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. 2025 Aug 7;4(8):e0000968.
doi: 10.1371/journal.pdig.0000968. eCollection 2025 Aug.

Associations between text communication engagement and maternal-neonatal outcomes in the Mobile WACh NEO Trial

James Peng  1 , Erica Wetzler  2 , Brenda Wandika  3 , Peninah Kithao  4 , June Moraa  4 , Jenna I Udren  2 , Olivia Schultes  2 , Esther Akinyi  4 , Lusi Osborn  4 , Anna Hedstrom  5 , Barbra A Richardson  1   2 , Manasi Kumar  6 , Dalton Wamalwa  7 , John Kinuthia  4 , Keshet Ronen  2 , Jennifer A Unger  8
Affiliations

Associations between text communication engagement and maternal-neonatal outcomes in the Mobile WACh NEO Trial

James Peng et al. PLOS Digit Health. .

Abstract

Despite a global reduction in neonatal deaths in the last few decades, high neonatal mortality rates persist in low- to middle-income countries. Mobile health interventions offer a promising solution to promote early newborn care (ENC) practices and improve neonatal health. The Mobile WACh NEO randomized controlled trial evaluated the effect of a text messaging communication intervention on neonatal health outcomes in Kenya from 2020 to 2023. Perinatal participants received automated messages from enrollment at 28-36 weeks gestation until six weeks postpartum and could message with a study nurse. This secondary analysis aimed to characterize participant text engagement and examine associations between engagement and maternal-neonatal health outcomes. Among 2,470 intervention participants retained through follow-up, median time in the intervention was 14 weeks. Participants received a median of 58 automated messages (average 0.58 per day), sent a median of 24 messages (average 0.25 per day), and received a median of 14 nurse responses (average 0.14 per day). Younger, more educated, unmarried, unemployed, and first-time mothers sent more messages, while those who had a lower social support score at baseline messaged less. Increased participant messaging was associated with greater increase in neonatal danger sign knowledge from baseline to six-week follow-up (Adj Est: 0.39; 95% CI: 0.09-0.68) and lower odds of early initiation of breastfeeding (aOR: 0.62; 95% CI: 0.45-0.86). Our findings contribute to the understanding of who can benefit from mobile health programs and how these interventions might impact behaviors and outcomes.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of the distribution of mothers through different messaging tracks over the course of the study.
Fig 2
Fig 2. Average number of participant messages sent by week, relative to the date of delivery.
Fig 3
Fig 3. Association between number of participant messages sent and trial outcomes.
(a) The top panel displays the estimated adjusted odds ratios when regressing each binary outcome on the normalized period-specific message count. (b) The bottom panel presents the estimated adjusted outcome differences when regressing the change in each score from baseline to 6-weeks on the normalized period-specific message count. For the home provision of KMC outcome, the unadjusted estimate is shown because only 11 participants had the positive outcome. For early breastfeeding and self-efficacy outcomes, multiple imputation was used to generate the estimates and confidence intervals due to missing outcome data.
Fig 4
Fig 4. Results of association analyses by subgroups (low-risk, preterm/low birthweight, first-time mother) for (a) NDS score change outcomes and (b) early breastfeeding.
Multiple imputation was used to obtain the early breastfeeding results.
See this image and copyright information in PMC

References

    1. Sharrow D, Hug L, You D, Alkema L, Black R, Cousens S, et al. Global, regional, and national trends in under-5 mortality between 1990 and 2019 with scenario-based projections until 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet Glob Health. 2022;10(2):e195–206. doi: 10.1016/S2214-109X(21)00515-5 - DOI - PMC - PubMed
    1. World Health Organization. Targets of Sustainable Development Goal 3 [Internet]. Geneva: WHO; [cited 2024 Nov 6]. Available from: https://www.who.int/europe/about-us/our-work/sustainable-development-goa...
    1. Akseer N, Lawn JE, Keenan W, Konstantopoulos A, Cooper P, Ismail Z, et al. Ending preventable newborn deaths in a generation. Int J Gynecol Obstet. 2015;131(S1):S43-8. - PubMed
    1. Blencowe H, Cousens S. Review: Addressing the challenge of neonatal mortality. Trop Med Int Health. 2013;18(3):303–12. doi: 10.1111/tmi.12048 - DOI - PubMed
    1. Ahmed KY, Thapa S, Hassen TA, Tegegne TK, Dadi AF, Odo DB, et al. Population modifiable risk factors associated with neonatal mortality in 35 sub-Saharan Africa countries: analysis of data from demographic and health surveys. EClinicalMedicine. 2024;73:102682. doi: 10.1016/j.eclinm.2024.102682 - DOI - PMC - PubMed

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