Research | Volume 2, Article 4, 23 Apr 2019

Use of short text message reminders to improve attendance of postnatal care at a referral maternity hospital, Kenya, 2016 - A randomised controlled trial

Violet Adeke Oramisi, Edwin Were, Elvis Oyugi, Mark Obonyo, Maurice Omondi Owiny, Jane Githuku, Zeinab Gura

Corresponding author: Violet Adeke, Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi Kenya

Received: 20 Oct 2018 - Accepted: 07 Mar 2019 - Published: 23 Apr 2019

Domain: Epidemiology

Keywords: Randomised control trial, postnatal care, failure-to-attend rates, Kenya

©Violet Adeke Oramisi et al Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Violet Adeke Oramisi et al . Use of short text message reminders to improve attendance of postnatal care at a referral maternity hospital, Kenya, 2016 - A randomised controlled trial. Journal of Interventional Epidemiology and Public Health. 2019;2:4.

Available online at: https://www.afenet-journal.net/content/article/2/4/full

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Research

Use of short text message reminders to improve attendance of postnatal care at a referral maternity hospital, Kenya, 2016 - A randomised controlled trial

Use of short text message reminders to improve attendance of postnatal care at a referral maternity hospital, Kenya, 2016—A randomised controlled trial

Violet Adeke Oramisi1,2,&, Edwin Were2, Elvis Oyugi1, Mark Obonyo1, Maurice Omondi Owiny1, Jane Githuku1, Zeinab Gura1

 

1Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi Kenya, 2Department of Reproductive Health, School of Medicine, Moi University, Nairobi, Kenya

 

 

&Corresponding author
Violet Adeke, Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi Kenya. oramisi4@gmail.com

 

 

Abstract

Introduction: Globally about 830 women die daily due to complications of pregnancy and child birth out of which 550 occur in Sub-Saharan Africa, with about 8,000 maternal deaths occurring annually in Kenya. 66% of maternal deaths occur within the first week and 85% of maternal deaths occur within two weeks post-delivery. Attendance of postnatal services during this time could significantly reduce morbidity and mortality. We determined effectiveness of short text message (SMS) in reducing failure-to-attend rates (FTA) of postnatal clinic at the largest maternity hospital in Nairobi, Kenya.

 

Methods: We conducted a hospital-based randomised controlled trial. Women who delivered between March and May 2016 at Pumwani Maternity Hospital were recruited, enrolled and randomised into SMS (intervention) or no SMS (control) arms. Women were masked to which arm they belonged during randomisation but were unmasked during the appointments as the intervention had been sent. The investigators were not masked. Reminders were sent three days prior to and on the morning of the appointment. Relative Risk (RR) at 95% Confidence Interval were calculated to estimate the effectiveness of intervention at two and six-weeks.

 

Results: We enrolled 754 women, with 377 randomly assigned into each arm. There were no differences in socio-demographic characteristics between the study arms at baseline. After two-weeks, women in the intervention arm had an 80% reduction in FTA risk (RR=0.2, 95% CI 0.1–0.3). After six weeks, women in the intervention arm had a 60% reduction in FTA risk (RR=0.4, 95% CI 0.2–0.6). Among participants, 80 (42.1%) women at two-weeks and 30 (41.7%) women at six-weeks cited forgetting appointment as the most common reason for failing to attend postnatal clinic.

 

Conclusion: SMS reminders were effective in reducing failure-to-attend clinic appointments. We recommend the use of SMS reminder strategy for postnatal care.

 

 

Introduction    Down

Postnatal care (PNC) includes services provided to women and newborns immediately after delivery and up to six months post-delivery as currently practiced in Kenya [1]. The services provided during the postnatal period are critical in the lives of mothers and their newborns as an estimated 60% of the world’s 270,000 annual maternal deaths occur within 48 hours post-delivery, and two thirds occur within the first week with more than 85% occurring within two-weeks of child birth [3]. Currently, the rates of provision of skilled care are lower post-delivery when compared to rates before and during delivery yet provision of quality PNC services could reduce ill health and even death associated with this period [2].

 

The World Health Organisation (WHO) guidelines recommend that all women should receive postnatal care within 48 hours post-delivery and follow up in PNC clinics for at least 42 days (6 weeks) [3]. In Kenya, the postnatal care guidelines recommend that all women should attend PNC clinics within 48hours, two-weeks, four to six-weeks and at six-months post-delivery but generally women do not attend routine PNC clinic consultation, except for serious or fatal complications, or when they are taking their children for example, for routine immunisation. The Government of Kenya introduced the Free Maternity Services Policy (FMSP) in 2013 as a strategy to increase hospital delivery, postnatal care attendance and to reduce maternal and perinatal mortality. The free maternity policy seeks to ensures that PNC services are accessible free of charge for the patient alongside other services like antenatal care and skilled attendance at delivery.

 

According to the Kenya Demographic and Health Survey (KDHS) report of 2014 [4], only 51% of the 39% of women who delivered at home sought postnatal care services at the health facility within 48 hours post-delivery and data from the Kenya District Health Information System (DHIS), 2015, showed that nationally, postnatal care coverage was only 53% and 55% for Nairobi County. Low uptake of PNC services has also been experienced in other countries like Pakistan where about 23% of women seek the services post-delivery [4-5]. There is no recent documentation in Kenya on the proportion of women who attend postnatal care clinics at two-weeks and four to six-weeks postpartum.

 

Documentation from various studies conducted in other countries have shown that patients cite reasons like forgetting date, time and place/location of the clinic as a reason for failing-to-attend their scheduled clinics [5–9]. Some strategies developed to mitigate the challenges include use of innovative technologies such as short message service (SMS), telephone calls, e-mail reminders, fax services or sending letters. In Nigeria, failure-to-attend the postnatal care was reduced by 22% with use of SMS reminders [9]. The SMS have also been successfully employed for various health applications including promoting adherence to drug treatments for chronic diseases, reminding patients to return for their scheduled appointments and it was shown that SMS were more effective as reminders and also cost effective [10]. A study done in Kenya in the year 2012 showed that in rural areas, mean phone ownership was 39% compared to urban regions where it was 58%, and in Nairobi 84% of individuals owned phones [11]. In this study, we assessed the effectiveness of SMS reminders in reducing failure-to-attend rates (FTA) of PNC clinic among women who delivered at Pumwani Referral Maternity hospital.

 

 

Methods Up    Down

Study design

 

This was a hospital based randomised control trial (RTC) where women delivering at a hospital from March 2016 through to May 2016 were recruited, enrolled, randomised into either control or intervention arm and followed up at the two and six-week visit.

 

Study site and population

 

The study was conducted at Pumwani Maternity Hospital, located in Nairobi County, Kenya. The hospital provides maternal services in an urban setting. In 2016, Pumwani Maternity Hospital recorded a total of 17,353 births (average of 48 deliveries per day).

 

Study participants

 

We included all women who delivered at Pumwani Maternity Hospital during study period and had a mobile phone with SMS features in their household (regardless of ownership as long as it belonged to one of the household members), and gave informed written consent. We excluded women who delivered at home or other facilities and those who refused to consent.

 

Interventions

 

For the Intervention arm, an automated SMS was sent twice before each visit to the women. The first SMS was sent three days prior to the appointment and the second SMS was sent on the morning of the scheduled appointment in addition to the usual reminders. The SMS read as follows; “Dear (Name), Good morning, this is to remind you to attend postnatal clinic on

Research

Use of short text message reminders to improve attendance of postnatal care at a referral maternity hospital, Kenya, 2016 - A randomised controlled trial

Research

Use of short text message reminders to improve attendance of postnatal care at a referral maternity hospital, Kenya, 2016 - A randomised controlled trial

Research

Use of short text message reminders to improve attendance of postnatal care at a referral maternity hospital, Kenya, 2016 - A randomised controlled trial

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Key words

Randomised control trial

Postnatal care

Failure-to-attend rates

Kenya