Table 2.

Direct messaging studies and programmatic reports

Study		Design		Messaging intervention		Target outcomes		Key results
Intervention studies – published literature:
Jiang et al, 2014 [14]		Quasi-experimental cluster randomized trial in Shanghai, China; N = 582 mothers in first trimester recruited from 4 community health clinics		Weekly SMS on infant feeding from 3rd trimester to 12 months postpartum; participants could text questions to a health professional		Increased exclusive breastfeeding (EBF) duration		Median duration EBF: 11.41 weeks (I.) vs 8.87 (C.). EBF at 6 months: 15.1% vs 6.3%
Unger et al, 2018 [18]		Randomized controlled trial (RCT) in Nairobi, Kenya; N = 298 pregnant mothers with own mobile phones.		Weekly SMS from pregnancy to 12 weeks postpartum. Group 2 also had bi-directional SMS communication with a nurse.		Increase facility-based delivery (FBD), EBF duration and postpartum contraception use.		No significant effects for FBD & contraceptive use. EBF probability significantly higher vs Control in both I-groups at 10 weeks (OR = 0.93; 95% CI = 0.86-0.97 and OR = 0.96; 95% CI = 0.89-0.98 vs OR = 0.79; 95% CI = 0.69-0.86; P < 0.005) and 16 weeks (OR = 0.82; 95% CI = 0.72-0.89 and OR = 0.93; 95% CI = 0.85-0.97 vs OR = 0.62; 95% CI = 0.52-0.71; P < 0.005) and in I-2 at 24 weeks (OR = 0.62; 95% CI = 0.51-0.72 vs OR = 0.41; 95% CI = 0.31-0.51; P = 0.005).
Flax et al, 2014 [16]	Cluster RCT in Bauchi state Nigeria; N = 390 mothers pregnant at baseline & interviewed when infants ≥6 months		Intervention × 10 months: monthly large group breastfeeding education; weekly SMS to small group who presented to monthly large group		Increase timely breastfeeding initiation and EBF duration		Timely initiation: OR = 2.6 (95% CI = 1.6-4.1). EBF to 6 months: OR = 2.4 (95% CI = 1.4-4.0)
Lund et al, 2012 [19]	Wired Mothers project; cluster RCT via 24 health facilities in Zanzibar, Tanzania; N = 2550 (Intervention: n = 1311)		Intervention group received 1-way SMS tips & reminders 2×/months to 36weeks gestation then 2×/week to 6 weeks postpartum; also received airtime voucher & health worker phone number.		Increase in skilled birth attendance		Skilled birth attendance: 60% vs 47% overall but non-significant for rural women. Urban OR = 5.73 (95% CI = 1.51-21.81).
Lund et al, 2014 [20]	As above		As above		Primary: Increase in mothers attending >4 antenatal care (ANC) visits. Secondary: improve timing and quality of ANC service delivery		4+ANC: 44% I vs 31% C. OR = 2.39 (95% CI = 1.03-5.55). Trend towards improved timing & quality of ANC services but not significant.
Lund et al, 2014 [21]	As above		As above		Reduced perinatal mortality		Significant difference in perinatal mortality: 19/1000 (I) vs 36/1000 (C). OR = 0.50 (0.27-0.93). Non-significant reduction in stillbirths (OR = 0.65; 95% CI = 0.34-1.24) & deaths in first 42 d of life (OR = 0.79; 95% CI = 0.36-1.74)
Fedha, 2014 [22]	RCT in 4 ANCs in Kenya. N = 397 pregnant mothers		Fortnightly SMS reminders of ANC visits and pregnancy health information		Increase uptake of ANC services and FBD. Reduce neonatal mortality.		<4 ANC visits: 3.6% (I) vs 9.7% (C) (P = 0.002). FBD: 88.0% (I) vs 72.8% (C) (P = 0.00). No significant difference in intrauterine deaths (1% vs 1.5%; P = 0.715) or neonatal deaths (1.0% vs 3.4%; P = 0.269).
Omole et al, 2016 [23]	Quasi-experimental pre/post study in 4 ANCs in Nigeria; N = 548 pregnant mothers with mobile phones		Weekly SMS reminders of ANC visits and pregnancy health information; two-way messaging for questions. Control = general health messages		Increase in mothers with 4 ANC visits and FBD		Difference-in-differences for FBD compared with prior pregnancies showed significantly greater increase in Intervention group (29% vs 13%).
Bangal et al, 2017 [24]	RCT in Ahmednagar, India. N = 400 pregnant mothers with mobile phones.		Phone call reminders for ANC visits. SMS messages with pregnancy health information.		Increase in mothers with 4 ANC visits, FBD and post-natal checks		>4 ANC: 57.5% (I) vs 23.5% (C) (P < 0.0001). FBD: 91.5% (I) vs 89% (C) (P-value not given). No postnatal visits: 5.9% (I) vs 29.3% (C) (P < 0.001).
Odeny et al, 2014 [25]	RCT in Nyanza region, Kenya; N = 388 HIV+ pregnant mothers enrolled in a prevention of mother-to-child transmission of HIV project, randomized to Intervention (n = 195) or Control (n = 193)		Intervention: 8 prenatal and 6 postnatal SMS messages. Participants in both study arms had SMS access to a study nurse.		Increase in postnatal care attendance and infant HIV testing by 8 weeks postpartum		Results (I. vs C.): Postnatal care attendance: 19.6% vs 11.8% (RR = 1.66; 95% CI = 1.02-2.70). Infant HIV testing: 92.0% vs 85.1% (RR = 1.08; 95% CI = 1.00-1.16)
Uddin et al, 2016 [26]	Quasi-experimental pre/post evaluation using population level household surveys in Bangladesh; N = 4158		SMS reminders to mothers timed to vaccination schedule		Increase vaccination coverage in hard-to-reach groups		Difference-in-differences for full vaccination: +29.5% (rural; P < 0.001) & +27.1% (urban; P < 0.05). OR = for rural: 3.8 (95% CI = 1.5-9.2); OR = for urban: 3.0 (95% CI = 1.4-6.4)
Haji et al, 2016 [27]	Quasi-experimental evaluation in 3 districts of rural Kenya with low coverage of 3rd dose pentavalent vaccine; N = 1116 children receiving first dose pentavalent vaccine		SMS vaccination appointment reminders compared with stickers or standard of care		Increase full vaccination coverage		SMS group significantly less likely to miss 3rd vaccine dose (OR = 0.2, CI = 0.04-0.8)
Gibson et al, 2017 [28]	Cluster RCT in rural Kenya; N = 2018 infants from 152 villages		SMS reminders before pentavalent & measles vaccination dates. Parents in 2 groups also received incentives of either KES75 (US$0.88) or KES200 (US$2.35) for timely immunization.		Increase full vaccination coverage (BCG, measles, 3 doses polio, 3 doses pentavalent) at 12 months		Overall 86% fully immunized. No significant effects for SMS or SMS+KES75 groups. SMS+KES200 group were significantly more likely to achieve full immunization vs control (RR = 1.09; 95% CI = 1.02-1.16; P = 0.014)
Zhou et al, 2016 [29]	Cluster RCT in 351 villages in Shaanxi Province, China; N = 1818 infants age 6-12 mo.		Free delivery of micronutrient powders plus daily SMS usage reminders compared with free delivery only and control		Increase caregiver compliance with micronutrient powder regimen; reduce child anaemia.		Higher compliance in SMS group (marginal effect: 0.10; 95% CI = 0.03-0.16). Greater decrease in anemia in SMS group relative to control group (marginal effect: -0.07; 95% CI = -0.12, -0.01), but not relative to delivery-only group (marginal effect = -0.03; 95% CI = -0.09-0.03).
Alam et al, 2017 [30]	Observational study comparing Aponjon subscribers from 5 districts of Bangladesh who did and did not receive prenatal messages; N = 476		Twice-weekly maternal and newborn health messages by SMS or IVR		Increase in skilled birth attendance; early initiation of breastfeeding; delayed newborn bathing; and postnatal care visits.		No significant differences between groups for any outcome.
Coleman et al, 2017 [31]	Retrospective study of HIV+ pregnant mothers, South Africa; N = 235 mothers receiving SMS intervention compared with non-users (N = 586)		Twice-weekly maternal health SMS messages tailored to stage of pregnancy and first year postpartum		Increase in ANC attendance and timely infant HIV testing; reduce low birth weight (<2500g).		SMS group were significantly more likely to attend ≥4 ANC visits (RR = 1.41; 95% CI = 1.15-1.72) and less likely to have a low birth weight infant (RR = 0.14; 95% CI = 0.02-1.07).
Intervention studies – grey literature:
Chowdhury, 2015 [32]	Retrospective observational study of MAMA’s Aponjon project in Bangladesh; N = 1473 (600 users +873 non-users matched by propensity score)		Subscriber-based MNCH messaging service using SMS or IVR, tailored to stage of pregnancy and infancy		Increase care seeking for MNCH		8/19 maternal care practices and 1/12 neonatal care practices significantly associated with Aponjon use (P < 0.05). No effect on infant feeding indicators.
Coleman & Xiong, 2017 [33]	Retrospective case-control study using clinical records, comparing MomConnect subscribers matched with non-subscribers in Johannesburg, South Africa. N = 98 per group for ANC data; n = 33 per group for infant immunization data.		Subscriber-based messaging service delivering twice-weekly pregnancy and post-partum health messages to personal phones; help desk for registered users to ask questions and give feedback on health services		Primary: ≥4 ANC visits; Secondary: total ANC visits; infant birth weight; infant immunization coverage		Descriptive results (I. vs C.) as sample size not achieved. ≥4 ANC visits: 68.4% vs 70.4%. Full immunization at 1 y: 97% vs 93.9%. 80.5% MomConnect users were satisfied with the service.
MatCH, 2016 [34]	Mixed methods evaluation of MomConnect (2011-2014) in KwaZuluNatal, South Africa. Quantitative: analysis of project monitoring data. Qualitative: interviews with subscribers (n = 60) and health workers (n = 37)		Subscriber-based messaging service delivering twice-weekly pregnancy and post-partum health messages to personal phones, linked to electronic medical records		Improved maternal and infant health and uptake of Prevention of Mother-to-Child HIV Transmission services		Enrollment targets were achieved and subscribers were highly satisfied with the SMS service. Further training for health workers and improved connectivity at health facilities were recommended to fully integrate the SMS service with electronic medical records.
Healthbridge Foundation of Canada, 2016 [35]	Quasi-experimental mixed methods study of 3M project (Men using Mobile phones to improve Maternal health) in Jharkhand state, India; N = 207 couples with pregnant mothers, divided into Intervention (n = 104) and Control groups (n = 103). Qualitative data collected through stakeholder interviews and six focus group discussions with participants.		Husbands in intervention group received weekly IVR messages with maternal health information and reminders. Mothers in both groups were counseled by frontline health workers using a job aid app with multimedia messages.		Improved uptake of maternal health services (4+ ANC visits; consumption of 100 iron-folic acid tablets; FBD)		On average, husbands in Intervention group listened to 9 of 29 messages, with 31% listening to none. Results (I. vs C.):4+ ANC visits: 68.3% vs 58.3%; P > 0.05. 100 Iron-folic acid tablets: 33.7% vs 27.2%; P > 0.05. FBD: 93.3% vs 62.1%; P < 0.001.
Implementation studies – published literature:
Crawford et al, 2014 [36]	Analysis of electronic monitoring records and quarterly phone-based user surveys in Chipatala Cha Pa Foni project, Malawi		Subscriber-based MNCH messaging service delivered through SMS or IVR sent to personal phone, or IVR stored and retrieved from a community phone		Increase knowledge and coverage of home- and facility-based MNCH care		Message delivery success was greatest for SMS subscribers (30% of users) who were also more likely to report intended or actual behavior change (P = 0.01)
Jiang et al, 2018 [37]	Description of implementation process and summary of process evaluation findings from monitoring records and qualitative interviews with participants at midterm (n = 22) and endline (n = 15).		Weekly SMS on infant feeding from 3rd trimester to 12 months postpartum; participants could text questions to a health professional		Increased EBF duration		3-phase implementation process: formative study; baseline questionnaire; message bank development. Process evaluation found high acceptability but preference for more in-depth and personalized content.
Flax et al, 2016 [38]	Evaluation of feasibility and acceptability of using group cell phones in cluster RCT with micro-credit clients in Nigeria. Analysis of data from exit interviews (n = 195) and in-depth interviews (n = 17) with participants, and focus group discussions (n = 16) with non-participants		Intervention x10 months: monthly large group breastfeeding education; weekly SMS to small groups who presented to monthly large group		Increase timely breastfeeding initiation and EBF duration		Participants reported that the group cell phones worked well (64%) and 44% met at least weekly to share BCC messages. Participants in groups meeting at least weekly were more likely to practice EBF to six months than those in groups that never met (OR = 5.6; 95% CI = 1.6-19.7).
Entsieh et al, 2015 [39]	Qualitative study; in-depth interviews (n=19) and focus group discussions (n=25 participants) with mothers who used Mobile Midwife messaging service in Ghana		Subscriber-based messaging service for maternal health		Improve maternal health and care-seeking		Participants described a gradual process of gaining trust in the Mobile Midwife messages, but needing to balance the new content with traditional practices. Engagement with the messages increased awareness of the need for skilled care and birth preparedness.
LeFevre et al, 2018 [40]	Evaluation of MomConnect reach and exposure from August 2014-April 2017 using system-generated data, South Africa		Subscriber-based messaging service delivering twice-weekly pregnancy and post-partum health messages to personal phones; help desk for registered users to ask questions and give feedback on health services		Improve maternal health and quality of health care services.		Half of all women attending ANC-1 registered with MomConnect (n = 1 159 431) and subscribers received over 80% of messages sent. In 2016, 26% of attempted registrations failed, indicating a need for on-going system monitoring and improvement.
Skinner et al, 2018 [41]	Qualitative study; in-depth interviews (n = 32) and 7 focus groups with MomConnect users, South Africa		Subscriber-based messaging service delivering twice-weekly pregnancy and post-partum health messages to personal phones; help desk for registered users to ask questions and give feedback on health services		Improve maternal health and quality of health care services.		Participants were satisfied with both the content and delivery system, with many saving the messages for future reference. Awareness of the help desk service was low.
Xiong et al, 2018 [42]	Evaluation of system data collected from August 14, 2014 to March 31, 2017 for MomConnect helpdesk, South Africa		Subscriber-based messaging service delivering twice-weekly pregnancy and post-partum health messages to personal phones; help desk for registered users to ask questions and give feedback on health services		Improve maternal health and quality of health care services.		Approximately 8% of MomConnect subscribers used the helpdesk (n = 95.288), sending over 250 messages per day; 78.5% were health questions.
Huggins & Valverde, 2018 [43]	Systems theory analysis of mNutrition using Malawi as a case study		SMS service delivering MNCH, household nutrition and agriculture content to smallholder farmers		Improve maternal and child nutrition		mNutrition was implemented within a complex system. Limited integration between sub-systems promoted more rapid implementation but likely compromised effectiveness and sustainability of messaging.
Implementation study – grey literature:
Chakraborty et al, 2019 [44]	Descriptive summary of monitoring findings (user surveys and focus group discussions) in Bihar, India		JEEViKA Mobile Vaani: interactive IVR platform allowing users to listen to pre-recorded content and record their own messages (curated). Core content focused on maternal diet diversity, complementary feeding, diarrhea management and social entitlements.		Increase intra-household dialogue on maternal and child nutrition, leading to improved practices		Extensive training facilitated user adoption of the JeeViKA platform. Implementing through self-help groups increased women’s participation but many were older women who engaged less with core content. Including non-core topics of interest to users increased overall engagement with content.
Feasibility studies – published literature:
Datta et al, 2014 [45]	Pre/post knowledge test and qualitative assessment in Tamil Nadu, India; N = 120		Participants received 10 MNCH messages over 10 d via SMS		Assess feasibility of SMS for improving MNCH knowledge		Knowledge scores improved and qualitative data indicated acceptability of SMS
Hazra et al, 2018 [46]	Quasi-experimental study in rural Uttar Pradesh, India. Quantitative survey (N = 881 husbands & 956 women). Qualitative in-depth interviews with 10 couples and 2 focus group discussions with frontline health workers		Husbands of pregnant women received IVR messages on 5 MNCH topics twice-weekly over 4 months		Assess feasibility of IVR to husbands for improving household MNCH discussions and practices		34% participants reported receiving messages; 16% discussed messages at home. Main barrier: calls came while at work. Mothers with husbands who discussed messages were more likely to report ANC visit in 3rd trimester (OR = 1.72, P < 0.05), postnatal visit within 7 d (OR = 3.02, P < 0.05) & delayed newborn bathing (OR = 1.93, P < 0.05).
Huang & Li, 2017 [47]	Survey of 129 randomly selected mothers who had registered for IVR service through community midwives in Cambodia.		Seven messages on neonatal care sent to mother’s phone from postnatal day 3-28		Assess acceptability of IVR to improve newborn care		Intervention was well accepted, with 60% indicating willingness to pay for the service. 43% reported taking baby to the health centre because of the IVR messages.
McBride et al, 2018 [48]	Qualitative endline evaluation of mMom users, Vietnam. 2 Focus Groups and 8 interviews with frontline health workers; 4 focus group discussions and 30 interviews with participants (n = 60)		2-3 times weekly SMS during pregnancy & infancy. 15% interactive messages. SMS service linked to Health Management Information System to enhance contact and follow up by health providers.		Increase access to MNCH services by ethnic minority women in remote areas		High satisfaction with SMS and most expressed willingness to pay for the service. Participants reported increased knowledge and care seeking and stronger relationships with frontline health workers.
Prieto et al, 2016 [49]	Mixed methods study: quantitative survey (all) and content analysis of text messages (groups 2 & 3). N = 78 Spanish speaking pregnant women or mothers of young infants in Guatemala.		All participants received a free basic mobile phone with prepaid credit. Group 1: 2 × weekly breastfeeding SMS. Group 2: group text messaging to discuss MNCH topics. Group 3: same as group 2 + breastfeeding messages + health professional facilitated group. Group 4: control		Compare text messaging approaches for MNCH with focus on breastfeeding		Knowledge of EBF at endline was greater in Groups 1 (60%) & 3 (50%) than Groups 2 (8%) & 4 (25%). Content analysis (groups 2 & 3): 62% messages related to social support; 35% health info; 3% other
Domek et al, 2016 [50]	Pilot RCT at 2 public health clinics in Guatemala City. N = 321 infants age 8-14 weeks presenting for 1st immunization dose.		3 SMS reminders one week before 2nd and 3rd immunization dose.		Assess feasibility and acceptability of SMS to improve adherence to full immunization.		No significant differences between groups (i. vs C.) for dose 2 (95.0% vs 90.1%; P = 0.12) or dose 3 (84.4% vs 80.7%; P = 0.69). Over 90% of participants wanted future SMS reminders with the Intervention group more willing to pay for the service (67.5% vs 49.6%; P = 0.01).
Wakadha et al, 2013 [51]	Pilot study in western Kenya; N = 72 mothers of infants age 0-3 weeks		SMS reminders sent 3 d before and on the day of Pentavalent vaccine doses 1 and 2. Mothers of infants vaccinated within 4 weeks of the scheduled date received KES150 (US$2) as either airtime credit (1/3) or mobile money transfer (2/3).		Assess feasibility and acceptability of SMS plus conditional cash transfers to improve timely vaccination.		63 children had known vaccination status at endline, of whom 90% received dose 1 and 85% received dose 2 within 4 weeks of the scheduled date. All mothers preferred mobile money transfer to airtime credit.
Formative research – published literature:
Hmone et al, 2016 [52]	Qualitative formative study with pregnant mothers and family members (n = 20 in-depth interviews) and service providers (n = 7 interviews; n = 15 focus group participants) in Yangon, Myanmar		SMS to increase EBF		Identify barriers and facilitators of EBF and of SMS communication in order to guide the design and messaging content for an RCT		EBF barriers include grandmothers’ recommendations for early supplementation, perception of insufficient breastmilk, and mothers’ return to work. Contextualized messages sent in the evening were recommended for the intervention.
Weerasinghe et al, 2016 [553]	Qualitative study in 2 tea estates, Sri Lanka. Focus group discussions with mothers (n = 109), fathers (n = 30) and older women (n = 32). Interviews with health and childcare providers (n = 15).		SMS or IVR for infant and young child feeding counseling		Explore issues related to infant and young child feeding, use of mobile phones and sources of nutritional information.		Most household have mobile phones, primarily used by men for voice calls. Infant and young child feeding counseling is provided in-person at regular growth monitoring sessions. Mothers and health workers preferred in-person counseling but were open to IVR as a supplementary intervention.
Kazi et al, 2017 [54]	Survey conducted in 8 health facilities in Northern Kenya; N = 284 attendees at routine ANC and immunization clinics.		SMS to promote ANC and immunization		Explore potential for SMS delivery platform		88% had access to mobile phones; 92% of those were interested in receiving a weekly SMS health message.
Yamin et al, 2018 [55]	Cross-sectional survey in Nangarhar Province, Afghanistan; N = 240 women		Direct Messaging for MNCH, including ANC and immunization reminders.		Explore perceptions related to use of mobile phones for MNCH communication.		91.7% routinely used mobile phones. 87.1% were willing to receive health messages. IVR was preferred to SMS.
Calderon et al, 2015 [56]	Cross-sectional survey in Arequipa, Peru. N = 220 mothers with at least one child under 5 y old		2-way SMS for child care during illness		Explore feasibility and acceptability of 2-way SMS platform		95% reported mobile phone access. 86% were interested in using SMS to receive child health messages or seek care but only 27% wanted to receive appointment reminders.
Brinkel et al, 2017 [57]	Qualitative study in four districts of the Greater Accra Region, Ghana; 4 focus group discussions with caregivers of at least one child under 10 y old N = 40		IVR for health seeking		Explore feasibility and acceptability of IVR platform		Participants were open to IVR but had no prior experience with it. Social, infrastructure and technology literacy barriers were identified. A toll-free number and training was recommended.
Case studies – grey literature:
MAMA Bangladesh [58]	Narrative report of intervention design process based on formative research findings		Subscriber-based MNCH messaging service using SMS or IVR; hotline for subscribers to contact a female doctor		Key design elements identified through formative research: options for users with low technology literacy; inclusion of family members; use female doctor voice; timing of message delivery; record messages in local dialects; adapt message content & frequency for rural vs urban clients
MOTECH ‘Mobile Midwife’ [59]	Narrative report of intervention design process and lessons learned		Subscriber-based IVR service for maternal health in rural Ghana		Message design & delivery guided by formative research. Collaboration with respected partners increased trust, and mHealth initiative integrated with efforts to improve ANC services.
Mobile Information for Maternal Health [60]	Narrative report of project design and monitoring results		Subscriber-based MNCH messaging service using IVR or SMS for pregnant mothers in Ghana, with interactive messages to assess retention of content		5400 subscribers; 73% report the messages are useful and the majority listen to >80% of the messages. Monitoring data showed IVR messages of 90 s retained 70% of users, so content was redeveloped to fit this optimal timing.
‘Healthy pregnancy, healthy Baby’ [61]	Narrative report of intervention design with lessons learned		Subscriber-based text messaging service in Tanzania with tracks for pregnant mothers, their supporters and general information-seekers		Lessons learned on content development: messages must be localized & pre-tested; best to craft in local language, not translate; include fun messages with formal health content. Implementation challenges include low female phone ownership & literacy; poor connectivity; responding to questions from subscribers.
‘Healthy Pregnancy Healthy Baby’ [62]	Narrative report of lessons learned from GSMA engagement with the ‘Healthy Pregnancy Healthy Baby’ program from 2014-2017, based on user feedback and surveys		Subscriber-based SMS service in Tanzania offering content on MNCH, prevention of mother-child HIV transmission and family planning, embedded in Ministry of Health mHealth platform		Key lessons learned: self-registration is challenging for many users but frontline workers assisting registration need regular refresher training; promoting the program via radio and TV ads doubled registrations; in-kind support from 4 national mobile network operators allows large reach at no cost to users; content must be both accurate and contextually appealing; appointment reminders are highly valued.
People In Need Cambodia [63]	Narrative report of intervention design process and pilot study		Subscriber-based IVR service in Cambodia delivering seven messages on neonatal care to mother’s phone from postnatal day 3-28		Message design and delivery guided by formative research. Contextual adaptations included use of voices representing locally authoritative figures; content geared to build community support for improved newborn care; midwives registered mothers after delivery; subscribers also received a hanging mobile toy with the messages. Key partnerships supported both content development and technology systems.
Kilkari [64]	Narrative report of lessons learned and best practices for implementation at scale		Subscriber-based weekly IVR service for MNCH in six states of India		2 million subscribers in first 12 months; 42% listen to ≥75% of messages. Content is narrated by a female doctor character and targets both fathers and mothers. Call costs are covered by Government of India. Ongoing investment in skilled technology support is needed to maintain large-scale implementation.
mNutrition [65]	Narrative report of intervention design and monitoring results		SMS service delivering MNCH and nutrition content in 8 countries: Malawi, Ghana, Tanzania, Kenya, Nigeria, Zambia, Uganda, Mozambique		Multi-partner initiative delivering localized content through mobile network providers. 1.59 million users across 8 countries by December 2017. 69% of users reported correct nutrition knowledge and practices vs 57% and 56% of non-users. 42% of users report sharing content with others. Repeated messages are appreciated and reinforce key content.

EBF – exclusive breastfeeding, FBD – facility-based delivery, RCT – randomized controlled trial, ANC – antenatal care, IVR – interactive voice response, MNCH – maternal newborn and child health