Meta-Analysis: Effectiveness of mHealth Utilization on Antenatal Care

Compliance with iron and folic acid supplementation is an important factor contributing to the prevention and treatment of anemia in pregnant women to meet the nutritional needs of the fetus during pregnancy. The use of mobile health interventions (mHealth) such as SMS reminders, voice messages, videos and telephones can provide behavioral support and health education needs of pregnant women. determine the effectiveness of mHealth use on compliance with iron and folic acid supplementation (IFAS) among pregnant women. Systematic review and meta-analysis wre conducted using PRISMA guidelines and PICO models which included Population = pregnant women; Intervention = mHealth, Comparison = does not use mHealth; Outcome = compliance with iron and folic acid supplementation. Articles were collected through databases such as BMJ, Google Scholar, PubMed, Open Journal System. 6 articles met the inclusion criteria for meta-analysis and were assessed using RevMan 5.3. Meta-analysis from Kenya, India, Brazil and Indonesia showed that pregnant women who used mHealth services were 1.87 times more likely to adhere to iron and folic acid supplements compared to those who did not use mHealth and the effect was statistically significant (OR= 1.87; 95% CI= 1.10 to 3.16; p <0.001). The use of mHealth can improve compliance of pregnant women in consuming iron and folic acid supplements.

BackgroundLimited information exists on the impact of mobile health (mHealth) use by community health workers (CHWs) on improving the use of maternal health services in sub-Saharan Africa (SSA).ObjectiveThis systematic review addresses 2 objectives: evaluating the impact of mHealth use by CHWs on antenatal care (ANC) use, facility-based births, and postnatal care (PNC) use in SSA; and identifying facilitators and barriers to mHealth use by CHWs in programs designed to increase ANC use, facility-based births, and PNC use in SSA using a sociotechnical system approach.MethodsWe searched for articles in 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus) from inception up to September 2022, with additional articles identified from Google Scholar. After article selection, 2 independent reviewers performed title and abstract screening, full-text screening, and data extraction using Covidence software (Veritas Health Innovation Ltd). In addition, we manually screened the references lists of the included articles. Finally, we performed a narrative synthesis of the outcomes.ResultsAmong the 2594 records retrieved, 10 (0.39%) studies (n=22, 0.85% articles) met the inclusion criteria and underwent data extraction. The studies were published between 2012 and 2022 in 6 countries. Of the studies reporting on ANC outcomes, 43% (3/7) reported that mHealth use by CHWs increased ANC use. Similarly, of the studies reporting on facility-based births, 89% (8/9) demonstrated an increase due to mHealth use by CHWs. In addition, in the PNC studies, 75% (3/4) showed increased PNC use associated with mHealth use by CHWs. Many of the studies reported on the importance of addressing factors related to the social environment of mHealth-enabled CHWs, including the perception of CHWs by the community, trust, relationships, digital literacy, training, mentorship and supervision, skills, CHW program ownership, and the provision of incentives. Very few studies reported on how program goals and culture influenced mHealth use by CHWs. Providing free equipment, accessories, and internet connectivity while addressing ongoing challenges with connectivity, power, the ease of using mHealth software, and equipment maintenance support allowed mHealth-enabled CHW programs to thrive.ConclusionsmHealth use by CHWs was associated with an increase in ANC use, facility-based births, and PNC use in SSA. Identifying and addressing social and technical barriers to the use of mHealth is essential to ensure the success of mHealth programs.Trial RegistrationPROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364

Health education is a key component of first antenatal visits. The aim of this study was to describe the health education needs of pregnant women on their first visit to antenatal clinics in Khayelitsha, South Africa. A quantitative descriptive survey was conducted, to investigate the lifestyle, pregnancy-related, psycho-social health education needs and predictors of health education needs during pregnant women’s first antenatal clinic visit. The research was conducted at two purposively selected antenatal clinics in Khayelitsha, a low-income suburb in Cape Town, South Africa. The respondents were considered eligible for the study if they were Xhosa speaking, pregnant, older than 18 years, making a first visit to antenatal care, and able to complete their consent form or provide consent from parents or relatives. Respondents were eligible for the study regardless of the number of pregnancies they had previously had, their age and previous medical conditions. There were a total of 240 (92%) respondents. Overall pregnancy-related health education needs were rated the highest (m=4.0, [95%CI3.95–4.09]), with information on how the baby grows and develops during pregnancy (m=4.6, [95%CI4.5–4.7]) the highest. The lowest rated health information needs were testing for HIV and prevention thereof (m=3.5, [95%CI3.3–3.7]) and how to use seat belts during pregnancy (m=3.2, [95%CI3.0–3.4]). A lack of awareness of the duration of pregnancy predicted significantly higher overall health education needs and lifestyle education needs. The study recommends that pregnant women should be provided with prioritised health information during their first antenatal visit, especially given the high risk of late bookings for first antenatal visits.

Background/aimsThe short message service is a part of mobile health, which is defined as medical and public health practices that are supported by mobile devices, such as mobile phones, personal digital assistants, and other wireless devices. Mobile health has documented positive outcomes on other health services, including focused antenatal care. The focused antenatal care model emphasises quality of care rather than quantity of antenatal visits, and the World Health Organization recommends a minimum of four targeted antenatal visits. This study examines the influence of short message service reminders on utilisation of focused antenatal care in rural Kenya.MethodsThis was a randomised controlled trial with 118 respondents in each of two study arms, intervention and control, conducted in Tharaka Nithi, Kenya. The study group were pregnant women attending their first antenatal care visit in Tharaka sub-county health facilities. The intervention was three short message service reminders a week before the scheduled visit. Structured questionnaires were used to collect baseline and exit interviews. The chi-square test and logistic regression were used to check associations between uptake of antenatal care and participant characteristics at 5% significance level.ResultsThree quarters (75%) of the respondents in the intervention group completed the four targeted antenatal visits, whereas only 10% of respondents attended the required four visits in the control group. None of the sociodemographic variables were found to have any association or influence on focused antenatal care attendance. Short message reminders increased the chances of attending the recommended visits by 27 times (P<0.001).ConclusionsShort message service reminders have a positive influence on utilisation of focused antenatal care. This research paper recommends that policymakers and health managers use short message service reminders to increase the uptake of focused antenatal care.

Care of Women with Obesity in Pregnancy

About 2.6million stillbirths per year occur globally with 98% occurring in low- and middle-income countries including Kenya, where an estimated 35000 stillbirths occur annually. Most studies have focused on the direct causes of stillbirth. The aim of this study was to determine the association between antenatal care utilization and quality with stillbirth in a Kenyan set up. This information is key when planning strategies to reduce the stillbirth burden. This was a case-control study in four urban tertiary hospitals carried out between August 2018 and April 2019. A total of 214 women with stillbirths (cases) and 428 with livebirths (controls) between 28 and 42weeks were enrolled. Information was obtained through interviews and data abstracted from medical records. Antenatal care utilization was assessed by the proportions of women not attending antenatal care; booking first antenatal care visit in first trimester and not making the requisite four antenatal care visits. Quality of antenatal care was assessed using individual surrogate indicators (antenatal profile testing, weight/blood pressure/urinalysis testing in each antenatal visit, utilization of early obstetric ultrasound, completeness of antenatal records) and a codified indicator made up of seven parameters (attending antenatal care, booking first antenatal care in the first trimester, making four or more antenatal visits, having all antenatal profile tests, having a complete antenatal record, having blood pressure and weight measured at all visits). The association between antenatal care utilization and quality with stillbirth was assessed using univariate and multivariate analysis using logistic regression. Statistical significance was defined as a two-tailed P value ≤.05. Women with stillbirth were likely to have a parity ≥4 (19.6% vs 12.6%, P=.02), have an obstetric complication (36% vs 8.6%, P=.001) and have a medical disorder (5.6% vs 1.6%, P=.01). The odds of a stillbirth were four times higher among those who did not attend antenatal care ( odds ratio [OR] 4.1, 95% confidence interval [CI] 1.6-10, P<.003). Compared with four antenatal care visits, those who had one or two visits had higher odds of a stillbirth: OR 2.96 (95% CI 1.4-6.1), P=.003, and OR 2.9 (95% CI 1.7-5), P=.003, respectively. As per the individual surrogate indicators, the likelihood of a stillbirth was lower in women who received good quality antenatal care: Hemoglobin testing (OR 0.6, 95% CI 0.4-0.8, P=.03), blood group test (OR 0.4, 95% CI 0.2-0.6, P<.001), HIV test (OR 0.3, 95% CI 0.2-0.5, P=.001), venereal disease research laboratory test (OR 0.2, 95% CI 0.1-0.4, P=.001), weight measurement (OR 0.7, 95% CI 0.5-1.0, P=.047). As per the composite indicator, the quality of antenatal care was poor across the board and there was no association between this surrogate indicator and stillbirth. Lack of antenatal care, attending fewer than four antenatal visits and poor quality antenatal care as measured by surrogate indicators were significantly associated with stillbirth. In addition, women with low education level, obstetric complications, multiparity and medical complications had a significantly higher likelihood of stillbirth. Improving the utilization of four or more antenatal visits and the quality of antenatal care can reduce the risk of stillbirth.

4.0 Screening and monitoring of <scp>HIV</scp>‐positive pregnant women

Background: In 2016, the World Health Organization (WHO) published new antenatal care guidelines recommending an increase from four visits during pregnancy to eight contacts with skilled personnel, among other recommendations. Currently there are ongoing discussions in respect to the cost implications and potential outcomes countries can anticipate, if they make this move. Cameroon has adopted the new recommendation without analysis of the cost implication. Notwithstanding, it is imperative to investigate if pregnant women are willing to make this change, the cost implications of such changes, and if pregnant women will be willing to pay the extra cost. This study sets out to find out women’s preferred number of antenatal visits, their willingness to pay for antenatal visits and to perform a cost- benefit analysis of 4 and 8 visits in Bamenda Health District (BHD). Method: An exit interview was conducted using a semi structured interviewer administered questionnaire with women attending antenatal clinic in some 14 health facilities in BHD. The health facilities were chosen purposively. A total of 396 women were interviewed. Results: Our results revealed that 177 (44.7%) of the women preferred 4 antenatal care visits while 174 (43.9%) preferred 8 antenatal care visits and 45 (11.4%) preferred more than 8 antenatal visits. The extra cost for 4 and 8 visits was 10,390FCFA. The average willingness -to –pay (WTP) for 4 extra visits was calculated to be 2,209FCFA. Conclusion: Although women preferred a model of antenatal care (ANC) with 8 or more ANC contacts, they were not willing to pay for the contacts, thus it is recommended that the 4 visits model be implemented in the Bamenda Health District.

In this editorial, we discuss how mobile phone technology has the potential to move the field forward in terms of understanding suicide risk as well as laying foundations for the development of effective treatments/interventions. We have focused on mobile health technology given the rapid growth of mobile health approaches in suicide prevention (De Jaegere & Portzky, 2014; Mishara & Kerkhof, 2013) and psychological research more generally (Myin-Germeys et al., 2009; Nock, Prinstein, & Sterba, 2009; Palmier-Claus et al., 2011) and because mobile phone use is ubiquitous, with 75% of the world having access to a mobile phone (Kay, 2011). (aut. ref.)

BACKGROUND:Neonatal mortality, infant mortality, and maternal mortality remained important public health in most developing countries, including Indonesia.Neonatal mortality rate in Puskesmas Kronjo, Tangerang Banten was 6 per 1000 live birth in 2014, and 7 per 1000 live birth in 2015.There is a need to assess the effect of health education and community awareness program on the knowledge in safe motherhood and number of antenatal care visits.This study aimed to determine effect of health education and "pregnant mother awareness movement" on knowledge and community participation in safe motherhood.SUBJECT AND METHODS: This was a quasi-experimental study, before and after intervention with no control design, conducted in Tangerang, Banten.A sample of 25 pregnant mothers was selected from Community Health Center (Puskesmas) Kronjo, Tangerang, Banten.The dependent variables were knowledge in safe motherhood and community participation in maternal care.The independent variable was a program consisting of health education and "Pregnant Women Awareness Movement" (Gerakan Peduli Ibu Hamil (GeLiBuMil).The health education was intended to give information on the important antenatal care and other safe motherhood services.The "Pregnant Women Awareness Movement" aimed to increase awareness of safe motherhood.A questionnaire was used to measure knowledge before and after the intervention.Document review was used to collect on community participation in safe motherhood.Change in percentage of pregnant mothers who had good knowledge in safe motherhood before and after intervention was estimated by Odds Ratio and tested by Chi Square test.RESULTS: Health education and "Pregnant Women Awareness Movement" altogether increased knowledge in safe motherhood among pregnant mothers.Pregnant mothers who received this intervention program were 3.19 times more likely to have good knowledge in safe motherhood than those who did not receive the program (OR=3.19;95%CI=1.00 to 10.17; p=0.047).There was 12% increase in the number of visit among pregnant mothers to use antenatal and other maternal care. CONCLUSION: Health education and "Pregnant Women AwarenessMovement" can effectively increase knowledge in safe motherhood and antenatal visits among pregnant mothers.

BackgroundMothers who attend antenatal care late miss the opportunity of early detection of HIV and STDs, malaria and anaemia prophylaxis, health education and treatment or prevention of complications. Whereas many women in Mulago hospital make their first antenatal care visit after 20 weeks of gestation, the reasons for coming late are not documented. The objectives were to determine the gestation age at which pregnant women make their first antenatal care visit and the reasons for late coming.MethodThe study was conducted in June 2012 among women with a gestation age of more than 20 weeks on their first antenatal care visit. We collected data on gestation age (from weeks of amenorrhea or based on ultrasound scan) and reasons for coming late.ResultsFour hundred women participated in the study. Their mean age was 25.2 years with a standard deviation of 5.2 years. The majority of the participants were Catholics (n = 126, 31.5%), they lived in a distance of greater than five kilometers from the hospital (n = 201, 50.3%) and had attained secondary education (n = 220, 55.0%). The mean of their weeks of amenorrhea was 27.9 (± 4.6) weeks. The results showed that 291 (72.7%) of the study participants did not know the right gestation age at which a pregnant woman should start attending antenatal care. One hundred and ten (27.5%) agreed that they did not have money for transport to bring them to the hospital while 37 (9.3%) thought that they had to pay for the antenatal care services. Two hundred thirteen (53.3%) reported that they did not have any problem with their current pregnancy and so they saw no reason to come early for antenatal care, even though some of these knew the right gestation age at which they should make their first antenatal care visit.ConclusionPregnant women who come late for antenatal care in Mulago hospital, Uganda are not well-informed about the right gestation age at which they should make their first antenatal care visit and/or of the importance of early attendance at antenatal care.

BackgroundAfter more than three years of violence in Syria, Lebanon hosts over one million Syrian refugees creating significant public health concerns. Antenatal care delivery to tens of thousands of pregnant Syrian refugee women is critical to preventing maternal and fetal mortality but is not well characterized given the multiple factors obtaining health data in a displaced population. This study describes antenatal care access, the scope of existing antenatal care, and antenatal and family planning behaviors and practice among pregnant Syrian refugees in various living conditions and multiple geographic areas of Lebanon.MethodsA field-based survey was conducted between July and October 2013 in 14 main geographic sites of refugee concentration. The assessment evaluated antenatal services among a non-randomized sample of 420 self-identified pregnant Syrian refugee women that included demographics, gestational age, living accommodation, antenatal care coverage, antenatal care content, antenatal health behaviors, antenatal health literacy, and family planning perception and practices.ResultsIn total, 420 pregnant Syrian refugees living in Lebanon completed the survey. Of these, 82.9% (348) received some antenatal care. Of those with at least one antenatal visit, 222 (63.8%) received care attended by a skilled professional three or more times, 111 (31.9%) 1–2 times, and 15 (4.3%) had never received skilled antenatal care. We assessed antenatal care content defined by blood pressure measurement, and urine and blood sample analyses. Of those who had received any antenatal care, only 31.2% received all three interventions, 18.2% received two out of three, 32.1% received one out of three, and 18.5% received no interventions. Only (41.2%) had an adequate diet of vitamins, minerals, and folic acid. Access, content and health behaviors varied by gestational age, type of accommodation and location in Lebanon.ConclusionsStandards of antenatal care are not being met for pregnant Syrian refugee women in Lebanon. This descriptive analysis of relative frequencies suggests reproductive health providers should focus attention on increasing antenatal care visits, particularly to third trimester and late gestational age patients and to those in less secure sheltering arrangements. With this approach they can improve care content by providing early testing and interventions per accepted guidelines designed to improve pregnancy outcomes.

BackgroundMobile health (mHealth) is emerging as a useful tool to improve healthcare access especially in the developing world, where limited access to health services is linked to poor antenatal care, and maternal and perinatal mortality.The objective of this study is to 1) understand pregnant women’s access and usage of cell phones and 2) survey the health information needs and interests in a population attending public hospitals and health centers of two cities in Argentina. This information is not available and it is the basis to develop a strategy for improving maternal care via cell phones.MethodsQuestionnaires were verbally administered to pregnant women who were attending an antenatal care visit in community health centers and public hospitals in Rosario, Santa Fe and Mercedes, Corrientes. Participants were 18 years of age or older and had previously given birth. The data obtained was qualitative and analyzed using SPSS version 18.ResultsA total of 147 pregnant women meeting inclusion criteria (Rosario: 63; Mercedes: 84) were approached and verbally consented to participate. The average age was 29.5 years, most lived in urban areas (89%) with a mean travel time of 43.4 minutes required to get to the health center and 57.3 minutes to get the hospital.Ninety-six percent of women (n = 140) responded that they would like to receive text messages and cell phone calls with information regarding prenatal care, although the topics and period of time to receive information varied greatly.ConclusionsConsidering the vast majority of the interviewed women had access to and were interested in receiving text messages and calls with educational information regarding pregnancy and infant health, pregnant women in Argentina could benefit from such an mHealth program. The low access to Internet suggests it is not an option for this population; however, this cannot be assumed as representative of the country’s situation.To retain active participation, other forms of health communication, such as a 2-way text message systems or toll-free numbers, could be considered in the future. Cost of use and implementing these options should be studied.

Introduction: The new focused antenatal care model recognizes that every pregnant woman is at risk for complications and four antenatal care visits are recommended for most pregnant women; the first one being early in the first trimester. When pregnant women attend antenatal care late they miss the cares being provided in the first 16 weeks. Therefore it is important to assess timing of first antenatal care visit and identify associated factors for late coming for the sake of intervention. Methods: Institutional based cross-sectional study was conducted among 362 randomly selected pregnant women from April to June 2014 in Dilla town, Southern Ethiopia. The data had been entered in to Epi Info version 7 and analyzed through SPSS version 20. Bivariate analysis was run to look for the association between dependent and explanatory variables; and using variables which have p-value ≤ 0.25 binary logistic regressions was fitted. Association presented in odds ratio with 95% confidence interval and significance determined at P-value less than 0.05. Results: The mean time of first antenatal care visit was found to be 15.9 (SD 3.7) weeks and the proportion of women who visit their first antenatal care within the recommended time (before or at 16 weeks of gestation) was 49.7%; nearly equal to late presentation. Rural residence (AOR=3.6, 95% CI (1.72, 6.62)), low monthly income (AOR=3.20, 95% CI (1.5, 6.74)), illiteracy (AOR=1.48, 95% CI (1.12, 3.04)), not being advised on timing of visit (AOR=4.64, 95% CI (2.32, 8.17) and unplanned pregnancy (AOR=5.02, 95% CI (2.21, 8.95)) were independent predictors of late presentation for first antenatal care. Conclusion: Even though, half of pregnant women started antenatal care attendance during the first trimester the finding was not satisfactory. Hence, further activities are needed through health education and promotion.

Background: Antenatal care has proven to be an effective way to reduce maternal mortality and save the life of newborn. Nepal also follows the World Health Organization’s recommendations of initiation of four antenatal care visits that has helped in decreasing the maternal mortality of the country. Still, the country has to do a lot in improving the antenatal care provision.Objective: The objective of this study was to find out the antenatal care practices among the women with children less than five years of age in a district of eastern Nepal.Methods: A descriptive cross-sectional study was conducted among residents of Aurabani village of Sunsari district. Non probability convenient sampling technique was used to collect data from 15th January to 30th January, 2015. Data of 100 women having children less than five years of age were collected and analyzed in descriptive and inferential ways.Results: Women with nuclear family are more likely to have antenatal care visits (73.8%) compared to women with joint family (66.7%). The study showed that attendance of antenatal care visits among the educated women was higher (71.8%) than those illiterate (66.7%). In the study, 84.8% of women of primi-gravida completed antenatal care visit which was significantly higher than women with multi gravida (59.3%) (p &lt;0.05). Further, 83.1% of respondents who completed tetanus toxoid injections had not walked &lt;30 meters distance for health services which was significantly higher than those walking &gt;30 meters distance (52.9%). An almost similar trend was found among pregnant women taking iron tablets and vitamin A. Furthermore, walking distance shows stronger association with women taking albendazole during pregnancy (p &lt;0.001).Conclusion: A large percentage of women completed all four recommended antenatal visits. Women and their husbands who were educated placed high importance on antenatal visits. Gravida of the pregnancy was also related to the antenatal care visit. High number of primi-gravida women completed antenatal care visits than women with multigravida. Use of medicines like iron tablets, albendazole tablets, vitamin A and tetanus toxoid injection was directly related with the walking distance to the health center.Journal of Kathmandu Medical CollegeVol. 5, No. 3, Issue 17, Jul.-Sep., 2016, page: 89-94