RT Journal Article
SR Electronic
T1 The impact of a direct to beneficiary mobile communication program on reproductive and child health outcomes: a randomised controlled trial in India
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e008838
DO 10.1136/bmjgh-2022-008838
VO 6
IS Suppl 5
A1 Amnesty Elizabeth LeFevre
A1 Neha Shah
A1 Kerry Scott
A1 Sara Chamberlain
A1 Osama Ummer
A1 Jean Juste Harrisson Bashingwa
A1 Arpita Chakraborty
A1 Anna Godfrey
A1 Priyanka Dutt
A1 Rajani Ved
A1 Diwakar Mohan
A1 ,
YR 2022
UL http://gh.bmj.com/content/6/Suppl_5/e008838.abstract
AB Background Direct-to-beneficiary communication mobile programmes are among the few examples of digital health programmes to have scaled widely in low-resource settings. Yet, evidence on their impact at scale is limited. This study aims to assess whether exposure to mobile health information calls during pregnancy and postpartum improved infant feeding and family planning practices.Methods We conducted an individually randomised controlled trial in four districts of Madhya Pradesh, India. Study participants included Hindi speaking women 4–7 months pregnant (n=5095) with access to a mobile phone and their husbands (n=3842). Women were randomised to either an intervention group where they received up to 72 Kilkari messages or a control group where they received none. Intention-to-treat (ITT) and instrumental variable (IV) analyses are presented.Results An average of 65% of the 2695 women randomised to receive Kilkari listened to ≥50% of the cumulative content of calls answered. Kilkari was not observed to have a significant impact on the primary outcome of exclusive breast feeding (ITT, relative risk (RR): 1.04, 95% CI 0.88 to 1.23, p=0.64; IV, RR: 1.10, 95% CI 0.67 to 1.81, p=0.71). Across study arms, Kilkari was associated with a 3.7% higher use of modern reversible contraceptives (RR: 1.12, 95% CI 1.03 to 1.21, p=0.007), and a 2.0% lower proportion of men or women sterilised since the birth of the child (RR: 0.85, 95% CI 0.74 to 0.97, p=0.016). Higher reversible method use was driven by increases in condom use and greatest among those women exposed to Kilkari with any male child (9.9% increase), in the poorest socioeconomic strata (15.8% increase), and in disadvantaged castes (12.0% increase). Immunisation at 10 weeks was higher among the children of Kilkari listeners (2.8% higher; RR: 1.03, 95% CI 1.00 to 1.06, p=0.048). Significant differences were not observed for other maternal, newborn and child health outcomes assessed.Conclusion Study findings provide evidence to date on the effectiveness of the largest mobile health messaging programme in the world.Trial registration number Trial registration clinicaltrials.gov; ID 90075552, NCT03576157.Data are available upon reasonable request. Anonymised data are available upon reasonable request from the study Principal Investigator Dr. Amnesty LeFevre aelefevre@gmail.com.