Girma Gilano

Introduction: Prelacteal feeding, the practice of giving newborns substances other than breast milk within the first few days of life, remains a common yet harmful practice in many low- and middle-income countries, including Ethiopia. No evidence in Ethiopia indicates that mHealth can help improve prelacteal feeding. This study aimed to evaluate the effect of mobile health (mHealth) intervention on reducing prelacteal feeding practices and improving antenatal care (ANC) and postnatal care (PNC) utilization among mothers in South Ethiopia. Methods: A cluster-randomized controlled trial (CRT) was conducted in rural areas of South Ethiopia. A total of 20 clusters were selected using simple random sampling for intervention (mHealth) and control groups, each containing 340 women. Mothers in the intervention group received automated weekly SMS messages and reminders on exclusive breastfeeding, prelacteal feeding risks, ANC, and PNC. Mothers were only selected if they could read, write, and use mobile phones. Results: The mHealth intervention significantly reduced prelacteal feeding practice (AOR = 0.19, 95% CI: 0.06–0.58); p < 0.05). Higher ANC visits related to decreased prelacteal feeding (AOR = 0.28, 95% CI: 0.21–0.39; p < 0.001). The log count of ANC visit increased by 0.14 among intervention groups (IRR = 1.15, 95% CI: 1.06–1.25; p < 0.001). The PNC time was delayed 2.05 days among controls (β = −2.05, 95% CI: −2.66–−1.42; p < 0.001). Maternal and partner education, postnatal time, and ANC visits influenced prelacteal feeding. Conclusions: This finding might suggest that mHealth can reduce prelacteal feeding practices and improve maternal healthcare behaviors such as ANC attendance and timely PNC. These findings highlight the potential of mobile health interventions in promoting healthy maternal and infant practices in rural settings, where healthcare access is limited. Further research is needed to explore the long-term impacts of such interventions on maternal and child health outcomes. Multi-level analysis reduced variability. However, an unexplained variance could be reduced by including more cluster-level variables.

Introduction: Postpartum family planning (PPFP) is a critical strategy for improving maternal and child health by preventing unintended pregnancies and optimizing birth spacing. However, PPFP uptake remains suboptimal in Ethiopia, where sociocultural barriers, limited health information, and inadequate counseling impede progress. Mobile health (mHealth) interventions have shown promise in overcoming these challenges by delivering targeted health information directly to individuals. This study aimed to evaluate the effect of an mHealth intervention on uptake and the intention to use PPFP among postpartum women in South Ethiopia. Methods: We conducted a cluster-randomized controlled trial in randomly selected health facilities in South Ethiopia. Pregnant women from primary hospitals and health centers were selected from registers and family folders. Data were collected using face-to-face and mobile interviews and analyzed using a generalized linear mixed model (GLMM) to account for the clustering. Results: The mHealth intervention significantly increased PPFP uptake (OR = 2.89, 95% CI: 1.55–5.37) and the intention to use PPFP (AOR = 2.05, 95% CI: 1.24–3.46) compared to standard care. The predicted probability of using PPFP was 85% in the intervention group. Women who discussed family planning with their partners (AOR = 2.10, 95% CI: 1.30–3.35) had a higher probability of using PPFP, and those exposed to media (AOR = 1.58, 95% CI: 1.07–2.32) had an increased likelihood of planning to use PPFP. Conversely, limited autonomy in decision-making and delays in postnatal care attendance were associated with reduced uptake and intention to use PPFP. Conclusions: The mHealth intervention improved uptake of PPFP and increased intention to use PPFP among postpartum women in South Ethiopia. PPFP uptake was higher in the intervention group (85%) than in the control group (68%). Partner involvement, decision-making autonomy, and media exposure emerged as significant facilitators of PPFP adoption. Scaling up mHealth interventions could address unmet family planning needs, but integration with broader strategies that address sociocultural barriers and enhanced counseling is essential. Interventions must be contextually tailored and grounded in behavioral theory (HBM, TPB, and TAM) to maximize effectiveness. Future research should examine the long-term sustainability and adaptability of mHealth approaches across diverse contexts.

Childhood vaccination is a cornerstone of public health, significantly reducing morbidity and mortality from vaccine-preventable diseases. However, immunization coverage remains suboptimal in many low-resource settings, including Ethiopia. Mobile health (mHealth) interventions, such as SMS reminders, have shown promise in improving healthcare service utilization, yet their effectiveness in enhancing childhood vaccination uptake remains underexplored in Ethiopia. This study assesses the impact of an mHealth intervention on childhood vaccination coverage and associated factors among mothers in the Gamo and Gofa zones of South Ethiopia. A cluster randomized controlled trial (cRCT) was conducted among 680 pregnant mothers recruited from 20 randomly selected health institutions in the Gamo and Gofa zones. Participants were assigned to either the intervention group (n = 340), which received SMS reminders and health education messages, or the control group (n = 340), which received standard care. Eligible participants were pregnant women (≥ 18 years old) with a gestational age of 16–28 weeks, literate, and able to use mobile phones. The primary outcome was childhood vaccination completion, while secondary outcomes included timely Bacillus Calmette-Guérin (BCG) vaccination at birth. Data were collected through structured interviews and analyzed using multilevel logistic regression and generalized linear mixed models. The intervention group demonstrated a significantly higher childhood vaccination completion rate (AOR = 4.80, 95% CI: 1.75–13.01, p < 0.01). Timely BCG vaccination at birth was also significantly improved in the intervention group (Log Odds = 2.19, 95% CI: 0.69–3.70, p < 0.01). Sociodemographic factors, such as maternal age, colostrum feeding, provider, and family planning, were significantly associated with vaccination uptake. The study suggests that mHealth interventions, such as SMS health information and reminders, might significantly enhance childhood vaccination coverage. Implementing mobile-based strategies could help bridge immunization gaps and support national vaccination programs. Future studies should explore the scalability of mHealth interventions in diverse settings. Clinical Trial Registration number: PACTR202211547107725; Date 22/11/2022.

Introduction: Exclusive breastfeeding (EBF) is vital for optimal infant health, reducing the risk of infections and enhancing cognitive development. Despite WHO’s recommendation of EBF for the first six months of life, global adherence remains suboptimal, particularly in low-resource settings. This study evaluates the impact of mobile health (mHealth) interventions on exclusive breastfeeding (EBF) among mothers in South Ethiopia. Methods: A cluster randomized controlled trial was conducted in the Gamo Gofa zones, South Ethiopia, involving 20 health facilities (10 intervention and 10 control). The study included 680 pregnant mothers recruited using simple random sampling from antenatal care (ANC) registers and family folders. Mothers in the intervention group received mHealth support, including breastfeeding information and reminders, while the control group received standard care. Participants were followed from the second trimester to six months postpartum. Multilevel survival analysis was applied to assess EBF duration, and multilevel logistic regression was used to evaluate complementary feeding within the first month. Results: The intervention group had a significantly higher probability of maintaining EBF at six months than the control group (AHR = 0.40, 95% CI: 0.26–0.62, p < 0.001). The secondary outcome also shows higher odds of early breastfeeding initiation in the intervention group (AOR = 4.71, 95% CI: 3.10–7.16, p < 0.001). ANC frequency was associated with a lower hazard of stopping EBF (AHR = 0.87, 95% CI: 0.79–0.97, p p < 0.05). College and above partner education was associated with high hazards of EBF (AHR = 2.41, 95% CI: 1.01–5.78, p < 0.05). The random effects variance (Var = 0.10, 95% CI: 0.01–0.07) indicated significantly lowered cluster-level variability. Conclusion and Recommendations: The mHealth intervention significantly improved EBF adherence and early breastfeeding initiation among mothers in South Ethiopia. Early breastfeeding, ANC frequency, and family size were protective factors, while high partner education and diarrhea disease increased the risk of early cessation of EBF. These findings highlight the potential of mHealth in addressing key barriers to EBF. Scaling up similar interventions, focusing on high-risk groups, could enhance adherence to WHO’s breastfeeding recommendations and improve maternal and child health outcomes in resource-limited settings.

Mobile health (mHealth) interventions have shown potential to improve maternal and child health outcomes in Africa, but their effectiveness depends on specific interventions, context, and implementation quality. Challenges such as limited infrastructure, low digital literacy, and sustainability need to be addressed. Further evaluation studies are essential to summarize the impact of mHealth interventions. Thus, this synthesis focuses on qualitative evidence of the impact of mHealth on maternal and child health in Africa to summarize such evidence to help policy decisions. A qualitative systematic review guided by the concepts of Intervention, Context, Mechanism, and Outcome (ICAMO) was employed in this study. The GRADE CERQual assessment and methodological constraints tools were utilized in the review to ascertain the level of confidence in the evidence and to examine the methodological limitations. The JBI checklist for qualitative research appraisal was also consulted during the review. The current review contains 32 eligible studies from databases such as CINAHL, EMBASE, MEDLINE, Scopus, Web of Science, HINARI, and Cochrane Library. The review demonstrated substantial improvements in the HCP-woman relationship, communication system, maternal and child healthcare uptake, health-seeking behavior, and HCP skills. Economic capacities, maternal education, and the low quality of existing services challenged participants. mHealth significantly improves maternal and child health outcomes in Africa. This review showed it can improve healthcare access, empower women, and contribute to the region's goal of universal health coverage. However, the challenges such as low partner support, high costs for services, and poor quality of current care as narrated by women need commitment from health authorities in the continent. The evidence from this review suggests that mHealth can be implemented to improve maternal and child health in Africa. PROSPERO: CRD42023461425.

Introduction: Vaccine-preventable diseases are the public health problems in Africa, although vaccination is an available, safe, simple, and effective method prevention. Technologies such as mHealth may provide maternal access to health information and support decisions on childhood vaccination. Many studies on the role of mHealth in vaccination decisions have been conducted in Africa, but the evidence needs to provide conclusive information to support mHealth introduction. This study provides essential information to assist planning and policy decisions regarding the use of mHealth for childhood vaccination. Methods: We conducted a systematic review and meta-analysis for studies applying mHealth in Africa for vaccination decisions following the Preferred Reporting Items for Systematic and Meta-Analysis [PRISMA] guideline. Databases such as CINAHL, EMBASE, PubMed, PsycINFO, Scopus, Web of Science, Google Scholar, Global Health, HINARI, and Cochrane Library were included. We screened studies in Endnote X20 and performed the analysis using Revman 5.4.1. Results: The database search yielded 1,365 articles [14 RCTs and 4 quasi-experiments] with 21,070 participants satisfied all eligibility criteria. The meta-analysis showed that mHealth has an OR of 2.15 [95% CI: 1.70–2.72; P2 = 90%] on vaccination rates. The subgroup analysis showed that regional differences cause heterogeneity. Funnel plots and Harbord tests showed the absence of publication bias, while the GRADE scale showed a moderate-quality body of evidence. Conclusion: Although heterogeneous, this systematic review and meta-analysis showed that the application of mHealth could potentially improve childhood vaccination in Africa. It increased childhood vaccination by more than double [2.15 times] among children whose mothers are motivated by mHealth services. MHealth is more effective in less developed regions and when an additional incentive party with the messaging system. However, it can be provided at a comparably low cost based on the development level of regions and can be established as a routine service in Africa. Registration: PROSPERO: CRD42023415956.

Introduction: Maternal and child mortality remained higher in developing regions such as Southern Ethiopia due to poor maternal and child health. Technologies such as mobile applications in health may be an opportunity to reduce maternal and child mortality because they can improve access to information. Therefore, the main aim of this study was to explore the role of mHealth in improving maternal and child health in Southern Ethiopia. Methods: This study employed a qualitative study design to explore the role of mHealth in improving maternal and child health among health professionals in Southern Ethiopia from December 2022 to March 2023. We conducted nine in-depth interviews, six key informants’ in-depth interviews, and four focused group discussions among health professionals. This is followed by thematic analyses to synthesize the collected evidence. Results: The results are based on 226 quotations, 5 major themes, and 24 subthemes. The study participants discussed the possible acceptance of mHealth in terms of its fitness in the existing health system, its support to health professionals, and its importance in improving maternal and child health. The participants ascertained the importance of awareness creation before the implementation of mHealth among women, families, communities, and providers. They reported the importance of mHealth for mothers and health professionals and the effectiveness of mHealth services. The participants stated that the main challenges related to acceptance, awareness, negligence, readiness, and workload. However, they also suggested strategic solutions such as using family support, provider support, mothers’ forums, and community forums. Conclusion: The evidence generated during this analysis is important information for program implementations and can inform policy-making. The planned intervention needs to introduce mHealth in Southern Ethiopia. Planners, decision-makers, and researchers can use it in mobile technology-related interventions. For challenges identified, we recommend solution-identified-based interventions and quality studies.

Introduction: Poor child feeding practice is a public health problem in Africa. Mobile health (mHealth) is a supportive intervention to improve this problem; however, the evidence available in the current literature is inconsistent and inconclusive in Africa. Some studies state that exclusive breastfeeding is not different between controls and mHealth interventions in the first month. Other studies state that health providers need additional training for the success of mHealth interventions. Objective: This systematic review and meta-analysis aims to provide the summarized effect of mHealth on child-feeding practices in Africa to improve future planning and decisions. Method: We conducted a systematic review and meta-analysis based on the published and unpublished evidence gathered from PubMed, Web of Science, Cochrane Library, and Embase databases between January 1, 2000, and March 1, 2022. Studies included were randomized control trials and experimental studies that compared mHealth to standards of care among postpartum women. Preferred Reporting Items for Systematic Review and Meta-analysis guidelines followed for the reporting. Results: After screening 1188 studies, we identified six studies that fulfilled the study criteria. These studies had 2913 participants with the number of total intervention groups 1627 [1627/2913 = 56%]. Five studies were completed within 24 weeks while one required 12 weeks. We included two RCTs, two cluster RCTs, and two quasi-experimental studies all used mHealth as the major intervention and usual care as controls. We found significant improvement in child-feeding practices among intervention groups. Conclusion: This systematic review and meta-analysis showed that the application of mHealth improved child-feeding practices in Africa. Although the finding is compelling, the authors recommend high-quality studies and mHealth interventions that consider sample size, design, regional differences, and environmental constraints to enhance policy decisions. The place of residence, access, low socioeconomic development, poor socio-demographic characteristics, low women empowerment, and low women’s education might cause high heterogeneity in the included regions and need consideration during interventions. Registration number: PROSPERO: CRD42022346950.