Efficacy of Electronic Mobile Phone Application Compared With Mother and Child Health Booklet in Improving Quality of Antenatal Care From First Visit Through Third Trimester at Kenyatta National Hospital, a Randomized Controlled Trial

Abstract

Antenatal care (ANC) directly reduces maternal and perinatal morbidity and mortality through detection and treatment of complications during pregnancy as well as indirectly through identification of women at risk of developing labour and delivery complications. It also provides an opportunity to prevent, detect and manage comorbidities such as HIV and Malaria, which as part of indirect causes, contribute to 25% of maternal deaths and near misses.In regions which have the highest maternal mortality rates, such as sub-Saharan Africa, fewer pregnant women received ≥ 4 ANC visits (52%), and in Kenya, 58% of them had ≥ 4 ANC visits (KDHS 2014). The mother and child booklet was developed by the Ministry of Health and launched in 2010 to provide health workers and mothers practical guidance on maternal and child health. However, the fill in rate has been found to be inadequate in previous studies. In low resource settings, a mobile phone solution may increase the access to higher quality and standardized ANC for pregnant women especially in more remote areas.Limited studies on mobile phone application to enhance quality of ANC in SSA have demonstrated the feasibility and potentialof mobile health applicationfor completing and standardizing ANC visits according to WHO guidelines. The use of mobile phone application versus standard of care, MBB for enhancing quality of ANC in Kenya has not been studied. Objective:To determine the efficacy of an electronic mobile phone application in improving quality of antenatal care from first visit to third trimester as compared to the Mother and Child Health booklet at Kenyatta National Hospital. Methodology:An open labelrandomized controlled trial, in which eligible pregnant women at gestation less than 28 weeks, were either randomized to antenatal mobile phone or to the Mother and Child Health Booklet based care at first visit and followed until 28 weeks. All subsequent visits were conducted as per the randomization arm. The primary outcomes were complete antenatal care records and birth and emergency care plan. The secondary outcomes were identificationof risk factors for adverse pregnancy outcomes, subsequent ANC visit rates and average duration of each visit. The qualitative data which was the health worker experience was collected using technology acceptance model questionnaires with a Likert scale. Study setting: Kenyatta National Hospital Antenatal Care Clinic Data collection tool: Electronic mobile phone application, Mother and Child Health Booklet, and interviewer administered questionnaires were used. Analysis plan: Data was collected using the mobile phone application for the mobile phone armand questionnaires for MCH Booklet arm.The data was downloaded from the KNH serverand analyzed by the use of SPSS® version 21. Categorical data was analyzed and presented as frequencies and proportions and compared using chi square test, while continuous data was summarized and presented as means and standard deviations or median and interquartile range and compared using independent student t test. Risk estimates were obtained and p value <0.05 considered statistically significant. All analyses were intention to treat.The qualitative data used to assess health worker xvi experience was collected using technology acceptance model questionnaires with a Likert scale. The data was then analyzed by frequencies of their responses. Results: Between 3rd June 2019 and 6th November 2019, 215 women were screened and 101 enrolled. The baseline characteristics were found to be similar. The mobile phone application had more complete records for Hepatitis B screening, physical examination and education and counselling, birth and emergency plans compared to the Mother and Child Booklet (p=<0.001). Women in the mobile phone application arm were more likely to be screened for previous hypertensive disorder, hepatitis B and anomaly scan. Compared to the Mother and Child Booklet, the mobile phone application had significantly longer average duration at first visit (22.9min vs 12.1min) and at subsequent visits (13.6min vs 7.4min) (p=<0.001). The health worker experience was positive overall with all three intending to continue to use it if available. Conclusion: Compared to the standard MCH booklet, mobile phone application for ANC improved the quality of ANC by increasing completeness of records,increasing the duration of ANC visits and was highly acceptable to health care providers. Key words: mobile phone, antenatal care, booklet