A Short Message Service (SMS) increases postpartum care-seeking behavior and uptake of family planning of mothers in peri-urban public facilities in Kenya

Abstract

Background It is estimated that one third of maternal deaths in Kenya in 2014 could have been prevented by more timely care-seeking. Mobile health interventions are increasingly being recognized as tools for the delivery of health education and promotion. Many maternal deaths occur in the first few weeks after delivery and mothers who are given adequate care in the postpartum period have better health outcomes. Kiambu County, Kenya has a high level of literacy and phone ownership amongst mothers delivering in public hospitals and was chosen as a site for a postpartum short message service intervention. Methods Women were recruited after delivery and randomized to receive a package of mobile messages or standard of care only. Messages covered danger signs, general postpartum topics, and family planning. Endline phone surveys were conducted at 8 weeks postpartum to assess knowledge, care seeking behavior and family planning uptake. Analysis was conducted using Stata and is presented in odds ratios. Results Women who received the danger sign messages were 1.6 times more likely to be able to list at least 1 danger sign and 3.51 times more likely to seek treatment if they experienced postpartum danger signs. There was no significant difference in routine postpartum care seeking or care seeking behaviors concerning newborns. Women who received family planning messages were 1.85 times more likely to uptake family planning services compared to controls and 2.1 times more likely to choose a long-acting method.

The Influence of Design and Implementation Characteristics on the Use of Maternal Mobile Health Interventions in Kenya: Systematic Literature Review

“…Some of the most common uses of SMS include the delivery of health information and appointment reminders. Interventions implemented different SMS calibrations, including one-way (push) or two-way SMS, most of which were computer-automated, with a human component to respond to client questions, often referred to as hybrid systems [ 31 - 33 , 36 , 37 , 41 , 42 ]. Fewer programs incorporated other channels such as voice [ 13 , 39 ], which were mostly available for the health care provider for follow-up purposes, and even fewer reported using other messaging options such as WhatsApp (Meta Platforms, Inc) [ 38 ].…”

“…Most of the deployments were short-lived funded pilot studies, whereas 2 interventions [ 44 , 45 ] represented proprietary social enterprises that were privately owned. Almost all the interventions that had been evaluated were RCTs [ 32 , 33 , 36 , 37 , 42 ]. Of the 3 interventions whose evaluation details could not be traced, 2 (66%) were privately owned social enterprises, and one was a multi-stakeholder program [ 43 ].…”

“…The results of our synthesis show that interventions were more readily adopted and used when they were offered free of charge [ 31 , 32 , 36 , 37 , 39 , 42 ]. Interventions whose content was not stage-based, such as mWACh-PrEP, experienced diminished use after some time.…”

“…Almost all interventions reported the use of SMS to deliver messages related to maternal health care. mHealth programs, particularly those using SMS, have been shown to increase the uptake of maternal health services in developing countries [ 32 , 36 , 42 ]. In the randomized trials, the users in the two-way SMS intervention arms showed better engagement with the mHealth intervention [ 31 - 33 , 36 , 37 , 39 ].…”

Evaluation of a Two-Way SMS mHealth Strategy to Reduce Neonatal Mortality: Rationale, Design and Methods of a Randomized Controlled Trial in Kenya

“…51,63,64 Two-way SMS has also been found to be associated with higher ANC attendance and facility delivery, as well as higher post-partum knowledge and care-seeking behavior for treatment of maternal danger signs. [65][66][67] Studies measuring the impact of SMS interventions directly on perinatal mortality are limited. Fedha et al evaluated antenatal SMS visit reminders and pregnancy health information every two weeks and found no effect on neonatal or intrauterine mortality in Kenya, though the study lacked statistical power and the intervention did not extend into the postpartum period.…”