Evidence map›Paper›PMID 31388661›Full record

ArticleEClinicalMedicine2019

The effect of an mHealth clinical decision-making support system on neonatal mortality in a low resource setting: A cluster-randomized controlled trial.

Hannah Brown Amoakoh, Kerstin Klipstein-Grobusch, Irene Akua Agyepong, Nicolaas P A Zuithoff, Mary Amoakoh-Coleman, Gbenga A Kayode, Charity Sarpong, Johannes B Reitsma, Diederick E Grobbee, Evelyn K Ansah

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EClinicalMedicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 5 pooled it
4.0field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 5 syntheses or guidelines pooled it, 27 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 4 countries.

Hannah Brown AmoakohJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht the Netherlands.
Kerstin Klipstein-GrobuschSchool of Public Health, University of Ghana, Accra, Ghana.
Irene Akua AgyepongResearch and Development Division, Ghana Health Service, Dodowa, Ghana.
Nicolaas P A ZuithoffJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht the Netherlands.
Mary Amoakoh-ColemanNoguchi Memorial Institute, University of Ghana, Legon, Accra, Ghana.
Gbenga A KayodeJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht the Netherlands.
Charity SarpongRegional Health Directorate, Ghana Health Services, Koforidua, Ghana.
Johannes B ReitsmaJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht the Netherlands.
Diederick E GrobbeeJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht the Netherlands.
Evelyn K AnsahUniversity of Allied Sciences, Ho, Ghana.
University Medical Center Utrecht · NLGhana Health Service · GHInstitute of Human Virology · NGNoguchi Memorial Institute for Medical Research · GHUniversity of Ghana · GHUniversity of Health and Allied Sciences · GH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMHealth interventions promise to bridge gaps in clinical care but documentation of their effectiveness is limited. We evaluated the utilization and effect of an mhealth clinical decision-making support intervention that aimed to improve neonatal mortality in Ghana by providing access to emergency neonatal protocols for frontline health workers.

methodsIn the Eastern Region of Ghana, sixteen districts were randomized into two study arms (8 intervention and 8 control clusters) in a cluster-randomized controlled trial. Institutional neonatal mortality data were extracted from the District Health Information System-2 during an 18-month intervention period. We performed an intention-to-treat analysis and estimated the effect of the intervention on institutional neonatal mortality (primary outcome measure) using grouped binomial logistic regression with a random intercept per cluster. This trial is registered at ClinicalTrials.gov (

findingsThere were 65,831 institutional deliveries and 348 institutional neonatal deaths during the study period. Overall, 47 ∙ 3% of deliveries and 56 ∙ 9% of neonatal deaths occurred in the intervention arm. During the intervention period, neonatal deaths increased from 4 ∙ 5 to 6 ∙ 4 deaths and, from 3 ∙ 9 to 4 ∙ 3 deaths per 1000 deliveries in the intervention arm and control arm respectively. The odds of neonatal death was 2⋅09 (95% CI (1 ∙ 00;4 ∙ 38); p = 0 ∙ 051) times higher in the intervention arm compared to the control arm (adjusted odds ratio). The correlation between the number of protocol requests and the number of deliveries per intervention cluster was 0 ∙ 71 (p = 0 ∙ 05).

interpretationThe higher risk of institutional neonatal death observed in intervention clusters may be due to problems with birth and death registration, unmeasured and unadjusted confounding, and unintended use of the intervention. The findings underpin the need for careful and rigorous evaluation of mHealth intervention implementation and effects.

fundingNetherlands Foundation for Scientific Research - WOTRO, Science for Global Development; Utrecht University.

Indexed as

GhanaLow and middle income countriesmHealthNeonatal mortality

Identifiers

PMID31388661
PMCPMC6677648
OpenAlexW2954752074

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.