SMS communication improves exclusive breastfeeding and early postpartum contraception in a low to middle income country setting: A randomised trial.
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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 3-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 14 years old with access to a phone and able to read SMS were eligible for participation. METHODS: Women were randomised (1:1:1) to receive 1-way SMS versus 2-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 Χ2 tests using intent-to-treat analyses. Results The overall facility delivery rate was high (98%) and did not differ by arm. Compared to controls, probability of EBF was higher in 1-way SMS arm at 10 and 16 weeks, and in 2-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 [1-way SMS: 72% and 2-way SMS: 73%; p=0·03 and 0·02 versus 57% control, respectively] however this difference was not significant when correcting for multiple comparisons. CONCLUSION: One-way and 2-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. This article is protected by copyright. All rights reserved.
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