Randomized control trial of SMS for postpartum behaviors and family planning in Kiambu County, Kenya

Background It is estimated that one third of maternal deaths in Kenya in 2014 could have been prevented by more timely care-seeking. Mobile health interventions are increasingly being recognized as tools for the delivery of health education and promotion. Many maternal deaths occur in the first few weeks after delivery and mothers who are given adequate care in the postpartum period have better health outcomes. Kiambu County, Kenya has a high level of literacy and phone ownership amongst mothers delivering in public hospitals and was chosen as a site for a postpartum short message service intervention.             Methods       Women were recruited after delivery and randomized to receive a package of mobile messages or standard of care only. Messages covered danger signs, general postpartum topics, and family planning. Endline phone surveys were conducted at 8 weeks postpartum to assess knowledge, care seeking behavior and family planning uptake. Analysis was conducted using Stata and is presented in odds ratios.            Results   Women who received the danger sign messages were 1.6 times more likely to be able to list at least 1 danger sign and 3.51 times more likely to seek treatment if they experienced postpartum danger signs. There was no significant difference in routine postpartum care seeking or care seeking behaviors concerning newborns. Women who received family planning messages were 1.85 times more likely to uptake family planning services compared to controls and 2.1 times more likely to choose a longacting method. Conclusions Simple, low-cost mobile interventions can support women in the early postpartum period when the information is targeted to particular points in the postpartum continuum. Additional research is needed to understand the interplay between healthcare providers and mobile health interventions. Health policy makers should consider direct mobile interventions for women as an option for supporting positive maternal health outcomes in certain populations. Enrollment took place over 5 months, beginning in November 2017 and concluded in March 2018 at three public hospitals in Kiambu County, Kenya. Research assistants approached all eligible women on the day they would be discharged from the facility after giving birth and gave them information describing the study. If a woman consented to participate, she completed the in-person baseline survey administered by a research assistant at the hospital before discharge and was enrolled in the study. Endline survey data was collected 8 weeks after discharge through a phone survey. Endline data collection concluded in May 2018. All hospitals were enrolling simultaneously during the enrollment period. Survey data were recorded on a tablet using SurveyCTO software (2016 Dobility, Inc, 225 Cambridge, MA). Calls were attempted 4 times before the participant was deemed unreachable. The dataset was processed so that the baseline and endline data is contained in the final dataset and linked by a unique identifier ("case_id"). The dataset was processed in STATA 13.  We removed potentially identifiable information (such as age, residential location, hospital names, unique health issues, and comments) and added a small random number of days (less than 7) to all dates to further de-identify any care-seeking behavior, delivery dates, and survey dates. The variable names are used in the first Excel tab, and the labels (survey question) is provided in the 2nd tab ("Labels").