The Impact of Mobile Health Interventions on Antenatal and Postnatal Care Utilization in Low- and Middle-Income Countries: A Meta-Analysis.

Despite many efforts, the utilization of full antenatal and postnatal care remains a significant concern in low- and middle-income countries (LMICs). We planned to retrieve the relevant literature and pooled the data for meta-analysis to evaluate the impact of mobile health (mHealth) intervention on antenatal and postnatal care utilization in low- and middle-income countries. We searched the literature through major electronic databases such as PubMed, MEDLINE, Embase, Cochrane, Scopus, CINAHL, Clinical key, Google Scholar, and Ovid with selected keywords and explored the reference list of articles. Meta-analysis was performed using the RevMan software version 5.4; p-value < 0.05 was considered statistically significant. The effect of variables was measured in odds ratio (OR) with a fixed-effects model. Six published interventional studies were selected as per the eligibility and participants, intervention, comparison, and outcome (PICO) framed for systematic review and meta-analysis. The search was restricted to articles in the English language, articles published online, and preprinted articles until September 2020. Outcome variables include antenatal and postnatal care utilization by pregnant and delivered mothers. The results have been presented in the form of a forest plot. The findings of this meta-analysis depicted the significant increase in four or more antenatal care (ANC) attendance (OR = 1.81, 95% confidence interval (CI) = 1.49-2.19), tetanus toxoid (TT) immunization (OR = 1.63, 95% CI = 1.17-2.27), compliance to iron supplementation (OR = 1.88, 95% CI = 1.18-3.00), and postnatal care attendance (OR = 2.54, 95% CI = 2.15-2.99) among those pregnant mothers who received mHealth intervention compared with the control group. This meta-analysis creates evidence for the effectiveness of mHealth with pooled data of interventional studies with limited sample sizes. Technology is changing, but even with limited support such as short messaging service (SMS), there was an improvement in antenatal and postnatal service utilization. This meta-analysis concluded that mHealth has the potential to increase the utilization of antenatal and postnatal care compared to standard care, although the level of evidence is moderate.