title: Effectiveness of mHealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review.
abstract: Low- and middle-income countries (LMICs) face the highest burden of maternal and neonatal deaths. Concurrently, they have the lowest number of physicians. Innovative methods such as the exchange of health-related information using mobile devices (mHealth) may support health care workers in the provision of antenatal, delivery, and postnatal care to improve maternal and neonatal outcomes in LMICs.
  
  
  
  We conducted a systematic review evaluating the effectiveness of mHealth interventions targeting health care workers to improve maternal and neonatal outcomes in LMIC.
  
  
  
  The Cochrane Library, PubMed, EMBASE, Global Health Library, and Popline were searched using predetermined search and indexing terms. Quality assessment was performed using an adapted Cochrane Risk of Bias Tool. A strength, weakness, opportunity, and threat analysis was performed for each included paper.
  
  
  
  A total of 19 studies were included for this systematic review, 10 intervention and 9 descriptive studies. mHealth interventions were used as communication, data collection, or educational tool by health care providers primarily at the community level in the provision of antenatal, delivery, and postnatal care. Interventions were used to track pregnant women to improve antenatal and delivery care, as well as facilitate referrals. None of the studies directly assessed the effect of mHealth on maternal and neonatal mortality. Challenges of mHealth interventions to assist health care workers consisted mainly of technical problems, such as mobile network coverage, internet access, electricity access, and maintenance of mobile phones.
  
  
  
  mHealth interventions targeting health care workers have the potential to improve maternal and neonatal health services in LMICs. However, there is a gap in the knowledge whether mHealth interventions directly affect maternal and neonatal outcomes and future research should employ experimental designs with relevant outcome measures to address this gap.
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands, Utrecht, Netherlands. menba19@yahoo.com.
authors.forename: Mary
authors.identifier: 0000-0002-0320-0396
authors.initials: M
authors.lastname: Amoakoh-Coleman
authors.forename: Alexander Berend-Jan
authors.identifier: 0000-0002-5179-1207
authors.initials: AB
authors.lastname: Borgstein
authors.forename: Stephanie Fv
authors.identifier: 0000-0002-8413-9645
authors.initials: SF
authors.lastname: Sondaal
authors.forename: Diederick E
authors.identifier: 0000-0003-4472-4468
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Andrea Solnes
authors.identifier: 0000-0003-4681-7043
authors.initials: AS
authors.lastname: Miltenburg
authors.forename: Mirjam
authors.identifier: 0000-0003-3711-0572
authors.initials: M
authors.lastname: Verwijs
authors.forename: Evelyn K
authors.identifier: 0000-0003-0401-8606
authors.initials: EK
authors.lastname: Ansah
authors.forename: Joyce L
authors.identifier: 0000-0001-7048-3245
authors.initials: JL
authors.lastname: Browne
authors.forename: Kerstin
authors.identifier: 0000-0002-5462-9889
authors.initials: K
authors.lastname: Klipstein-Grobusch
mesh_terms: D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D011203:Poverty; D011247:Pregnancy; D011256:Pregnancy Outcome; D012923:Social Class; D017216:Telemedicine / Q000379:methods*
keywords: low- and middle-income countries; mHealth; maternal; neonatal; providers of care