BJOG: An International Journal of Obstetrics & Gynaecology

Volume 125, Issue 12 p. 1620-1629

Maternal medicine

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

JA Unger,

Corresponding Author

JA Unger

[email protected]

Department of Global Health, University of Washington, Seattle, WA, USA

Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA

Correspondence: Dr JA Unger, Department of Global Health, University of Washington, Box 359909, Seattle, WA 98195, USA. Email: [email protected]Search for more papers by this author

K Ronen,

K Ronen

Department of Global Health, University of Washington, Seattle, WA, USA

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T Perrier,

T Perrier

Department of Computer Science and Engineering, University of Washington, Seattle, WA, USA

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B DeRenzi,

B DeRenzi

Department of Computer Science, University of Cape Town, Cape Town, South Africa

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J Slyker,

J Slyker

Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA

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AL Drake,

AL Drake

Department of Global Health, University of Washington, Seattle, WA, USA

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D Mogaka,

D Mogaka

Department of Research and Programmes, Kenyatta National Hospital, Nairobi, Kenya

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J Kinuthia,

J Kinuthia

Department of Research and Programmes, Kenyatta National Hospital, Nairobi, Kenya

Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya

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G John-Stewart,

G John-Stewart

Department of Global Health, University of Washington, Seattle, WA, USA

Department of Epidemiology, University of Washington, Seattle, WA, USA

Department of Medicine, University of Washington, Seattle, WA, USA

Department of Pediatrics, University of Washington, Seattle, WA, USA

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JA Unger,

Corresponding Author

JA Unger

[email protected]

Department of Global Health, University of Washington, Seattle, WA, USA

Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA

Correspondence: Dr JA Unger, Department of Global Health, University of Washington, Box 359909, Seattle, WA 98195, USA. Email: [email protected]Search for more papers by this author

K Ronen,

K Ronen

Department of Global Health, University of Washington, Seattle, WA, USA

Search for more papers by this author

T Perrier,

T Perrier

Department of Computer Science and Engineering, University of Washington, Seattle, WA, USA

Search for more papers by this author

B DeRenzi,

B DeRenzi

Department of Computer Science, University of Cape Town, Cape Town, South Africa

Search for more papers by this author

J Slyker,

J Slyker

Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA

Search for more papers by this author

AL Drake,

AL Drake

Department of Global Health, University of Washington, Seattle, WA, USA

Search for more papers by this author

D Mogaka,

D Mogaka

Department of Research and Programmes, Kenyatta National Hospital, Nairobi, Kenya

Search for more papers by this author

J Kinuthia,

J Kinuthia

Department of Research and Programmes, Kenyatta National Hospital, Nairobi, Kenya

Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya

Search for more papers by this author

G John-Stewart,

G John-Stewart

Department of Global Health, University of Washington, Seattle, WA, USA

Department of Epidemiology, University of Washington, Seattle, WA, USA

Department of Medicine, University of Washington, Seattle, WA, USA

Department of Pediatrics, University of Washington, Seattle, WA, USA

Search for more papers by this author

First published: 20 June 2018

https://doi.org/10.1111/1471-0528.15337

Citations: 66

Trial Registration: This trial was registered with ClinicalTrials.gov number NCT01894126. https://clinicaltrials.gov/ct2/show/NCT01894126?cond=SMS&cntry1=AF%3AKE&draw=1&rank=5

Linked article This article is commented on by S Lund, p. 1630 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.15345

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Abstract

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.

Supporting Information

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Citing Literature

Volume125, Issue12

November 2018

Pages 1620-1629

Filename	Description
bjo15337-sup-0001-TableS1.pdfPDF document, 516.5 KB	Table S1. Sensitivity analyses of effect of SMS intervention on facility delivery.
bjo15337-sup-0002-TableS2.pdfPDF document, 520.2 KB	Table S2. Sensitivity analyses of effect of SMS intervention on exclusive breastfeeding.
bjo15337-sup-0003-TableS3.pdfPDF document, 515.7 KB	Table S3. Sensitivity analyses of effect of SMS intervention on contraceptive initiation.
bjo15337-sup-0004-TableS4.pdfPDF document, 501.4 KB	Table S4. Effect of SMS interventions on key secondary infant outcomes.
bjo15337-sup-0005-ICMJES1.pdfPDF document, 1.2 MB
bjo15337-sup-0006-ICMJES2.pdfPDF document, 1.2 MB
bjo15337-sup-0007-ICMJES3.pdfPDF document, 1.2 MB
bjo15337-sup-0008-ICMJES4.pdfPDF document, 1.2 MB
bjo15337-sup-0009-ICMJES5.pdfPDF document, 1.2 MB
bjo15337-sup-0010-ICMJES6.pdfPDF document, 1.2 MB
bjo15337-sup-0011-ICMJES7.pdfPDF document, 1.2 MB
bjo15337-sup-0012-ICMJES8.pdfPDF document, 1.2 MB
bjo15337-sup-0013-ICMJES9.pdfPDF document, 1.2 MB

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

Abstract

Objective

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusion

Source of funding

Tweetable abstract

Supporting Information

References

Citing Literature

References

Information

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

Abstract

Objective

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusion

Source of funding

Tweetable abstract

Supporting Information

References

Citing Literature

References

Related

Information