Short message service communication improves exclusive breastfeeding and early postpartum contraception in a low- to middle-income country setting: a randomised trial

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Study Justification:
– The study aimed to assess the effect of short message service (SMS) communication on facility delivery, exclusive breastfeeding (EBF), and contraceptive use in a low- to middle-income country setting.
– This research was important because improving maternal and neonatal health is a global priority, and finding effective and low-cost interventions is crucial in resource-limited settings.
– The use of SMS communication has the potential to reach a large population and provide timely and tailored information to pregnant women and new mothers.
Highlights:
– The study found that both one-way and two-way SMS communication improved exclusive breastfeeding practices and early postpartum contraception use.
– The probability of exclusive breastfeeding was higher in the one-way SMS arm at 10 and 16 weeks, and in the two-way SMS arm at 10, 16, and 24 weeks.
– Contraceptive use was significantly higher in both intervention arms compared to the control arm by 16 weeks.
– The results suggest that SMS messaging can influence the uptake of interventions that improve maternal and neonatal health.
Recommendations:
– Implement SMS communication programs in maternal child health (MCH) clinics to promote exclusive breastfeeding and early postpartum contraception.
– Tailor the SMS content to the individual characteristics and timing of pregnancy or postpartum to maximize effectiveness.
– Conduct further research to explore the long-term effects of SMS communication on maternal and neonatal health outcomes.
– Consider integrating SMS communication into existing healthcare systems to ensure sustainability and scalability.
Key Role Players:
– Researchers and scientists to design and conduct further studies on the effectiveness of SMS communication in improving maternal and neonatal health outcomes.
– Healthcare providers and nurses to implement SMS communication programs in MCH clinics and deliver tailored messages to pregnant women and new mothers.
– Policy makers and government officials to support and fund the integration of SMS communication into existing healthcare systems.
Cost Items for Planning Recommendations:
– Development and maintenance of SMS communication platforms and infrastructure.
– Training and capacity building for healthcare providers on delivering SMS messages and providing support to pregnant women and new mothers.
– Monitoring and evaluation of the SMS communication programs to assess effectiveness and make necessary improvements.
– Integration of SMS communication into existing healthcare systems, including updating electronic health records and ensuring interoperability.
– Public awareness campaigns to promote the use and benefits of SMS communication in improving maternal and neonatal health.

Objective: To assess the effect of short message service (SMS) communication on facility delivery, exclusive breastfeeding (EBF), and contraceptive use. Design: Mobile WACh was a three-arm unblinded individually randomised controlled trial. Setting: A public sector maternal child health (MCH) clinic in Nairobi, Kenya. Population: Three hundred women attending antenatal care were randomised, 100 to each arm, and followed for 24 weeks postpartum. Pregnant women, at least 14 years old with access to a mobile phone and able to read SMS were eligible for participation. Methods: Women were randomised (1:1:1) to receive one-way SMS versus two-way SMS with a nurse versus control. Weekly SMS content was tailored for maternal characteristics and pregnancy or postpartum timing. Main outcome measures: Facility delivery, EBF, and contraceptive use were compared separately between each intervention arm and the control arm by Kaplan–Meier analysis and chi-square tests using intent-to-treat analyses. Results: The overall facility delivery rate was high (98%) and did not differ by arm. Compared with controls, probability of EBF was higher in the one-way SMS arm at 10 and 16 weeks, and in the two-way SMS arm at 10, 16, and 24 weeks (P < 0.005 for all). Contraceptive use was significantly higher in both intervention arms by 16 weeks (one-way SMS: 72% and two-way SMS: 73%; P = 0.03 and P = 0.02 versus 57% control, respectively); however, this difference was not significant when correcting for multiple comparisons. Conclusion: One-way and two-way SMS improved EBF practices and early contraceptive use. Two-way SMS had an added benefit on sustained EBF, providing evidence that SMS messaging influences uptake of interventions that improve maternal and neonatal health. Source of funding: Funding was provided by the National Institutes of Health (K12HD001264 to JAU, R01HD080460, K24HD054314 to GJS, and K01AI116298 to ALD), the National Science Foundation (Graduate Research Fellowship to TP and BD), as well as the University of Washington Global Center for Integrated Health of Women Adolescents and Children (Global WACh). Tweetable abstract: The Mobile WACh RCT demonstrates that SMS improved practice of exclusive breastfeeding and early postpartum contraception.

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The recommendation to improve access to maternal health is to implement a short message service (SMS) communication system. This recommendation is based on a randomized trial conducted in Nairobi, Kenya, which found that SMS communication significantly improved exclusive breastfeeding (EBF) practices and early postpartum contraception use.

In the trial, pregnant women attending antenatal care were randomly assigned to one of three groups: one-way SMS, two-way SMS with a nurse, or a control group. The SMS content was tailored to the women’s characteristics and pregnancy or postpartum timing. The results showed that compared to the control group, both the one-way SMS and two-way SMS groups had higher probabilities of EBF at 10, 16, and 24 weeks. Additionally, contraceptive use was significantly higher in both intervention groups by 16 weeks.

This study provides evidence that SMS messaging can effectively influence the uptake of interventions that improve maternal and neonatal health. Implementing an SMS communication system can help healthcare providers stay connected with pregnant women and new mothers, providing them with important information and support. This innovation has the potential to improve access to maternal health services and promote positive health behaviors.
AI Innovations Description
The recommendation to improve access to maternal health is to implement a short message service (SMS) communication system. This recommendation is based on a randomized trial conducted in Nairobi, Kenya, which found that SMS communication significantly improved exclusive breastfeeding (EBF) practices and early postpartum contraception use.

In the trial, pregnant women attending antenatal care were randomly assigned to one of three groups: one-way SMS, two-way SMS with a nurse, or a control group. The SMS content was tailored to the women’s characteristics and pregnancy or postpartum timing. The results showed that compared to the control group, both the one-way SMS and two-way SMS groups had higher probabilities of EBF at 10, 16, and 24 weeks. Additionally, contraceptive use was significantly higher in both intervention groups by 16 weeks.

This study provides evidence that SMS messaging can effectively influence the uptake of interventions that improve maternal and neonatal health. Implementing an SMS communication system can help healthcare providers stay connected with pregnant women and new mothers, providing them with important information and support. This innovation has the potential to improve access to maternal health services and promote positive health behaviors.
AI Innovations Methodology
To simulate the impact of implementing an SMS communication system on improving access to maternal health, you can follow these steps:

1. Identify the target population: Determine the specific group of pregnant women and new mothers who would benefit from the SMS communication system. Consider factors such as age, mobile phone access, and ability to read SMS.

2. Randomize participants: Randomly assign the identified population into different groups, similar to the randomized trial conducted in Nairobi. This will help ensure that the groups are comparable and any differences observed can be attributed to the SMS intervention.

3. Implement the SMS communication system: Develop a tailored SMS content that addresses the women’s characteristics, pregnancy or postpartum timing, and specific maternal health topics. Set up a system to send one-way or two-way SMS messages to the intervention groups, while the control group receives no SMS communication.

4. Monitor and collect data: Track the participants’ outcomes related to maternal health, such as facility delivery, exclusive breastfeeding, and contraceptive use. Collect data at regular intervals, similar to the 10, 16, and 24-week time points used in the Nairobi trial.

5. Analyze the data: Use statistical methods, such as Kaplan-Meier analysis and chi-square tests, to compare the outcomes between the intervention groups and the control group. Conduct intent-to-treat analyses to account for any dropouts or non-compliance.

6. Evaluate the impact: Assess the impact of the SMS communication system on improving access to maternal health by comparing the outcomes of the intervention groups with the control group. Look for significant differences in exclusive breastfeeding rates, contraceptive use, and other relevant indicators.

7. Consider additional factors: Take into account any potential confounding variables, such as socioeconomic status, education level, or healthcare infrastructure, that may influence the outcomes. Adjust the analysis if necessary to account for these factors.

8. Draw conclusions and make recommendations: Based on the simulation results, determine whether the SMS communication system has a positive impact on improving access to maternal health. Consider the strengths and limitations of the simulation and provide recommendations for implementing the SMS intervention in real-world settings.

Remember, this simulation methodology is based on the abstract and publication provided. It is important to adapt and customize the methodology to fit the specific context and resources available in your setting.

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