High-impact essential newborn care practices and interventions are available to support neonatal survival, but coverage remains a challenge in sub-Saharan Africa, where neonatal mortality is unacceptably high. Adherence to these practices and uptake of life-saving interventions requires that a mother understands neonatal care and illness and that she is supported to implement care. It is estimated that up to 80% of neonatal deaths occur as a result of delays in mothers? recognition of infant illness and decision to seek care. Two-way mobile health (mHealth) communication strategies can enable mothers to remotely interact with a healthcare worker (HCW) and receive real-time education, counseling, encouragement, motivation and decisional guidance to support neonatal health. We hypothesize that two-way SMS communication in late pregnancy and the neonatal period can prevent neonatal mortality by (1) supporting maternal implementation of essential newborn care (early and exclusive breastfeeding, cord care, and thermal care), (2) improving identification of neonatal danger signs and care seeking, and (3) augmenting maternal social support and self-efficacy, and reducing depressive symptoms. We have developed a unique two-way SMS platform (Mobile WACh) that combines automated bulk SMS messaging and dialogue with a HCW. We have adapted this approach for intensive neonatal support and evaluations (Mobile WACh-NEO). Mobile WACh NEO (MWN) enhances the benefits of SMS messaging by engaging mothers with SMS communication and bringing timely information and support - asking critical questions at crucial times in order to assess the needs and health of newborns. Our overarching aim is to determine the effect of Mobile WACh NEO on neonatal mortality and understand the mechanisms by which this innovation impacts neonatal health. We propose to determine the effect of MWN on neonatal mortality, essential newborn care, care seeking, and maternal mental health in the first 6 weeks postpartum, in a 2-armed randomized controlled trial.
In AIM 1 we will determine the effect of Mobile WACh NEO on neonatal mortality, compared to no SMS control.
In AIM 2, we will examine the effect of Mobile WACh NEO on maternal implementation of essential newborn care and care seeking behavior.
In AIM 3 we will examine the effects of Mobile WACh NEO on maternal social support, self-efficacy and depression. Finally, we will explore the associations between maternal mental health, implementation of essential newborn care, neonatal care seeking and participant engagement by SMS. This study will evaluate a novel intervention to address a crucial gap in supporting mothers to care for their neonates and seek care when needed, and has the potential to make a significant contribution to the World Health Organization?s Every Newborn Action Plan to end preventable neonatal death and stillbirth.

Public Health Relevance

To improve neonatal mortality it is critical to engage families, especially mothers, in essential newborn practices and appropriate care seeking for neonatal illness as well as to support maternal mental health and self-efficacy. This randomized controlled trial (RCT) aims to determine the effect and mechanisms of a two- way mobile health (mHealth) SMS intervention, Mobile WACh NEO, on neonatal mortality, essential newborn practices, care-seeking and maternal mental health outcomes.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Clinical Management of Patients in Community-based Settings Study Section (CMPC)
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Davis, Maurice
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University of Washington
United States
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