title: Mobile phone intervention reduces perinatal mortality in zanzibar: secondary outcomes of a cluster randomized controlled trial.
abstract: BACKGROUND
  Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse.
  
  
  OBJECTIVE
  We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting.
  
  
  METHODS
  This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as a proxy of neonatal mortality.
  
  
  RESULTS
  Within the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births. The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74).
  
  
  CONCLUSIONS
  Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01821222; http://www.clinicaltrials.gov/ct2/show/NCT01821222 (Archived by WebCite at http://www.webcitation.org/6NqxnxYn0).
authors.affiliation: Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen N, Denmark. stine_lund@dadlnet.dk.
authors.forename: Stine
authors.initials: S
authors.lastname: Lund
authors.forename: Vibeke
authors.initials: V
authors.lastname: Rasch
authors.forename: Maryam
authors.initials: M
authors.lastname: Hemed
authors.forename: Ida Marie
authors.initials: IM
authors.lastname: Boas
authors.forename: Azzah
authors.initials: A
authors.lastname: Said
authors.forename: Khadija
authors.initials: K
authors.lastname: Said
authors.forename: Mkoko Hassan
authors.initials: MH
authors.lastname: Makundu
authors.forename: Birgitte Bruun
authors.initials: BB
authors.lastname: Nielsen
keywords: developing countries; mobile phones; perinatal mortality; text messaging (SMS)
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