Do mothers pick up a phone? A cross-sectional study on delivery of MCH voice messages in Lagos, Nigeria.

BACKGROUND: Voice messages have been employed as an effective and efficient approach for increasing health service utilization and health promotion in low- and middle-income countries. However, unlike SMS, voice message services require their users to pick up a phone call at its delivery time. Furthermore, voice messages are difficult for the users to review their contents afterward. While recognizing that voice messages are more friendly to specific groups (eg, illiterate or less literate populations), there should be several challenges in successfully operationalizing its intervention program. OBJECTIVE: This study is aimed to estimate the extent to which voice message service users pick up the phone calls of voice messages and complete listening up to or beyond the core part of voice messages. METHODS: A voice message service program composed of 14 episodes on maternal, newborn, and child health was piloted in Lagos, Nigeria, from 2018 to 2019. A voice message call of each of 14 episodes was delivered to the mobile phones of the program participants per day for 14 consecutive days. A total of 513 participants in the voice message service chose one of five locally spoken languages as the language to be used for voice messages. Two multilevel logistic regression models were created to understand participants' adherence to the voice message: (a) Model 1 for testing whether a voice message call is picked up; and (b) Model 2 for testing whether a voice message call having been picked up is listened to up to the core messaging part. RESULTS: The greater the voice message episode number became, the smaller proportion of the participants picked up the phone calls of voice message (aOR: 0.98; 95% CI: 0.97-0.99; P = .01). Only 854 of 3765 voice message calls having been picked up by the participants (22.7%) were listened to up to their core message parts. It was found that picking up a phone call did not necessarily ensure listening up to the core message part. This indicates a discontinuity between these two actions. CONCLUSIONS: The participants were likely to stop picking up the phone as the episode number of voice messages progressed. In view of the discontinuity between picking up a phone call and listening up to the core message part, we should not assume that those picking up the phone would automatically complete listening to the entire or core voice message.

Expanding access to maternal health services for pregnant adolescent girls.

A significant proportion of pregnant adolescent girls do not seek appropriate care during pregnancy because antenatal care services are ill-adapted to their age-group. To bridge this gap, the Lagos State Government established a -Young Moms Clinic‖ where antenatal care services uniquely tailored to the needs of pregnant adolescents was piloted for six months. During this period, 106 pregnant adolescent girls enrolled in the clinic and 98% of them completed the minimum four ANC visits required of them. In addition, they acquired knowledge on newborn care, sexual reproductive health and were either re-integrated back to school or empowered with income-generating skills following delivery. In this regard, the Young Mom's Clinic is a promising approach to meet the needs of pregnant adolescent girls as it expanded their access to the type of specialized care not readily accessible to them within public health facilities.

Underlying causes of underutilization of maternal, neonatal and child health (MNCH) services in Africa: A survey from Lagos State, Nigeria.

Lagos State, Nigeria, Africa's largest city with an estimaed 21 million population, continues to face challenges in its attempts to reduce maternal mortality (555 deaths per 100,000 live births) and deaths of children under five (59 per 1,000 live births). These deaths are more common among women and children living in poverty, many of whom rarely utilize health services. This paper describes the trend in the use of maternal, neonatal and child health (MNCH) services in the State in the past decade and shows barriers to the use of the services. Significant improvement in the coverage of the services were not observed. We identified the following five types of barriers to the use of MNCH services: i) financial barriers, ii) physical barriers, iii) cognitive barriers, iv) organizational barriers, and v) psychological and socio-cultural barriers. To address these interrelated barriers, the Lagos State Ministry of Health should prioritize regular outreach health services including health promotion, and realize the current initiative for massive recruitment of health personnel and appropriate deployment of them.