Effect of mHealth intervention on maternal health service utilization and birth outcomes in Northwest Ethiopia: a two-site non-randomized controlled trial

Globally, mobile phone technologies, including short message service (SMS), have emerged as an essential tool for supporting the healthcare system and improving health outcomes. However, evidence on their effectiveness in improving maternal healthcare service utilization and birth outcomes remains limited. This study therefore aimed to examine whether a mobile phone-based SMS reminders with follow-up calls to pregnant women increased the uptake of focused antenatal care (FANC) and skilled birth attendance (SBA), and reduced the incidence of low birth weight (LBW) in neonates. We conducted a non-randomized controlled trial (nRCT) between July 2019 and December 2020 among pregnant women attending antenatal care (ANC) at Debre Markos and Finoteselam public hospitals in northwest Ethiopia. The hospitals were purposively assigned to either the intervention (Debre Markos) or control group (Finoteselam) to avoid cross-contamination. Eligible women attending ANC at each hospital were enrolled accordingly. The intervention group received weekly SMS reminders and biweekly phone calls throughout their pregnancy, starting from their first visit until delivery. The control group received standard routine care. Analyses followed an intention-to-treat approach. Binary and multivariable logistic regressions were used, and any variable with a p-value less than 0.05 was declared statistically significant. We enrolled 386 pregnant women–194 in the intervention group at Debre Markos hospital and 192 in the control group at Finoteselam hospital. Among participants who completed our evaluation, the proportion of FANC uptake was higher in the intervention group (69.6%) compared to the control group (55.7%) (adjusted odds ratio (AOR): 1.75; 95% confidence interval (CI): 1.10, 2.80) during the follow-up. SBA was 51% in the intervention group and 41.1% in the control group (AOR: 1.49; 95% CI: 0.95, 2.34). The proportion of LBW was lower in the intervention group (17.5%) than in the control group (25.5%) (AOR: 0.55; 95%CI: 0.32, 0.90). The mHealth intervention was associated with FANC services uptake and LBW. Policy- and decision-makers should consider integrating mHealth intervention into routine maternal, newborn, and child healthcare delivery systems. This trial is registered with the Pan African Clinical Trials Registry (PACTR202205597300585), date: 04/05/2022.