title: Assessing the Effect of mHealth Interventions in Improving Maternal and Neonatal Care in Low- and Middle-Income Countries: A Systematic Review.
abstract: Maternal and neonatal mortality remains high in many low- and middle-income countries (LMIC). Availability and use of mobile phones is increasing rapidly with 90% of persons in developing countries having a mobile-cellular subscription. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This systematic review assessed the effect of mHealth interventions that support pregnant women during the antenatal, birth and postnatal period in LMIC.
  
  
  
  The review was registered with Prospero (CRD42014010292). Six databases were searched from June 2014-April 2015, accompanied by grey literature search using pre-defined search terms linked to pregnant women in LMIC and mHealth. Quality of articles was assessed with an adapted Cochrane Risk of Bias Tool. Because of heterogeneity in outcomes, settings and study designs a narrative synthesis of quantitative results of intervention studies on maternal outcomes, neonatal outcomes, service utilization, and healthy pregnancy education was conducted. Qualitative and quantitative results were synthesized with a strengths, weaknesses, opportunities, and threats analysis.
  
  
  
  In total, 3777 articles were found, of which 27 studies were included: twelve intervention studies and fifteen descriptive studies. mHealth interventions targeted at pregnant women increased maternal and neonatal service utilization shown through increased antenatal care attendance, facility-service utilization, skilled attendance at birth, and vaccination rates. Few articles assessed the effect on maternal or neonatal health outcomes, with inconsistent results.
  
  
  
  mHealth interventions may be effective solutions to improve maternal and neonatal service utilization. Further studies assessing mHealth's impact on maternal and neonatal outcomes are recommended. The emerging trend of strong experimental research designs with randomized controlled trials, combined with feasibility research, government involvement and integration of mHealth interventions into the healthcare system is encouraging and can pave the way to improved decision making on best practice implementation of mHealth interventions.
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Stephanie Felicie Victoria
authors.initials: SF
authors.lastname: Sondaal
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Joyce Linda
authors.initials: JL
authors.lastname: Browne
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.|School of Public Health, University of Ghana, Legon, Accra, Ghana.
authors.forename: Mary
authors.initials: M
authors.lastname: Amoakoh-Coleman
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Alexander
authors.initials: A
authors.lastname: Borgstein
authors.affiliation: Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Andrea Solnes
authors.initials: AS
authors.lastname: Miltenburg
authors.affiliation: Afya Connect(4)Change, Change Lake Zone, Mwanza, Tanzania.|International Institute for Communication and Development, The Hague, The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Verwijs
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.|Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Klipstein-Grobusch
mesh_terms: D040421:Cell Phone; D003906:Developing Countries; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008428:Maternal Mortality; D017063:Outcome Assessment, Health Care; D018743:Perinatal Care; D011247:Pregnancy; D011295:Prenatal Care; D017216:Telemedicine