Utilization of Mobile Phone Short Message Service to Enhance Uptake of Focused Antenatal Care in Tharaka Nithi County, Kenya
Makunyi, Eliphas Gitonga
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The Sustainable Development Goals targets a global maternal mortality ratio not greater than 70 maternal deaths per 100 000 live births by 2030. In Kenya, the maternal mortality ratio is high at 362 maternal deaths per 100,000 live births. Focused ante natal care approach recommends four targeted visits commencing before 16 weeks and until delivery. The utilization of focused ante natal care in Kenya, Tharaka Nithi County and Tharaka sub-county is 58%, 56% and 40% respectively. There are few studies on short message reminders on focused ante natal care in rural Kenya. This study examined the influence of short message service in enhancing utilization of focused ante natal care among pregnant women. A single blind randomized controlled trial was carried in Tharaka sub-county of Tharaka Nithi County, Kenya in three facilities that were purposively sampled; Chiakariga, Tunyai and Matiri. The final sample that was analysed was 241. Eligible participants were recruited using systematic sampling with Kth as 5. The subjects were randomly allocated through a computer application to interventional or control arm at a ratio of 1:1. The intervention was three short message reminders which were sent a week before the scheduled appointment date. The study instruments were interviewer administered questionnaires, focus group discussion guide, key informant interview guide and a checklist for desk review. The study period was December 2016 to June 2017. The inferential statistics that were used were t test, chi square, Fisher’s exact, effect size and logistic regression. Qualitative data was thematically organized and reported as narratives. The uptake of focused ante natal care for intervention and control group was 75% and 13% respectively. Short message reminders increased the probability of using focused ante natal care by 19.6 times (OR: 19.6, P<0.001, CI = 10.06 – 38.37). The effect size was very large with Cohen’s D of 1.55. Presence of a risk factor in pregnancy reduced the chances of utilizing focused ante natal care (OR = 0.485, P = 0.016, CI = 0.27 – 0.874). Ante natal profile was completed by 82% of the intervention group while 54% completed in the control group. Being in the intervention group increased the chances of completion by 3.7 times (OR: 3.7, P<0.001, CI = 2.086 – 6.708). Hindrances to attending scheduled visit included forgetting, non-prioritization, busy schedules and long distances with cost implications to the health facility. The benefits of mobile text reminders that were identified were convenience, constant memory, impression of care by the service providers and prioritization of the ante natal care. Negative perceptions on mobile SMS reminders were religious beliefs that they are demonic, that phones can cause cancer and instant deaths. However, there was no influence of socio-demographic, economic, accessibility and phone related variables on uptake of focused ante natal care. In conclusion, mobile phone short message reminders enhance utilization of focused ante natal care. This study recommends that the stakeholders in health should use short message reminders to enhance utilization of focused ante natal care. A further study should be conducted to examine the cost benefit analysis of short message reminders on uptake of focused ante natal care and outcomes of short message reminders in enhancing focused antenatal care.