Mobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: a cluster-randomised controlled trial.
OBJECTIVE
To examine the association between a mobile phone intervention and skilled delivery attendance in a resource-limited setting.


METHODS
Pragmatic cluster-randomised controlled trial with primary healthcare facilities as the unit of randomisation.


METHODS
Primary healthcare facilities in Zanzibar.


METHODS
Two thousand, five hundred and fifty pregnant women (1311 interventions and 1239 controls) who attended antenatal care at one of the selected primary healthcare facilities were included at their first antenatal care visit and followed until 42 days after delivery. All pregnant women were eligible for study participation.


METHODS
Twenty-four primary healthcare facilities in six districts in Zanzibar were allocated by simple randomisation to either mobile phone intervention (n = 12) or standard care (n = 12). The intervention consisted of a short messaging service (SMS) and mobile phone voucher component.


METHODS
Skilled delivery attendance.


RESULTS
The mobile phone intervention was associated with an increase in skilled delivery attendance: 60% of the women in the intervention group versus 47% in the control group delivered with skilled attendance. The intervention produced a significant increase in skilled delivery attendance amongst urban women (odds ratio, 5.73; 95% confidence interval, 1.51-21.81), but did not reach rural women.


CONCLUSIONS
The mobile phone intervention significantly increased skilled delivery attendance amongst women of urban residence. Mobile phone solutions may contribute to the saving of lives of women and their newborns and the achievement of Millennium Development Goals 4 and 5, and should be considered by maternal and child health policy makers in developing countries.
Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark. stine_lund@dadlnet.dk
S
S
Lund
M
M
Hemed
B B
BB
Nielsen
A
A
Said
K
K
Said
M H
MH
Makungu
V
V
Rasch
D000293:Adolescent; D000328:Adult; D040421:Cell Phone; D016000:Cluster Analysis; D036861:Delivery, Obstetric / Q000592:standards*; D005260:Female; D058015:Health Communication / Q000379:methods*; D006266:Health Education / Q000379:methods; D006801:Humans; D008880:Midwifery / Q000592:standards / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000379:methods / Q000592:standards; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods* / Q000592:standards; D017010:Reminder Systems / Q000295:instrumentation; D012423:Rural Health; D013636:Tanzania; D014504:Urban Health; D055815:Young Adult