Abstract
IntroductionMaternal and neonatal mortality remains high in many low- and middle-income countries (LMIC). Availability and use of mobile phones is increasing rapidly with 90% of persons in developing countries having a mobile-cellular subscription. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This systematic review assessed the effect of mHealth interventions that support pregnant women during the antenatal, birth and postnatal period in LMIC.MethodsThe review was registered with Prospero (CRD42014010292). Six databases were searched from June 2014–April 2015, accompanied by grey literature search using pre-defined search terms linked to pregnant women in LMIC and mHealth. Quality of articles was assessed with an adapted Cochrane Risk of Bias Tool. Because of heterogeneity in outcomes, settings and study designs a narrative synthesis of quantitative results of intervention studies on maternal outcomes, neonatal outcomes, service utilization, and healthy pregnancy education was conducted. Qualitative and quantitative results were synthesized with a strengths, weaknesses, opportunities, and threats analysis.ResultsIn total, 3777 articles were found, of which 27 studies were included: twelve intervention studies and fifteen descriptive studies. mHealth interventions targeted at pregnant women increased maternal and neonatal service utilization shown through increased antenatal care attendance, facility-service utilization, skilled attendance at birth, and vaccination rates. Few articles assessed the effect on maternal or neonatal health outcomes, with inconsistent results.ConclusionmHealth interventions may be effective solutions to improve maternal and neonatal service utilization. Further studies assessing mHealth’s impact on maternal and neonatal outcomes are recommended. The emerging trend of strong experimental research designs with randomized controlled trials, combined with feasibility research, government involvement and integration of mHealth interventions into the healthcare system is encouraging and can pave the way to improved decision making on best practice implementation of mHealth interventions.
Highlights
Maternal and neonatal mortality remains high in many low- and middle-income countries (LMIC)
3777 articles were found, of which 27 studies were included: twelve intervention studies and fifteen descriptive studies. Mobile health (mHealth) interventions targeted at pregnant women
MHealth and Maternal and Neonatal Care increased maternal and neonatal service utilization shown through increased antenatal care attendance, facility-service utilization, skilled attendance at birth, and vaccination rates
Summary
Maternal and neonatal mortality remains high in many low- and middle-income countries (LMIC). Availability and use of mobile phones is increasing rapidly with 90% of persons in developing countries having a mobile-cellular subscription. This systematic review assessed the effect of mHealth interventions that support pregnant women during the antenatal, birth and postnatal period in LMIC. The availability and use of mobile phones is increasing rapidly in low- and middle-income countries (LMIC) [1,2,3]. In 2014, 90% of persons in developing countries have a mobile-cellular subscription (pre-paid and post-paid), 89% in the Asia-Pacific region and 69% in Africa [2]. One of the key-areas addressed by mHealth interventions is the support of pregnant women during the antenatal, birth and postnatal period, in order to tackle high maternal and neonatal mortality [3]. LMIC account for the majority of the 2,612,100 neonatal deaths worldwide [11,12],which is approximately 40% of the deaths of children under five [1]
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