Technology-based innovative healthcare solutions for improving maternal and child health outcomes in LMICs: a systematic review and network meta-analysis
ABSTRACT
Background:
Technology-based healthcare interventions (TBIs) are being considered as a promising solution to effectively strengthen maternal and child health (MCH) service uptake in resource-limited settings.
Objective:
To identify the most effective TBIs that could achieve the best functional MCH outcomes in low- and middle-income countries (LMICs).
Methods:
A comprehensive search was performed on January 2021. Two independent researchers identified randomized controlled trials (RCTs) implemented in LMICs using the PICO framework: P-healthy pregnant women; I-TBIs; C-usual care/non-TBIs; O-MCH outcomes. We estimated direct, indirect and relative effects, with their certainty based on GRADE approach, for a wide range of MCH outcomes.
Results:
Thirty trials with 70,807 participants were included, and 80% had low risk of bias. Our network meta-analysis (NMA) estimates indicated that TBIs, particularly SMS or phone call with mobile voucher interventions, were likely to be effective in improving MCH outcomes. The one-way communication intervention was likely to be most effective for the uptake of ≥4 antenatal care visits (RR 1.81 [95% CI: 1.33–2.45], moderate certainty), facility delivery (RR 1.45 [95% CI: 1.10–1.91], moderate certainty), early breastfeeding initiation (RR 1.18 [95% CI: 1.02–1.37], moderate certainty), and caesarean delivery (RR 0.87 [95% CI: 0.84–0.91], low certainty) outcomes; however, two-way communication intervention for skilled birth attendance (RR 1.36 [95% CI: 1.14–1.63], low certainty), maternal (RR 2.04 [95% CI: 1.05–3.96], very-low certainty) and infant’s postnatal care utilization (RR 1.55 [95% CI: 1.19–2.04], low certainty), exclusive breastfeeding practice (RR 1.53 [95% CI: 1.14–2.05], moderate certainty), and perinatal death (RR 0.51 [95% CI: 0.32–0.83], low certainty) outcomes. There was no substantial inconsistency between direct and indirect evidences, but small study effects detected in the NMAs.
Conclusions:
Different forms of TBIs have a possibility to improve MCH outcomes in LMICs, and can be integrated into the existing health systems based on their priorities. This study suggests implementation of large scale well-designed RCTs in low-income countries due to the limited number of RCTs in the NMAs. Clinical Trial: PROSPERO registration number: CRD42021239185
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