Risk factors for stillbirth and neonatal mortality among participants in Mobile WACh NEO pilot, a two-way SMS communication program in Kenya

Abstract

Globally, 2.5 million neonates die and 2 million more are stillborn each year; the vast majority occur where access to life-saving care is limited. High quality, feasible interventions are needed to reach, educate and empower pregnant women and new mothers to improve care-seeking behaviors. Mobile WACh (Mobile solutions for Women’s and Children’s health) NEO is a human-computer hybrid mobile health (mHealth) system that allows for two-way short message service (SMS) communication between women and healthcare workers during the peripartum period. We performed a secondary prospective cohort analysis of data from the Mobile WACh NEO pilot study to determine maternal characteristics associated with neonatal death and stillbirth and examine participant messaging associated with these events. Pregnant women were enrolled at two Kenyan public health clinics between 28–36 weeks gestation. They received personalized, educational, action-oriented SMS messages during pregnancy and through 14 weeks postpartum. Participants could message the study at any time and study nurses responded. Standardized questionnaires assessed participant characteristics at baseline and 14 weeks postpartum. Outcomes were ascertained at study visits or by SMS report. Among 798 pregnant women enrolled, median age was 24 years [IQR 21, 29], 37% were primiparous and 92% used SMS as a primary mode of communication. Seventeen neonatal deaths and 13 stillbirths occurred. Older maternal age was associated with increased risk of stillbirth [aRR 1.12 (CI 1.02–1.24), p <0.05]. We found no significant predictors of neonatal death. Participant messaging to study nurse about concerns in the week preceding death was less common prior to infant death after discharge home from facility birth (9%) than prior to stillbirth (23%). We found limited predictors of neonatal death and stillbirth, suggesting identifying women prenatally for targeted support may not be a feasible strategy. Scarce messaging from mothers whose neonates died may reflect difficulties identifying illness or rapid deterioration and needs to be better understood to design and test interventions for this high-risk period. Messaging prior to stillbirth, while at similar levels as other periods, does not appear to have an impact as most women do not experience identifiable signs or symptoms prior to the event.

Types, reporting and acceptability of community-based interventions for stillbirth prevention in sub-Saharan Africa (SSA): a systematic review

“… N/A Rwanda Qualitative 1,2,3 Good 27 Innovating for maternal and child health in Africa (IMCHA) Joseph 2021 46 Participatory women groups, community mobilisation and health education N/A Tanzania Qualitative Community only 1,2,3 Good 28 Sustainable Emergency Referral care Patel N.D 50 Low-cost emergency transport, health/emergency education, health worker training N/A Ghana Qualitative (mixed) Community and hospitals 1,2,3 Good 29 N/A Fatti 2016 42 Home visits, health education, counselling for anti-retroviral therapy initiation and adherence. N/A South Africa Cohort Community only 1,2 Fair 30 Mobile WACh NEO Hedstrom 2022 43 Personalised text based health education and action oriented SMS N/A Kenya Cohort Community only 1,2 Good 31 N/A Okafor 2015 39 TBA training and supervision N/A Nigeria Cross sectional Community only 1,2 Fair 32 National health promotion policy Mostert 2021 41 National health promotion policy (cigarette control), home visits and health education. N/A South Africa Cross sectional Community only 1,2 Good 33 RBF4MNH Makuluni 2021 40 Result based financing for stillbirth reduction.…”

“…Ten studies were cRCTs, 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 three were RCTs 28 , 29 , 30 and one was a non-randomised controlled trial. 31 Seven studies had a pre-post design, 32 , 33 , 34 , 35 , 36 , 37 , 38 three were cross sectional, 39 , 40 , 41 two were cohort studies, 42 , 43 and four were qualitative, 44 , 45 , 46 , 47 three were mixed method studies, 48 , 49 , 50 while one implementation report did provide sufficient detail on methods used 51 [ Table 1 ].…”

“…Of the 34 studies included, 25 were conducted solely in the community, 18 , 19 , 20 , 22 , 23 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 39 , 41 , 42 , 43 , 46 , 47 , 49 , 51 while nine had some element of health facility implementation including purchasing equipment, employing adjunct medical staff, and training health workers. 21 , 26 , 34 , 38 , 40 , 50 , 52 , 53 Most studies were conducted in one country, while three studies were conducted in two or more countries 20 , 24 , 52 [ Table 1 ].…”

“…This was the most common group of interventions with 22 studies. 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 32 , 34 , 35 , 37 , 38 , 41 , 43 , 44 , 46 , 47 , 51 , 52 The researchers aimed to reduce stillbirths by influencing health behaviours through pregnancy health education such as recognising danger signs in pregnancy. Increasing access to skilled childbirth attendants through training of community health workers, traditional birth attendants and reducing delays that women face in accessing skilled care.…”

“…This was the most common group of interventions with 22 studies. 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 32 , 34 , 35 , 37 , 38 , 41 , 43 , 44 , 46 , 47 , 51 , 52 The researchers aimed to reduce stillbirths by influencing health behaviours through pregnancy health education such as recognising danger signs in pregnancy.…”