Despite many efforts, the utilization of full antenatal and postnatal care remains a significant concern in low-and middle-income countries (LMICs). We planned to retrieve the relevant literature and pooled the data for meta-analysis to evaluate the impact of mobile health (mHealth) intervention on antenatal and postnatal care utilization in low-and middle-income countries. We searched the literature through major electronic databases such as PubMed, MEDLINE, Embase, Cochrane, Scopus, CINAHL, Clinical key, Google Scholar, and Ovid with selected keywords and explored the reference list of articles. Meta-analysis was performed using the RevMan software version 5.4; p-value < 0.05 was considered statistically significant. The effect of variables was measured in odds ratio (OR) with a fixed-effects model. Six published interventional studies were selected as per the eligibility and participants, intervention, comparison, and outcome (PICO) framed for systematic review and meta-analysis. The search was restricted to articles in the English language, articles published online, and preprinted articles until September 2020. Outcome variables include antenatal and postnatal care utilization by pregnant and delivered mothers. The results have been presented in the form of a forest plot. The findings of this meta-analysis depicted the significant increase in four or more antenatal care (ANC) attendance (OR = 1.81, 95% confidence interval (CI) = 1.49-2.19), tetanus toxoid (TT) immunization (OR = 1.63, 95% CI = 1.17-2.27), compliance to iron supplementation (OR = 1.88, 95% CI = 1.18-3.00), and postnatal care attendance (OR = 2.54, 95% CI = 2.15-2.99) among those pregnant mothers who received mHealth intervention compared with the control group. This meta-analysis creates evidence for the effectiveness of mHealth with pooled data of interventional studies with limited sample sizes. Technology is changing, but even with limited support such as short messaging service (SMS), there was an improvement in antenatal and postnatal service utilization. This meta-analysis concluded that mHealth has the potential to increase the utilization of antenatal and postnatal care compared to standard care, although the level of evidence is moderate.

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ObjectiveTo evaluate the effectiveness of mHealth interventions on antenatal and postnatal care utilization in low and middle-income countries.DesignSystematic review and meta-analysisSettingStudies from low and middle-income countries were included for analysis.ParticipantsWe searched the literature through major electronic databases such as PubMed, MEDLINE, Embase, Cochrane, Scopus, CINAHL, Clinical key, Google Scholar, Ovid databases with selected keywords, and explored the reference list of articles. Meta-analysis was performed in RevMan 5.4 software; p-value < 0.05 was considered statistically significant. The effect of variables was measured in the Odds ratio with a fixed-effect model. Six published interventional studies were selected as per the eligibility and PICO framed for the systematic review and meta-analysis. Search restricted to articles in the English language, online published, and preprint articles till September 2020.Primary and secondary outcome measuresWe evaluated the effectiveness of mHealth intervention on antenatal care utilization, including four antenatal check-ups, iron-folic acid supplementation, two tetanus toxoid immunizations, and postnatal care utilization, which includes postnatal check-ups of delivered mothers.ResultsResults have been presented in the form of a forest plot. Findings of this meta-analysis depicted the significant increase in four or more antenatal care attendance (OR=1.89, 95% CI-1.49-2.19), TT immunization (OR=1.63 (95% CI-1.17-2.27), compliance to iron supplementation (OR=1.88, 95% CI-1.18-3.00) and postnatal care attendance (OR=2.54 (95% CI-2.15-2.99) among those pregnant mothers who received mHealth intervention compared to control group.ConclusionThis meta-analysis concluded that m-health has the potential to increase the utilization of full antenatal care and postnatal care compared to standard care, although the level of evidence is moderate.Trial registrationCRD42020204618, PROSPERO, International prospective register of systematic reviewsArticle SummaryStrengths and limitations of this studyThis meta-analysis creates an evidence for the effectiveness of mHealth with pooled data of interventional studies with limited sample sizes.Technology is changing, but even with limited support like SMS, there was an improvement in antenatal and postnatal service utilization.Sensitivity analysis identified possible reasons for heterogeneity among studies.Studies included from LMICs so results can be generalized for the respective population.mHealth as an intervention is a broad term that created heterogeneity also.

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