title: The Effects of a Locally Developed mHealth Intervention on Delivery and Postnatal Care Utilization; A Prospective Controlled Evaluation among Health Centres in Ethiopia.
abstract: BACKGROUND
  Although there are studies showing that mobile phone solutions can improve health service delivery outcomes in the developed world, there is little empirical evidence that demonstrates the impact of mHealth interventions on key maternal health outcomes in low income settings.
  
  
  METHODS
  A non-randomized controlled study was conducted in the Amhara region, Ethiopia in 10 health facilities (5 intervention, 5 control) together serving around 250,000 people. Health workers in the intervention group received an android phone (3 phones per facility) loaded with an application that sends reminders for scheduled visits during antenatal care (ANC), delivery and postnatal care (PNC), and educational messages on dangers signs and common complaints during pregnancy. The intervention was developed at Addis Ababa University in Ethiopia. Primary outcomes were the percentage of women who had at least 4 ANC visits, institutional delivery and PNC visits at the health center after 12 months of implementation of the intervention.
  
  
  RESULTS
  Overall 933 and 1037 women were included in the cross-sectional surveys at baseline and at follow-up respectively. In addition, the medical records of 1224 women who had at least one antenatal care visit were followed in the longitudinal study. Women who had their ANC visit in the intervention health centers were significantly more likely to deliver their baby in the same health center compared to the control group (43.1% versus 28.4%; Adjusted Odds Ratio (AOR): 1.98 (95%CI 1.53-2.55)). A significantly higher percentage of women who had ANC in the intervention group had PNC in the same health center compared to the control health centers (41.2% versus 21.1%: AOR: 2.77 (95%CI 2.12-3.61)).
  
  
  CONCLUSIONS
  Our findings demonstrated that a locally customized mHealth application during ANC can significantly improve delivery and postnatal care service utilization possibly through positively influencing the behavior of health workers and their clients.
authors.affiliation: Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Solomon
authors.initials: S
authors.lastname: Shiferaw
authors.affiliation: Maastricht University, CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.|General Practice Research Unit, Department of Community Medicine, the Arctic University of Norway, Tromsø, Norway.
authors.forename: Mark
authors.initials: M
authors.lastname: Spigt
authors.affiliation: UNFPA - Liaison Office, Addis Ababa, Ethiopia.
authors.forename: Michael
authors.initials: M
authors.lastname: Tekie
authors.affiliation: UNFPA - East and Southern Africa Regional Office, Johannesburg, South Africa.
authors.forename: Muna
authors.initials: M
authors.lastname: Abdullah
authors.affiliation: Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Mesganaw
authors.initials: M
authors.lastname: Fantahun
authors.affiliation: Maastricht University, CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Dinant
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D005002:Ethiopia; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D009726:Nurses / Q000592:standards / Q000706:statistics & numerical data; D011181:Postnatal Care / Q000379:methods / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult