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.

Cost-effectiveness of SMS appointment reminders in increasing vaccination uptake in Lagos, Nigeria: A multi-centered randomized controlled trial.

OBJECTIVE: It is expected that mHealth largely contribute to increasing the coverages of key maternal and child health services. This study aims to estimate the cost-effectiveness of the SMS text reminders in clients' return visits to the health facilities for child vaccinations (incl. vitamin A supplementations), antenatal care (ANC) and family planning (FP), in urban communities of Lagos, Nigeria. METHODS: A multi-centered randomized control trial was conducted at 33 primary health centers (PHCs) in Lagos, Nigeria. All the clients having visited any of the 33 PHCs for child vaccinations, ANC and FP were randomly assigned either to intervention group or to control group. The participants in the intervention group were sent an SMS text reminder two days before their appointments. Those not having showed up on the appointment dates received an additional SMS text reminder seven days after original appointment dates as defaulter tracing. The primary outcome was whether a client made return visit to PHCs for the upcoming appointments. RESULTS: Of 12,779 appointments for 9,368 clients during the period of 1stApril to 30thJune 2019, 12,175 were included in the analysis. The return rate for child vaccinations in the intervention group was significantly higher (p < 0.001) by 4.8% - 6.0% than that in the control group, consistently across all the five different timings (on time as scheduled, and by 7 days, 14 days, 30 days, and 3 months after appointment dates). No significant difference between the two groups was detected in the increase in return rates for ANC and FP services. The incremental recurrent cost was estimated at 7.90 US Dollars per return case. CONCLUSION: SMS text reminders led to a significant increase in the number of return visits for child vaccinations, Lagos, Nigeria, while no significant increase in return visits was confirmed for ANC and FP appointments.

Socioeconomic barriers to facility-based delivery in urban poor communities of Lagos: Wealth, linguistic capacity, and residential area.

Background: The objective of this study is to describe delivery care utilizations and to identify socioeconomic barriers to practicing facility-based deliveries, in urban poor communities of Lagos, Nigeria. Methods: The study was a prospective cohort study conducted in Lagos Mainland, a local government area of Lagos State, Nigeria. A total of 723 randomly selected pregnant women participated in this study. The socio-economic barriers were sought from three different perspectives, i.e., household wealth as a financial barrier, linguistic capacity as a social barrier, and residential area as a physical barrier. The data were analyzed with descriptive and multivariate statistical methods using the imputed datasets. Results: While 41.9% of the participants delivered at governmental health facilities, 28.3% and 29.8% of them gave births at private health facilities and other places, respectively. As the results of the analyses, household wealth was positively associated with childbirth at a governmental health facility. Egun-speaking women were more likely to give births at private facilities than Yoruba-speaking women, while Igbo-speaking and Hausa-speaking women were more likely to choose other places for their childbirths. Conclusion: This study identified the financial and linguistic barriers to facility-based deliveries among women in urban poor communities.