Effect of enhanced reminders on postnatal clinic attendance in Addis Ababa, Ethiopia: a cluster randomized controlled trial

ABSTRACT

Background: Failure to attend maternal health services is an intractable challenge for the health-care system in low- and middle-income countries. The use of technology for reminding patients about their appointments has been demonstrated to be an effective (future) tool toward increased health care services utilization in developing countries, such as Ethiopia.

Objective: We aimed to investigate the effect of enhanced reminders on postnatal care attendance versus usual care (notification of an appointment at discharge).

Methods: The study was a cluster randomized controlled trial: out of eligible 86 health centers, 16 health centers in Addis Ababa (AA) were randomized to either the intervention (8) or the control (8) groups; with a total of 350 mothers equally randomized into each arm. Mothers in the intervention group received the SMS (short message service) or a voice call reminder at 48 and 24 hours before the due postnatal appointment, whereas the control group received only the usual notification of appointments provided by health professionals at discharge from the ward following delivery. We recruited participants on wards after delivery at discharge and followed them up to 6 weeks. This study’s primary outcome was postnatal visit compliance. Our assessment consisted of a two-level bivariate and a multivariate ordinal logistic regression analysis.

Results: The majority (97.7%) of the participants completed the study; 173(98.9%) of women in the intervention group and 169 (96.5%) of women in the control group. There was a statistically significant difference in postnatal care (PNC) compliance among women who were in the intervention versus the control group (p-value = 0.005). Higher odds of postnatal compliance was observed among the intervention group (AOR:2.98, 95% CI 1.51–5.8).

Conclusions: Mobile phone reminders were effective in terms of enhancing adherence to PNC appointments. This indicates integration of mobile phone reminders in postnatal care could improve postnatal appointment compliance.

KEYWORDS:

• Appointments reminders
• short message service
• voice call
• postnatal compliance
• cluster randomized trial
• mobile phones

Responsible Editor Peter Byass, Umeå University, Sweden

Responsible Editor Peter Byass, Umeå University, Sweden

Acknowledgments

Authors would like to thank the African Union Commission and the Pan African University for funding this study. We would like to extend our gratitude to the University College Hospital, University of Ibadan, Department of Obstetrics and Gynecology the host institution. We are also grateful to the study health facilities, data collectors and intervention supervisors. Last but not least we want to thank the mothers who participated in this study.

Author contributions

All authors of this paper contributed from the conception, design of the study to the field work and finalizing the work. ASK, IOA and AOA conceived the idea. ASK designed the study, collected and supervised the field data. ASK undertook the analysis and IOA and AOA approved the work and revised thoroughly. ASK produced the draft of the manuscript and other authors reviewed and contributed to the final draft. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Ethical clearances for the study were obtained from the University of Ibadan/University College Hospital Institutional Review Board (UI/UCH/17/0050) and Ethiopian Public Health Institute Scientific and Ethical Review Committee (EPHI-IRB-034-2017). The permission to conduct the study was given by Addis Ababa health bureau. Written informed consent was obtained from mothers participating in the study after counseling. Parental or guardian informed assent was obtained for study participants less than 18 years of age. Women who refused to give consent to participate in the study were excluded without prejudice to their hospital care. Information gathered from the participants was stored in a secured cabinet by the first author and the contacts provided were confidentially kept by the research team.

Paper context

High PNC compliance will avert the toll maternal and neonatal death. There is an indication from WHO and systematic reviews, that mobile phone reminders can be used to improve attendance to health appointments. However, there is no rigorous study evaluated the role of this reminders in postnatal care service in the current study setting. We hope our study will provide a basis for further studies and policy translation.

Additional information

Funding

Pan African University Life and Earth Sciences Institute (Including Health and Agriculture) have funded this study.