Abstract:
Introduction: Globally about 830 women die daily due to complications of pregnancy
and child birth out of which 550 occur in Sub-Saharan Africa, with about 8,000
maternal deaths occurring annually in Kenya. 66% of maternal deaths occur within
the first week and 85% of maternal deaths occur within two weeks post-delivery.
Attendance of postnatal services during this time could significantly reduce morbidity
and mortality. We determined effectiveness of short text message (SMS) in reducing
failure-to-attend rates (FTA) of postnatal clinic at the largest maternity hospital in
Nairobi, Kenya. Methods: We conducted a hospital-based randomised controlled
trial. Women who delivered between March and May 2016 at Pumwani Maternity
Hospital were recruited, enrolled and randomised into SMS (intervention) or no SMS
(control) arms. Women were masked to which arm they belonged during
randomisation but were unmasked during the appointments as the intervention had
been sent. The investigators were not masked. Reminders were sent three days prior to
and on the morning of the appointment. Relative Risk (RR) at 95% Confidence Interval
were calculated to estimate the effectiveness of intervention at two and six-weeks.
Results: We enrolled 754 women, with 377 randomly assigned into each arm. There
were no differences in socio-demographic characteristics between the study arms at
baseline. After two-weeks, women in the intervention arm had an 80% reduction in
FTA risk (RR=0.2, 95% CI 0.1–0.3). After six weeks, women in the intervention arm
had a 60% reduction in FTA risk (RR=0.4, 95% CI 0.2–0.6). Among participants, 80
(42.1%) women at two-weeks and 30 (41.7%) women at six-weeks cited forgetting
appointment as the most common reason for failing to attend postnatal clinic.
Conclusion: SMS reminders were effective in reducing failure-to-attend clinic
appointments. We recommend the use of SMS reminder strategy for postnatal care.