In collaboration with IPA Kenya and Jacaranda Health, researchers conducted a randomized evaluation to measure the effects of a digital health platform, PROMPTS, on women’s knowledge and behavior in antenatal and postnatal care for themselves and their newborns. Women enrolled in PROMPTS improved their knowledge and care seeking behavior during both the antenatal and postnatal periods, alongside better newborn care practices.

Many pregnant and postpartum women lack information about key aspects of their health and are not empowered to seek recommended care—for both routine and acute cases—at the right place and time.¹ Moreover, studies suggest that visits are often short—lasting less than five minutes—leaving mothers with little opportunity to receive important information that empowers them to take care of their health and that of their newborn.^2,3 In Kenya, 40 percent of pregnant women do not receive the recommended number of antenatal care visits and only slightly over 50 percent receive any postnatal care.^3,4 In an effort to address these issues, Jacaranda Health—a Kenyan nonprofit that aims to improve maternal and newborn quality and outcomes in public health facilities—developed a digital platform called PROMPTS. The SMS-based platform combines a sequence of informational messages (e.g., appointment reminders and milestone updates), a two-way clinical helpdesk that triages and responds to mothers’ questions by urgency, and an anonymous feedback channel for women to report their care experiences.

In partnership with Jacaranda Health and IPA Kenya, researchers conducted a randomized evaluation to measure the effects of PROMPTS on women’s knowledge and behavior in antenatal, delivery and postnatal periods for themselves and their newborns. The intervention included 6,139 pregnant women from 40 health facilities across eight counties in Kenya. The health facilities were randomly assigned to the following groups:

1. Intervention group: Pregnant women seeking antenatal care in health facilities receiving the intervention were systematically invited to enroll in the PROMPTS platform. Women who opted into PROMPTS received approximately 10-40 messages per month during pregnancy and 10 messages per month during the first year postpartum.
2. Comparison group: Pregnant women seeking antenatal care in health facilities not receiving the intervention received care as usual, though they could still enroll in the platform independently through other channels.

The PROMPTS digital health platform demonstrated broad success in improving maternal and newborn healthcare at a low cost of 74 cents per woman enrolled. About 85 percent of women invited through facilities receiving the intervention enrolled in PROMPTS, compared to less than 10 percent of women from the comparison facilities. There were significant improvements in both knowledge and health-seeking behaviors among women recruited from intervention facilities. Knowledge of antenatal danger signs improved, though no impact was found in knowledge of postpartum and neonatal danger signs. Birth preparation activities improved by nearly 10 percent, and awareness of labor signs improved.

Additionally, maternal care-seeking behaviors and postnatal health practices improved. A higher share of women in the intervention group received at least the national-guideline-recommended number of antenatal and postnatal visits than in the comparison group, with a 17 percent relative increase in the postnatal period. Furthermore, women enrolled in the intervention group reported higher rates of discussions about and examinations of their own health during postnatal care visits, with relative increases of 8 percent and 13 percent, respectively. They also improved newborn care practices through breastfeeding, consistently placing their newborn to sleep on their back at night, and frequently singing or talking to them throughout the day.

Read the published paper here.

Sources

¹ Esti Yunitasari, Filomena Matos, Hakim Zulkarnain, Dewi Indah Kumalasari, Tiyas Kusumaningrum, Tantya Edipeni Putri, Ah Yusuf, and Nining Puji Astuti. 2023. “Pregnant Woman Awareness of Obstetric Danger Signs in Developing Country: Systematic Review.” BMC Pregnancy and Childbirth 23 (1). https://doi.org/10.1186/s12884-023-05674-7. ; Kichamu G, Abisi IN, Karimurio L. Maternal and Child Health. Kenya Demographic and Health Survey. 2003. https://dhsprogram.com/pubs/pdf/fr151/09chapter09.pdf.

² Irving, Greg, Ana Luisa Neves, Hajira Dambha-Miller, Ai Oishi, Hiroko Tagashira, Anistasiya Verho, and John Holden. 2017. “International Variations in Primary Care Physician Consultation Time: A Systematic Review of 67 Countries.” BMJ Open 7 (10): e017902. https://doi.org/10.1136/bmjopen-2017-017902.

³ Kenya Department of Family Health. “Healthy Mothers and Newborns; Guidelines for Postnatal Care. Kenya Ministry of Health. 2018. https://familyhealth.go.ke/wp-content/uploads/2018/02/Guidelines-for-postnatal-care-to-mothers-and-newborns-2016-18-12-2016B.pdf.

⁴ Macharia, Peter M, Noel K Joseph, Gorrette Nalwadda, Beatrice Mwilike, Aduragbemi Banke-Thomas, Lenka Benova, Olatunji Johnson. 2022. “Spatial Variation and Inequities in Antenatal Care Coverage in Kenya, Uganda and Mainland Tanzania Using Model-Based Geostatistics: A Socioeconomic and Geographical Accessibility Lens” 22. https://doi.org/10.1186/s12884-022-05238-1

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