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Abstract
Introduction Kenya’s progress towards reducing maternal and neonatal deaths is at present ‘insufficient’. These deaths could be prevented if the three delays, that is, in deciding to seek healthcare (delay 1), in accessing formal healthcare (delay 2) and in receiving quality healthcare (delay 3), are comprehensively addressed. We designed a mobile phone enhanced 24 hours Uber-like transport navigation system coupled with personalised and interactive gestation-based text messages to address these delays. Our main objective was to evaluate the impact of this intervention on women’s adherence to recommended antenatal (ANC) and postnatal care (PNC) regimes and facility birth.
Methods We conducted a prospective cohort study. Women were eligible to participate in the study if they were 15 years or older and less than 28 weeks gestation. We defined cases as those who received the standard of care plus the intervention and the control group as those who received the standard of care only. For analysis, we used logistic regression analysis and report crude and adjusted OR (aOR) and 95 % CI.
Results Cases (women who received the intervention) had five times higher odds of having four or more ANC visits (aOR=4.7, 95% CI 3.20 to 7.09), three times higher odds of taking between 30 and 60 min to reach a health facility for delivery (aOR=3.14, 95% CI 2.37 to 4.15) and four times higher odds of undergoing at least four PNC visits (aOR=4.10, 95% CI 3.11 to 5.36).
Conclusion An enhanced community-based Uber-like transport navigation system coupled with personalised and interactive gestation-based text messages significantly increased the utilisation of ANC and PNC services as well as shortened the time taken to reach an appropriate facility for delivery compared with standard care.
- health facility delivery
- three delays model
- Mhealth
- Uber
- health services accessibility
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Footnotes
Handling editor Seye Abimbola
Contributors MAOn designed the intervention, oversaw its implementation, evaluation, data collection and analysis, drafted the first manuscript draft, reviewed subsequent drafts, provided final approval of the version to be published and agrees to be accountable for all aspects of the work. SW was the lead statistical analyst, contributed to the writing of the initial manuscript, revising subsequent drafts, provided final approval of the version to be published and agrees to be accountable for all aspects of the work. PW, CKA, LWW, TS, MAOw and PO contributed to the implementation and collection of data, critical revision of the drafted manuscript, provided final approval of the version to be published and agree to be accountable for all aspects of the work.
Funding We received financial support from the United Kingdom Department for International Development (DFID) funded County Innovation Challenge Fund.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The ethical review committee at AMREF Health Africa approved the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.