PRENACEL – a mHealth messaging system to complement antenatal care: a cluster randomized trial

The aim of this study was to determine whether PRENACEL (a bi-directional, mobile-phone based, short text message service (SMS)) increases the coverage of recommended antenatal care (ANC) practices. A parallel, cluster-randomized trial in which 20 public primary Health Care Units (PHCUs) were randomly allocated to the intervention (10 PHCUs) or control (10 PHCUs) group. The study population included pregnant women aged 18 or above with a gestational age of 20 weeks or less. Pregnant women receiving ANC in intervention PHCUs were invited through leaflets and posters to register in PRENACEL. Women who registered in PRENACEL received a weekly set of short text messages with health education and health promotion content related to pregnancy and childbirth and were also able to clarify ANC queries through SMS. All women received routine ANC. The primary outcome was the proportion of women with high ANC Score, a composite measure of coverage of recommended ANC practices. Chi-square or Fisher’s exact tests and multivariate log-binomial regression were used to analyze the outcomes. A total of 1210 eligible women received ANC in the participating PHCUs and took part of this study (770 in the intervention group and 440 in the control group). 20.4% (157/770) of intervention-group women registered in PRENACEL, but only 116 read all messages (73.9% of women who registered in PRENACEL, 116/157). The adjusted intention-to-treat analysis suggested no difference between intervention and control groups in the primary outcome (Adjusted Relative Risk (AdjRR): 1.05 (95% Confidence Interval (CI): 1.00–1.09). Both crude and adjusted per-protocol analysis suggested a positive effect of PRENACEL (Crude RR (95% CI): 1.14 (1.06–1.22), AdjRR (95% CI): 1.12 (1.05–1.21). The multivariate analysis also suggests that the PRENACEL group (women who read all SMS) had higher mean ANC score [48.5 (±4.2) vs 45.2 (±8.7), p < 0.01], higher proportion of women with ≥6 ANC visits (96.9% vs. 84.8%, p = 0.01), and higher rates of syphilis testing (40.5% vs. 24.8%, p = 0.03) and HIV testing (46.6% vs. 25.7%, p < 0.01) during ANC. A bi-directional, mobile-phone based, short text message service is potentially useful to improve the coverage of recommended ANC practices, including syphilis and HIV testing. Clinical trial registry: RBR-54zf73 , U1111–1163-7761. O objetivo deste estudo foi determinar se o PRENACEL, um servico bidirecional de mensagens curtas de texto (SMS) com base na telefonia celular, aumenta a cobertura das praticas recomendadas de cuidados pre-natais (PN). um ensaio paralelo, aleatorizado por conglomerados, no qual 20 unidades basicas de saude (UBS) foram alocadas aleatoriamente para o grupo de intervencao (10 UBS) ou controle (10 UBS). A populacao estudada incluiu gestantes com idade igual ou superior a 18 anos com idade gestacional de 20 semanas ou menos. As gestantes que receberam PN em UBS intervencao foram convidadas atraves de folhetos e cartazes para se inscreverem no PRENACEL. As mulheres que se registraram no PRENACEL receberam um conjunto semanal de SMS com conteudo de educacao e promocao da saude relacionadas a gravidez e parto e tambem puderam esclarecer duvidas relacionadas ao PN atraves de SMS. Todas as mulheres receberam PN de rotina. O desfecho primario foi a proporcao de mulheres com um alto escore de PN, uma medida da cobertura das principais praticas recomendadas no PN. um total de 1.210 mulheres participaram deste estudo (770 no grupo de intervencao e 440 no grupo de controle). 20,4% (157/770) das mulheres do grupo de intervencao demonstraram interesse e foram registradas no PRENACEL, mas apenas 116 leram as mensagens (73,9%, 116/157). A analise ajustada de intencao de tratamento sugeriu ausencia de efeito da intervencao no desfecho primario (Risco Relativo (RR) ajustado: 1,05, Intervalo de Confianca (IC) de 95%: 1,00–1,09). A analise por protocolo sugeriu um efeito positivo do PRENACEL [RR bruto (IC 95%): 1,14 (1,06–1,22), RR ajustado (IC 95%): 1,12 (1,05–1,21)]. A analise multivariada sugeriu que as mulheres que leram os SMS apresentaram a maior media do escore de PN [48,5 (±4,2) vs 45,2 (±8,7), p < 0,01], maior proporcao de mulheres com ≥6 consultas (96,9% vs. 84,8%, p = 0,01) e maiores taxas de teste de sifilis (40,5% vs. 24,8%, p = 0,03) e HIV (46,6% vs. 25,7%, p < 0,01) durante o PN. o sistema PRENACEL e potencialmente util para melhorar a cobertura das praticas recomendadas de PN, incluindo testes de sifilis e HIV.