Table 3.
Summary of findings.a
| Outcomes | Anticipated absolute effectsb | Relative effect, RRc (95% CI) | Number of participants (studies) | Certainty of the evidence (GRADEd,e) | Comments | |
|
|
Risk with standard care | Risk with mHealthf intervention (95% CI) |
|
|
|
|
| 4 or more ANCg visits (1-way communication) | 234 per 1000 | 501 per 1000 (412-609) | 2.14 (1.76-2.60) | 1945 (2 RCTsh) | Moderatei | One-way mHealth intervention likely results in large increase in 4 or more ANC visit utilizations among pregnant women in LMICsj, and further research may change the estimate. |
| 4 or more ANC visits (2-way communication) | 659 per 1000 | 771 per 1000 (712-837) | 1.17 (1.08-1.27) | 1762 (3 RCTs) | Lowk,l | Two-way mHealth intervention may result in an increase in 4 or more ANC visit utilizations among pregnant women in LIMCs and further research is likely to change the estimate. |
| SBAm (1-way communication) | 771 per 1000 | 802 per 1000 (748-848) | 1.04 (0.97-1.10) | 3460 (3 RCTs) | Very lowi,l,n | One-way mHealth intervention may not increase SBA during delivery in LMICs, but the evidence is very uncertain. |
| SBA (2-way communication) | 557 per 1000 | 685 per 1000 (635-740) | 1.23 (1.14-1.33) | 1212 (2 RCTs) | Moderateo | Two-way mHealth intervention likely results in an increase in SBA during delivery among pregnant women in LMICs, and further research may change the estimate. |
| Facility delivery (<80% at baseline) | 360 per 1000 | 604 per 1000 (467-787) | 1.68 (1.30-2.19) | 1819 (2 RCTs) | Moderateo | mHealth intervention likely results in an increase in facility delivery in LMICs where fewer pregnant women use facility delivery, and further research may change the estimate. |
| Facility delivery (80% or more at baseline) | 990 per 1000 | 1000 per 1000 (960-1000) | 1.01 (0.97-1.04) | 300 (1 RCT) | Lown,p | mHealth intervention may not increase facility delivery in LMICs where most pregnant women already use facility delivery, and further research is likely to change the estimate. |
amHealth intervention compared with standard care for improving ANC utilization, SBA during delivery, and facility delivery among pregnant women. Population: pregnant women; setting: LMICs (Brazil, China, Ethiopia, India, Kenya, Nigeria, and Tanzania); intervention: mHealth intervention; comparison: standard care.
bThe risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
cRR: risk ratio.
dGRADE: Grading of Recommendation, Assessment, Development and Evaluation.
eThe GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate—the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited—the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate—the true effect is likely to be substantially different from the estimate of effect.
fmHealth: mobile health.
gANC: antenatal care.
hRCT: randomized controlled trial.
iUnclear or lack of blinding of participants and outcome assessors.
jLMICs: low- and middle-income countries.
kUnclear or lack of sequence generation, blinding of participants and outcome assessors, and incomplete outcome data.
lStatistical heterogeneity (I2>50%).
mSBA: skilled birth attendance.
nCI crossed the threshold.
oUnclear sequence generation, blinding of participants, and outcome assessors.
pLack of blinding of participants and personnel.