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Glob Health Res Policy. 2019 Mar 22;4:8. doi: 10.1186/s41256-019-0098-y. eCollection 2019.

Effect of a community health worker mHealth monitoring system on uptake of maternal and newborn health services in Rwanda.

Author information

1
1Centre for Health Services and Policy Research, Faculty of Medicine, School of Population and Public Health, The University of British Columbia, 201-2206 East Mall, Vancouver, BC V6T1Z3 Canada.
2
2Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC Canada.
3
3School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.

Abstract

Background:

In an effort to improve access to proven maternal and newborn health interventions, Rwanda implemented a mobile phone (mHealth) monitoring system called RapidSMS. RapidSMS was scaled up across Rwanda in 2013. The objective of this study was to evaluate the impact of RapidSMS on the utilization of maternal and newborn health services in Rwanda.

Methods:

Using data from the 2014/15 Rwanda demographic and health survey, we identified a cohort of women aged 15-49 years who had a live birth that occurred between 2010 and 2014. Using interrupted time series design, we estimated the impact of RapidSMS on uptake of maternal and newborn health services including antenatal care (ANC), health facility delivery and vaccination coverage.

Results:

Overall, the coverage rate at baseline for ANC (at least one visit), health facility delivery and vaccination was very high (> 90%). The baseline rate was 50.30% for first ANC visit during the first trimester and 40.57% for at least four ANC visits. We found no evidence that implementing RapidSMS was associated with an immediate increase in ANC (level change: -1.00% (95% CI: -2.30 to 0.29) for ANC visit at least once, -1.69% (95% CI: -9.94 to 6.55) for ANC (at least 4 visits), -3.80% (95% CI: -13.66 to 6.05) for first ANC visit during the first trimester), health facility delivery (level change: -1.79, 95% CI: -6.16 to 2.58), and vaccination coverage (level change: 0.58% (95%CI: -0.38 to 1.55) for BCG, -0.75% (95% CI: -6.18 to 4.67) for polio 0). Moreover, there was no significant trend change across the outcomes studied.

Conclusion:

Based on survey data, the implementation of RapidSMS did not appear to increase uptake of the maternal and newborn health services we studied in Rwanda. In most instances, this was because the existing level of the indicators we studied was very high (ceiling effect), leaving little room for potential improvement. RapidSMS may work in contexts where improvement remains to be made, but not for indicators that are already very high. As such, further research is required to understand why RapidSMS had no impact on indicators where there was enough room for improvement.

KEYWORDS:

Interrupted time series analysis; Maternal and newborn health; RapidSMS; Rwanda demographic and health survey; mHealth

Conflict of interest statement

Data used in this study were obtained from the DHS Program (https://dhsprogram.com/data/available-datasets.cfm). Ethics approval for the use of the DHS data is covered by the “publicly available data clause (Item 7.10.3)” under the “policy number 89 of the University of British Columbia, Vancouver, BC, Canada: Research and Other Studies Involving Human Subjects” that regulates the use of public release data (https://universitycounsel.ubc.ca/files/2012/06/policy89.pdf).Not applicable.The authors declare that they have no competing interests.

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