Effectiveness of a WhatsApp-based communication on improving access to antenatal care interventions in sub-Saharan Africa: A randomized control health facility trial

Abstract

Background: Social media applications like WhatsApp are commonly used in sub-Saharan Africa (SSA), where access to health Interventions remains limited. This study aimed to assess the effectiveness of a WhatsApp based communication on improving access of antenatal care (ANC) interventions in resource limited setting.

Methods: This was a randomized controlled trial targeting pregnant women attending a Hospital in Yaounde, Cameroon. Participants were assigned to two arms using block randomization, stratified by age and parity, at a 1:1 ratio. Women in the intervention arm in addition to routine ANC were included in WhatsApp groups where short educational videos were posted weekly for 12 weeks, with ability to discuss, moderated by facility nurses. Participants in the control arm received routine ANC. The primary outcome was the completion of at least eight ANC contacts during pregnancy.

Results: A total of 316 pregnant women were enrolled and randomized into intervention (n = 159) and control (n = 157) arms. Thirty (20.1%) participants in the intervention arm and 10 (7.0%) participants in the control group complied with the recommended eight or more ANC contacts. The intervention significantly increased the likelihood of achieving at least eight ANC contacts (20.1% vs 7.0%) with an adjusted Risk Ratio (aRR): 2.65 (95% CI [1.34-4.79]) and an aRD: 0.12 (95% CI [0.04-0.20]). The intervention significantly reduced pregnancy-related anxiety, with participants 46% less likely to experience it compared to the control group (aRR: 0.54, 95% CI [0.34-0.78]), and improved pregnancy-related knowledge (adjusted Mean Difference (aMD): 0.34, 95% CI [0.08-0.61]). While a higher proportion of women in the intervention group completed the recommended intermittent preventive treatment of malaria in pregnancy doses, the adjusted effect was not statistically significant (aRR: 1.22, 95% CI [0.96-1.46]), and no significant differences were observed in mosquito net use (aRR 1.10; 95% CI [0.84-1.34]), malaria incidence (aRR: 1.05, 95% CI [0.76-1.36]), or satisfaction with ANC services aMD: 0.14, 95% CI [-0.07-0.36]).

Conclusions: Posting short pregnancy-related educational videos in WhatsApp groups involving moderating their discussion on the shared video contributes to significantly improving ANC attendance in a resource limited setting. The consistency of these findings should be documented across different contexts to enhance access to populations in need.

Trial registration: This trial was registered at Pan African Clinical Trials Registry (PACTR) under the registration number: PACTR202306721999803, on 13 June 2023.

Keywords: Pregnant women; WhatsApp; antenatal care.

Figure 1.

CONSORT diagram showing the flow of participants through each stage of a randomized trial.

Figure 2.

Weekly evolution of the intervention monitoring indicator.

Figure 3.

Adjusted risk ratio study outcomes between WhatsApp-based intervention and control groups among pregnant women attending antenatal care visits at Centre Médical Jean Zoa hospital.

Figure 4.

Adjusted mean difference of pregnancy-related knowledges and satisfaction with antenatal care between WhatsApp-based intervention and control groups among pregnant women attending ANC visits at Centre Médical Jean Zoa hospital.