Effects of mHealth Interventions on Improving Antenatal Care Visits and Skilled Delivery Care in Low- and Middle-Income Countries: Systematic Review and Meta-analysis

Abstract

Background The poor coverage of essential maternal services, such as antenatal care (ANC) and skilled delivery care utilization, accounts for higher maternal and infant mortality in low- and middle-income countries (LMICs). Although mobile health (mHealth) interventions could potentially improve the service utilization in resource-limited settings, their effectiveness remains unclear. Objective This review aimed to summarize the effect of mHealth interventions on improving the uptake of ANC visits, skilled birth attendance at the time of delivery, and facility delivery among pregnant women in LMICs. Methods We conducted a comprehensive search on 9 electronic databases and other resources from inception to October 2020. We included individual randomized controlled trials and cluster randomized controlled trials that assessed the effectiveness of mHealth interventions for improving perinatal health care utilization among healthy pregnant women in LMICs. We performed a random-effects meta-analysis and estimated the pooled effect size by using risk ratios (RRs) with 95% CIs. In addition, 2 reviewers independently assessed the risk of bias of the included studies by using the Cochrane risk of bias tool and the certainty of the evidence by using the Grading of Recommendation, Assessment, Development and Evaluation approach. Results A total of 9 studies (10 articles) that randomized 10,348 pregnant women (n=6254, 60.44% in the intervention group; n=4094, 39.56% in the control group) were included in this synthesis. The pooled estimates showed a positive effect of mHealth interventions on improving 4 or more ANC visit utilizations among pregnant women in LMICs, irrespective of the direction of interventions (1-way communications: RR 2.14, 95% CI 1.76-2.60, I2=36%, 2 studies, moderate certainty; 2-way communications: RR 1.17, 95% CI 1.08-1.27, I2=59%, 3 studies, low certainty). Only 2-way mHealth interventions were effective in improving the use of skilled birth attendance during delivery (RR 1.23, 95% CI 1.14-1.33, I2=0%, 2 studies, moderate certainty), but the effects were unclear for 1-way mHealth interventions (RR 1.04, 95% CI 0.97-1.10, I2=73%, 3 studies, very low certainty) when compared with standard care. For facility delivery, the interventions were effective in settings where fewer pregnant women used facility delivery (RR 1.68, 95% CI 1.30-2.19, I2=36%, 2 studies, moderate certainty); however, the effects were unclear in settings where most pregnant women already used facility delivery (RR 1.01, 95% CI 0.97-1.04, I2=0%, 1 study, low certainty). Conclusions mHealth interventions may contribute to improving ANC and skilled delivery care utilization among pregnant women in LMICs. However, more studies are required to improve their reproducibility and efficiency or strengthen the evidence of different forms of mHealth interventions because of the considerable heterogeneity observed in the meta-analyses. Trial Registration PROSPERO CRD42020210813; https://tinyurl.com/2n7ny9a7

Effects of a mHealth voice messaging intervention on antenatal care utilisation at primary care level in Lagos, Nigeria: a cluster randomised trial

“…22 A crucial aspect of our study is that it evaluates the efficacy of a mhealth intervention on ANC utilization based on the most recent WHO recommendation and focuses on a voice message-based intervention that has seldom been evaluated. 13 However, a few restrictions must be considered when interpreting our results. First, we took a pragmatic approach by randomizing PHCs instead of pregnant women.…”

“…11 Mobile devices have been utilized to enhance the utilization of maternal health care in low-and middle-income countries (LMICs), particularly to improve patient education and appointment adherence, disease self-management, and remote patient monitoring. 12,13 In particular, research has demonstrated that successful communication and interaction between skilled health workers (SHP) and pregnant women via simple short message systems (SMS) increased the utilization of maternity services. 14−16 Indeed, studies have demonstrated a correlation between mobile health and the utilization of maternal health services, particularly ANC.…”

“…17 Nevertheless, according to a systematic review conducted in 2022, no study has evaluated the efficacy of mHealth interventions on ANC utilization based on the new WHO model for eight ANC visits. 13 This study's purpose was to examine the impact of a mobile phone-based voice message intervention on ANC utilization, as defined by the 2016 WHO recommendation, at the primary health care (PHC) level in Lagos State, Nigeria.…”

Pre‐eclampsia in low and middle‐income settings: What are the barriers to improving perinatal outcomes and evidence‐based recommendations?

“…6 Globally, most pregnant women have access to prenatal care visits with a skilled health professional (i.e., a physician, nurse, or midwife), but only 65% receive WHO-recommended four visits during pregnancy, and this number is even worse considering only low-income countries. 9 Regular prenatal care guarantees close contact between pregnant women and the health system. The practices during visits are essential to early suspicion and diagnosis of many insults, including hypertensive disorders.…”

“…Once hypertension is identified, medication should be prescribed, and its availability is another issue that health professionals must deal with. 9,10 During prenatal care, it is possible to recognize a pregnant woman at high-risk of developing pre-eclampsia, and considering the social and economic context of LMICs, clinical evaluation is the strategy to be implemented for this purpose. Although many efforts have been made towards universal screening between 11 and 13 weeks of pregnancy, the algorithm applied usually involves maternal characteristics, evaluation of mean arterial blood pressure, uterine artery Doppler, and serum levels of placental growth factor and pregnancy-associated pregnancy protein-A.…”