title: Effectiveness of mHealth interventions for maternal, newborn and child health in low- and middle-income countries: Systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the effectiveness of mHealth interventions for maternal, newborn and child health (MNCH) in low- and middle-income countries (LMIC).
  
  
  METHODS
  16 online international databases were searched to identify studies evaluating the impact of mHealth interventions on MNCH outcomes in LMIC, between January 1990 and May 2014. Comparable studies were included in a random-effects meta-analysis.
  
  
  RESULTS
  Of 8593 unique references screened after de-duplication, 15 research articles and two conference abstracts met inclusion criteria, including 12 intervention and three observational studies. Only two studies were graded at low risk of bias. Only one study demonstrated an improvement in morbidity or mortality, specifically decreased risk of perinatal death in children of mothers who received SMS support during pregnancy, compared with routine prenatal care. Meta-analysis of three studies on infant feeding showed that prenatal interventions using SMS/cell phone (vs routine care) improved rates of breastfeeding (BF) within one hour after birth (odds ratio (OR) 2.01, 95% confidence interval (CI) 1.27-2.75, I(2) = 80.9%) and exclusive BF for three/four months (OR 1.88, 95% CI 1.26-2.50, I(2) = 52.8%) and for six months (OR 2.57, 95% CI 1.46-3.68, I(2) = 0.0%). Included studies encompassed interventions designed for health information delivery (n = 6); reminders (n = 3); communication (n = 2); data collection (n = 2); test result turnaround (n = 2); peer group support (n = 2) and psychological intervention (n = 1).
  
  
  CONCLUSIONS
  Most studies of mHealth for MNCH in LMIC are of poor methodological quality and few have evaluated impacts on patient outcomes. Improvements in intermediate outcomes have nevertheless been reported in many studies and there is modest evidence that interventions delivered via SMS messaging can improve infant feeding. Ambiguous descriptions of interventions and their mechanisms of impact present difficulties for interpretation and replication. Rigorous studies with potential to offer clearer evidence are underway.
authors.affiliation: eHealth Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, UK.
authors.forename: Siew Hwa
authors.initials: SH
authors.lastname: Lee
authors.affiliation: eHealth Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, UK.
authors.forename: Ulugbek B
authors.initials: UB
authors.lastname: Nurmatov
authors.affiliation: eHealth Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, UK.
authors.forename: Bright I
authors.initials: BI
authors.lastname: Nwaru
authors.affiliation: eHealth Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, UK ; Edinburgh Health Services Research Unit, Edinburgh, UK.
authors.forename: Mome
authors.initials: M
authors.lastname: Mukherjee
authors.affiliation: Edinburgh Global Health Academy, The University of Edinburgh Medical School, Edinburgh, UK.
authors.forename: Liz
authors.initials: L
authors.lastname: Grant
authors.affiliation: eHealth Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, UK ; Edinburgh Global Health Academy, The University of Edinburgh Medical School, Edinburgh, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Pagliari
mesh_terms: D001942:Breast Feeding; D040421:Cell Phone; D003906:Developing Countries; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services; D018743:Perinatal Care; D011247:Pregnancy; D011295:Prenatal Care; D017216:Telemedicine / Q000379:methods*; D060145:Text Messaging