Effect of Phone Text Messages on Postnatal Clinic Attendance among Mothers Delivering at Mulago - Kawempe Hospital, A randomized controlled trial

Abstract

Background There is high disparity in provision and utilization of postnatal care health services to mothers and babies especially in Uganda. This is a missed opportunity for services like: cervical cancer screening, family planning and baby care. Objectives: We set out with (1) To assess the effect of phone text message reminders on postnatal clinic attendance at six weeks after delivery among mothers who delivered at Mulago - Kawempe hospital. (2) To assess acceptability of phone text message reminders to mothers who delivered at Mulago - Kawempe on postnatal clinic attendance at 6th week. Methods: Randomized Controlled Trial involving 488 eligible postnatal mothers. Participants were recruited from postnatal ward, consented and allocated randomly to intervention or control group in ratio of 1:1. Intervention arm received text message reminders 3 days and 1 day before postnatal review at 6 weeks. Control group received standard care. Results: 173 out of 239 (72.4%) of the mothers in the intervention group returned for postnatal clinic at 6 weeks compared to 77 of 234 (32.9%) in the control group. Rate of attending 6-week postnatal visit among mothers who received phone text messages was 2.2 times the rate of attending 6-week postnatal visit among mothers who didn’t receive SMS (AOR; 2.2, 95%CI, (1.803 – 2.684) P-value <0.001). Conclusion: Mothers who receive SMS reminders were 2.2 more likely to attend postnatal clinic at 6 weeks compared to those who didn’t receive telephone text messages. Text messages are highly acceptable and recommended by mothers. Women who experience labour and delivery complications were more likely to utilize postnatal services at six weeks while those who lost babies before or after discharge were less likely to utilize postnatal services at 6 weeks. Recommendations: Ministry of Health could incorporate SMS reminders in postnatal care package. Mothers whose babies die during or after delivery need more counselling to attend postnatal care. A multicentre, qualitative and quantitative study needed to re-assess SMS acceptability and effect on morbidity and mortality in postnatal care.