This paper is in the following e-collection/theme issue:

TTRN CPH 2022: "Digital Health beyond COVID-19: Lessons Learned" (37)

Published on in Vol 8, No 1 (2022): Jan-Dec

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/40954, first published .
Technology-Based Innovative Health Care Solutions for Improving Maternal and Child Health Outcomes in Low- and Middle-Income Countries: Systematic Review and Network Meta-analysis

Technology-Based Innovative Health Care Solutions for Improving Maternal and Child Health Outcomes in Low- and Middle-Income Countries: Systematic Review and Network Meta-analysis

Technology-Based Innovative Health Care Solutions for Improving Maternal and Child Health Outcomes in Low- and Middle-Income Countries: Systematic Review and Network Meta-analysis

Authors of this article:

Md Obaidur Rahman1, 2 Author Orcid Image ;   Noyuri Yamaji1 Author Orcid Image ;   Daichi Suzuki3 Author Orcid Image ;   Kiriko Sasayama1 Author Orcid Image ;   Daisuke Yoneoka2 Author Orcid Image ;   Erika Ota1 Author Orcid Image
Article Authors Cited by Tweetations Metrics

    Abstract

    1Department of Global Health Nursing, Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan

    2Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan

    3Department of Nursing, Kanagawa Institute of Technology, Kanagawa, Japan

    Corresponding Author:

    Md Obaidur Rahman, MSc, PhD

    Department of Global Health Nursing

    Graduate School of Nursing Science

    St Luke's International University

    10-1 Akashi-cho

    Chuo-ku

    Tokyo, 104-0044

    Japan

    Phone: 81 3 3543 6391 ext 4990

    Fax:81 3 3543 1626

    Email: obaidur006@gmail.com


    Background: Technology-based health care interventions (TBIs) are being considered as a promising solution to effectively strengthen maternal and child health (MCH) service uptake in resource-limited settings.

    Objective: This study aimed to identify the most effective TBIs that could achieve the best functional MCH outcomes in low- and middle-income countries (LMICs).

    Methods: A comprehensive search was performed in January 2021. In all, 2 independent researchers identified randomized controlled trials (RCTs) implemented in LMICs using the Population, Intervention, Comparison, Outcomes framework: Population: healthy pregnant women; Intervention: TBIs; Comparison: usual care or non-TBIs; and Outcomes: MCH outcomes. We estimated the direct, indirect, and relative effects, with their certainty based on the Grading of Recommendations, Assessments, Development, and Evaluations approach, for a wide range of MCH outcomes.

    Results: In total, 30 trials with 70,807 participants were included, and 80% had low risk of bias. Our network meta-analysis (NMA) estimates indicated that TBIs, particularly SMS text messaging or phone call with mobile voucher interventions, were likely to be effective in improving MCH outcomes. The 1-way communication intervention was likely to be the most effective for the uptake of ≥4 antenatal care visits (relative risk [RR] 1.81, 95% CI 1.33-2.45; moderate certainty), facility delivery (RR 1.45, 95% CI 1.10-1.91; moderate certainty), early breastfeeding initiation (RR 1.18, 95% CI 1.02-1.37; moderate certainty), and caesarean delivery (RR 0.87, 95% CI 0.84-0.91; low certainty) outcomes; however, 2-way communication intervention was likely to be the most effective for the skilled birth attendance (RR 1.36, 95% CI 1.14-1.63; low certainty), maternal (RR 2.04, 95% CI 1.05-3.96; very low certainty) and infant’s postnatal care use (RR 1.55, 95% CI 1.19-2.04; low certainty), exclusive breastfeeding practice (RR 1.53, 95% CI 1.14-2.05; moderate certainty), and perinatal death (RR 0.51, 95% CI 0.32-0.83; low certainty) outcomes. There was no substantial inconsistency between direct and indirect evidence, but small study effects were detected in the NMA.

    Conclusions: Different forms of TBIs have a possibility to improve MCH outcomes in LMICs and can be integrated into the existing health systems based on their priorities. This study suggests the implementation of large-scale, well-designed RCTs in low-income countries due to the limited number of RCTs in the NMA.

    Trial Registration: PROSPERO CRD42021239185; https://tinyurl.com/yuvmp35x

    iproc 2022;8(1):e40954

    doi:10.2196/40954

    Keywords

    technology-based interventions; mobile health; digital health; telehealth; eHealth; maternal and child health; systematic review; network meta-analysis; low- and middle-income countries 

    Conflicts of Interest

    None declared.

    Edited by B Dinesen; This is a non–peer-reviewed article. submitted 11.07.22; accepted 17.08.22; published 19.08.22

    Copyright

    ©Md Obaidur Rahman, Noyuri Yamaji, Daichi Suzuki, Kiriko Sasayama, Daisuke Yoneoka, Erika Ota. Originally published in Iproceedings (https://www.iproc.org), 19.08.2022.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in Iproceedings, is properly cited. The complete bibliographic information, a link to the original publication on https://www.iproc.org/, as well as this copyright and license information must be included.