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

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

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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 rando...

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Main Authors: James Peng, Erica Wetzler, Brenda Wandika, Peninah Kithao, June Moraa, Jenna I Udren, Olivia Schultes, Esther Akinyi, Lusi Osborn, Anna Hedstrom, Barbra A Richardson, Manasi Kumar, Dalton Wamalwa, John Kinuthia, Keshet Ronen, Jennifer A Unger
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2025-08-01
Series:PLOS Digital Health
Online Access:https://doi.org/10.1371/journal.pdig.0000968
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Summary: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.
ISSN:2767-3170

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