Impact of mHealth interventions on antenatal and postnatal care utilization in low and middle-income countries: A Systematic Review and Meta-Analysis

ABSTRACT Objective To evaluate the effectiveness of mHealth interventions on antenatal and postnatal care utilization in low and middle-income countries. Design Systematic review and meta-analysis Setting Studies from low and middle-income countries were included for analysis. Participants We searched the literature through major electronic databases such as PubMed, MEDLINE, Embase, Cochrane, Scopus, CINAHL, Clinical key, Google Scholar, Ovid databases with selected keywords, and explored the reference list of articles. Meta-analysis was performed in RevMan 5.4 software; p-value < 0.05 was considered statistically significant. The effect of variables was measured in the Odds ratio with a fixed-effect model. Six published interventional studies were selected as per the eligibility and PICO framed for the systematic review and meta-analysis. Search restricted to articles in the English language, online published, and preprint articles till September 2020. Primary and secondary outcome measures We evaluated the effectiveness of mHealth intervention on antenatal care utilization, including four antenatal check-ups, iron-folic acid supplementation, two tetanus toxoid immunizations, and postnatal care utilization, which includes postnatal check-ups of delivered mothers. Results Results: have been presented in the form of a forest plot. Findings of this meta-analysis depicted the significant increase in four or more antenatal care attendance (OR=1.89, 95% CI-1.49-2.19), TT immunization (OR=1.63 (95% CI-1.17-2.27), compliance to iron supplementation (OR=1.88, 95% CI-1.18-3.00) and postnatal care attendance (OR=2.54 (95% CI-2.15-2.99) among those pregnant mothers who received mHealth intervention compared to control group. Conclusion This meta-analysis concluded that m-health has the potential to increase the utilization of full antenatal care and postnatal care compared to standard care, although the level of evidence is moderate. Trial registration CRD42020204618, PROSPERO, International prospective register of systematic reviews Article Summary Strengths and limitations of this study This meta-analysis creates an evidence for the effectiveness of mHealth with pooled data of interventional studies with limited sample sizes. Technology is changing, but even with limited support like SMS, there was an improvement in antenatal and postnatal service utilization. Sensitivity analysis identified possible reasons for heterogeneity among studies. Studies included from LMICs so results can be generalized for the respective population. mHealth as an intervention is a broad term that created heterogeneity also.