Effects of Timed Phone Call Surveillance Versus Routine Care on Postpartum Care, Identification of Risk Factors and Adverse Maternal and Neonatal Outcomes at Kenyatta National Hospital, a Randomized Controlled Trial

Abstract

Study title:Effect of timed phone call surveillance versus routine care on postpartum care, selected adverse maternal and neonatal outcomes at KNH, a randomized controlled trial. PI-Brian Liyayi; Supervisors: Bosire Alex, Osoti Alfred, Chemwey Rose Correspondence to: niqliy@gmail.com Background: Postnatal care (PNC) can lower newborn and or maternal morbidity and deaths by increasing recognition and management of postnatal complications that may affect the baby and the mother. In Kenya, only 51% receive good PNC in 48 hours after delivery while 57 % go for a postnatal checkup at 6 weeks postpartum. It is estimated that 10-27% of newborn deaths would be averted by adequate utilization of PNC. Mobile phone based postpartum interventions have improved day 3 PNC attendance from 45% to 81% in South Africa. They can therefore be scaled in the postpartum period to increase quality of PNC through recognition of danger signs and reminders for PNC visits. Objective: To determine the effect of timed phone call-based PNC compared to routine PNC on PNC attendance and selected adverse maternal and neonatal outcomes at 72 hours, 10-14days, and 6 weeks after delivery. Methodology: This was an open label randomized controlled trial where eligible postnatal women at KNH were randomly assigned to either an intervention, a timed phone call(n=70) or control, routine of care(n=71). The nature of intervention was impossible to blind. The intervention group received a phone call at 72 hours,10-14 days and 6 weeks postpartum. The routine care group received a phone call only at 6 weeks postpartum. During enrollment and each call, participants underwent interviewer administered questionnaire using a checklist. The primary outcomes were PNC attendance and identification of risk factors for adverse maternal and neonatal outcomes while the secondary outcomes were adverse maternal and neonatal outcomes. Study Population: Women who delivered at KNH and were within first 3 days postpartum. Study setting: KNH labor and postnatal wards. Analysis plan: Data was collected via ODK collect application, cleaned and analyzed using Stata®14. Categorical data were summarized as frequencies and proportions and compared between the two groups using Chi-square test or Fishers exact test. Continuous data were summarized as means and standard deviations or median and interquartile range and compared between the two groups using independent student t test or Mann Whitney u test. Relative Risk (RR)were also calculated. P value <0.05 was considered statistically significant.All analysis was intention to treat. Results: Between October and December 2019, 161 postnatal women were screened and 141 enrolled. The baseline characteristics were similar. The mobile phone call increased PNC attendance at 72 hours (5.7% vs 4.2%, RR=1.35[(95%CI 0.31 5.82) p=0.684].and at 10-14 days (69% vs 44%, RR=1.57[(95%CI 1.15 2.14) p=0.003]) compared to routine PNC. Women in the phone call group were more likely to identify risk factors for adverse outcomes compared to the routine care group (36.6% vs 8.6%, RR=4.56, P<0.001). Adverse maternal and neonatal outcomes were more likely to be recorded in the phone call group compared to the routine care group (20%vs 8.5%, RR=2.37, p=0.049). The study did not involve any medical intervention therefore no reported risk to the participants.

Conclusion: Compared to routine care, phone calls for PNC follow up improved the 2-week clinic attendance and resulted in more risk factor identification for adverse maternal and neonatal outcomes among women who delivered at KNH and were randomized into this study. Recommendations:Mobile Phone call interventions are recommended for use in the postpartum period to improve 10-14-day postnatal retention. They can as well be used to improve risk factor identification for adverse maternal and neonatal outcomes. Trial registration:PACTR202005876065918 Funding:Self-funded