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
Violet Adeke, Kenya Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi Kenya.
Received: 20/10/18 Accepted: 7/3/19 Published: 23/4/19
CITATION: 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. J Interv Epidemiol Public Health. 2019 Mar; 2(1).
© Violet Adeke Oramisi et al. Journal of Interventional Epidemiology and Public Health. 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.
Background: 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.