The effect of an interactive mobile health intervention to improve community-based essential neonatal care practices among postpartum women in northeast Ethiopia: a cluster randomized controlled trial

Background: Despite global declines in child mortality rates, Africa's reduction is lagging behind other regions. Neonatal survival remains a key priority in the sustainable development agenda. Promoting neonatal care practices at the individual and community levels is essential, and technology-based interventions can effectively reach potential future mothers. This study aimed to evaluate the effect of an interactive mobile health intervention on improving community-based essential neonatal care practices among postpartum women in northeast Ethiopia.

Methods: This study was conducted in Dessie and Kombolcha city zones, in northeast Ethiopia. A cluster randomized controlled trial was implemented among 743 participants (376 intervention and 367 control) from 2 January to 15 June 2023. Pregnant women at 30-weeks' gestation in selected clusters were enrolled and followed up to 45 days after childbirth. Data were collected using Open Data Kit and analysed with Stata version 17. Structural equation modelling through confirmatory factor analysis was employed. Model fitness was evaluated using the χ2:degree of freedom ratio, root mean square error of approximation and standardized root mean square residual, indicating a good model fit. Statistical significance was declared at a level <0.05 with a 95% confidence interval.

Results: The study revealed high narrow birth-to-pregnancy intervals of <24 months in both groups (48.5% control, 49.5% intervention). Awareness of neonatal care increased markedly in the intervention group, increasing from 62.0% to 85.9%, compared with an increase from 57.8% to 67.6% in the control group. Disagreement regarding immediate newborn bathing was more prevalent in the intervention group (73.9%) than in the control group (58.9%). Initiating breastfeeding within 1 h after birth was higher in the intervention group (85.4%) compared with the control group (74.4%). Postnatal visits to health facilities were more frequent in the intervention group (79.6%) than in the control group (54.8%). Mobile health intervention (β=0.393, p=0.007) and knowledge of neonatal care (β=0.347, p=0.012) had a significant positive effect on neonatal care practices. There were no significant indirect pathways between the variables analysed. Mobile health intervention and knowledge of neonatal care remain significant predictors with a total effect of β=0.382, p=0.009 and β=0.347, p=0.012, respectively, in enhancing neonatal care practices.

Conclusions: This study underscores the significant role of mobile health interventions and maternal knowledge in enhancing neonatal care practices. These findings should inform the design and implementation of maternal and child health programs, emphasizing the integration of technology and education to improve neonatal outcomes in resource-limited settings.

Trial registration: Protocol Registration and Results System Clinical Trial Registry, www.ClinicalTrials.gov, NCT05666050. Registered on 23 December 2022.