects (3G-OCP: 20.4% vs. 2G-OCP: 19.5%). Initially, the reported side-effects for 3G-OCP were higher than those for 2G-OCP (47.3% vs. 33.2%). However, after 24-weeks of use, the corresponding figures became similar (9.5% vs. 8.7%). The cumulative discontinuation rate due to side-effects was 22.8% and 25.2% for 3G- and 2G-OCP respectively which was not statistically significant (p=0.14). After adjusting for potential covariates, the likelihood of discontinuation of 3G-OCP was 14% lower (HR=0.86, p=0.075) than 2G-OCP which was statically significant at 10% level. The study observed three deaths (one in intervention and two in control), of which one death in the control group was due to stroke. Conclusion The 3G-OCP was less likely to be discontinued than the 2G-OCP due to side effects. After 24-weeks of use the reported side-effects of the two types of OCPs was similar. However, one stroke-related-mortality due to use of 2G-OCP, demanded further larger studies.