Evaluation of the impact of a mobile health system on adherence to antenatal and postnatal care and prevention of mother-to-child transmission of HIV programs in Kenya

Abstract

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.

The role of m-health in providing antenatal care in rural areas

“…16 Women who were registered in second trimester in this study were 59 in control group and 55 in study group which is similar to a study done by Mushamiri et al (53.5%) and lower than in a study done by Lund et al (71% in interventional group and 66% in control group). 14,16 Women registered in third trimester were 41 in control group and 38 in study group which was higher than compared to study by Lund et al where 9% in interventional and 7% in control group registered in third trimester. 16 In this study, women with more than 4 antenatal visits were 64 (62.7%) and 77 (75.49%) in control and study groups respectively.…”

“…14,15 In this study, only 17.6% of antenatal women had their own mobile phone and 82.3% used their husband's mobile for communication. This is lower when compared to study done by Lund et al where 38% of antenatal women owned mobile phone in interventional group.…”

Use of mobile phone for improvement in maternal health: a randomized control trial

“…13 Mushamiri I et al Study concluded that the incorporation of m-Health tools in CHW programs improved the adherence to ANC and PNC and enhanced PMTCT efforts. 14 Datta SS et al reported that seventy per cent of pregnant women were willing to receive health information via text messages, and 98.33 per cent believed text messages could effectively spread health messages. 15 A significant increase in knowledge was observed following delivery of the text messages.…”

Qualitative Assessment of the Feasibility, Usability, and Acceptability of a Mobile Client Data App for Community-Based Maternal, Neonatal, and Child Care in Rural Ghana

“…In particular, mobile apps, or software applications developed specifically for use on small, wireless computing devices such as smartphones or tablets, have been shown to improve the quality of care provided to pregnant and recently delivered women through electronic decision support [17, 18, 22], health worker planning [23, 24], and data collection and reporting [19, 25–27]. The reported ease of use and adaptability of mobile apps (or applications) for diverse populations also makes them an attractive, low-cost platform for developing health education and clinical care strategies [28–30].…”