Effect of enhanced reminders on postnatal clinic attendance in Addis Ababa, Ethiopia: a cluster randomized controlled trial

Abraham Sahilemichael Kebede, Ike Oluwapo O. Ajayi, Ayodele O. Arowojolu

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    Background: Failure to attend maternal health services is an intractable challenge for the health-care system in low- and middle-income countries. The use of technology for reminding patients about their appointments has been demonstrated to be an effective (future) tool toward increased health care services utilization in developing countries, such as Ethiopia. Objective: We aimed to investigate the effect of enhanced reminders on postnatal care attendance versus usual care (notification of an appointment at discharge). Methods: The study was a cluster randomized controlled trial: out of eligible 86 health centers, 16 health centers in Addis Ababa (AA) were randomized to either the intervention (8) or the control (8) groups; with a total of 350 mothers equally randomized into each arm. Mothers in the intervention group received the SMS (short message service) or a voice call reminder at 48 and 24 hours before the due postnatal appointment, whereas the control group received only the usual notification of appointments provided by health professionals at discharge from the ward following delivery. We recruited participants on wards after delivery at discharge and followed them up to 6 weeks. This study’s primary outcome was postnatal visit compliance. Our assessment consisted of a two-level bivariate and a multivariate ordinal logistic regression analysis. Results: The majority (97.7%) of the participants completed the study; 173(98.9%) of women in the intervention group and 169 (96.5%) of women in the control group. There was a statistically significant difference in postnatal care (PNC) compliance among women who were in the intervention versus the control group (p-value = 0.005). Higher odds of postnatal compliance was observed among the intervention group (AOR:2.98, 95% CI 1.51–5.8). Conclusions: Mobile phone reminders were effective in terms of enhancing adherence to PNC appointments. This indicates integration of mobile phone reminders in postnatal care could improve postnatal appointment compliance.

    Original languageEnglish
    Article number1609297
    JournalGlobal Health Action
    Issue number1
    Publication statusPublished - 24 May 2019

    Bibliographical note

    © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
    This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits
    unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


    • Appointments reminders
    • cluster randomized trial
    • mobile phones
    • postnatal compliance
    • short message service
    • voice call


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