JMIR Publications

ABSTRACT

Background:

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). Though mobile phone-based healthcare interventions (mHealth) could potentially improve the service utilization in resource-limited settings, its effectiveness, as yet remains unclear.

Objective:

The objective of this review was 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 nine electronic databases and other resources until October 2020. We included individual randomized controlled trials (RCTs) and cluster RCTs that assessed effectiveness of mHealth interventions for improving perinatal healthcare utilization among healthy pregnant women in LMICs. We performed random effects meta-analysis and estimated the pooled effect size in risk ratio (RR) with 95% CI. Two reviewers independently assessed the risk of bias of the included studies using the Cochrane risk of bias tool and certainty of the evidence using GRADE approach.

Results:

Nine studies (10 articles) randomizing 10,348 pregnant women (6,254 in intervention group, 4,094 in control group) were included in this synthesis. The pooled estimates showed a positive effect of mHealth interventions on improving 4 or more ANC visit utilization among pregnant women in LMICs, irrespective of the direction of interventions (one-way communications: RR 2.14, 95% CI: 1.76 - 2.60, I2=36%, 2 studies, moderate-certainty; two-way communications: RR 1.17, 95% CI: 1.08 - 1.27, I2=59%, 3 studies, low-certainty). Only two-way mHealth interventions were effective in improving use of skilled birth attendant during delivery (RR 1.23, 95% CI: 1.14 - 1.33, I2=0%, 2 studies, moderate-certainty) but the effects were unclear for one-way mHealth interventions (RR 1.04, 95% CI: 0.97 - 1.10, I2=73%, 3 studies, very low-certainty), compared to standard care. For facility delivery, the interventions were effective in the settings where fewer pregnant women used facility delivery (RR 1.68, 95% CI: 1.30 - 2.19, I2=36%, 2 studies, moderate-certainty) but the effects were unclear where most pregnant women already used facility delivery (RR 1.01, 95% CI: 0.97 - 1.04, I2=0%, one study, low-certainty).

Conclusions:

mHealth interventions may contribute towards improving ANC and skilled delivery care utilization among pregnant women in LMICs. However, more studies are required to improve its reproducibility and efficiency or strengthen the evidence of different forms of mHealth interventions, because of the considerable heterogeneity observed in the meta-analyses. Clinical Trial: The review protocol was registered at PROSPERO: CRD42020210813.