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Journal Articles

Scaling up a health and nutrition hotline in Malawi: the benefits of multisectoral collaboration

British Medical Journal

Carla Blauvelt and colleagues describe a multisectoral collaboration that enabled the scale up of a health advice telephone service and its transition to government in Malawi.

Strengthening the home-to-facility continuum of newborn and child health care through mHealth: Evidence from an intervention in rural Malawi

June 10, 2015
African Population Studies Special Edition 2015

This paper assesses the impact of a mobile health (mHealth) project on uptake of home-based care for newborn and child health, and investigates the extent to which uptake of home-based care resulted into lessened pressure on health facilities for conditions that can be handled at the household level. It uses mixed methods consisting of cross-sectional household surveys data from a quasi-experimental pre-test post-test design as well as qualitative data. The results show a large, positive effect of the project on the aggregate home-based care for child health, and a sharp, negative impact on facility-based care seeking for fever among children whose mothers/caretakers used the services offered by the intervention. Reasons for using the services mainly relate to the potential of avoiding unnecessary trips to the health facility for care that could be provided at home. The project provides insights on mHealth and community-based programming to improve newborn and child health care delivery

Fostering the use of quasi-experimental designs for evaluating public health interventions: insights from an mHealth project in Malawi

June 10, 2015
African Population Studies Special Edition 2015

The evidence base to support the growing field of mHealth is relatively nascent, with most studies lacking the level of rigor needed to inform scale up of interventions. This paper investigates the impact of a maternal, newborn and child health (MNCH) mHealth project in Malawi, comparing the intention-to-treat (ITT) and the treatment on the treated (TOT) estimates, and discussing the implications for future evaluations. Services offered included a toll-free case management hotline and mobile messaging service for women and children. The evaluation methods included a quasi-experimental pre-test post-test design, consisting of cross-sectional household surveys. A total of 4,230 women were interviewed in the intervention area and 2,463 in the control site. While the intervention did not have any ITT effects of the MNCH outcomes studied, there were large TOT effects. Rigorous evaluation designs can be successfully applied to mHealth pilot projects, helping to understand what works and what does not.

Improving care-seeking for facility-based health services in a rural, resource-limited setting

June 1, 2015
African Population Studies Special Edition 2015

The aim of this paper was to investigate the impact of a toll-free hotline and mobile messaging service on care-seeking behaviors. Due to the low uptake of the services, the treatment on the treated estimate is used. For maternal health, the intervention had a strong, positive impact on antenatal care initiation and skilled birth attendance. No effect was observed for postnatal check-ups, receiving the recommended four antenatal care visits and vitamin A uptake. A negative effect was observed on tetanus toxoid coverage. For child health, no change was seen in child immunization, and a significant decrease was observed for care-seeking for children with fever. Different factors are associated with care-seeking, which may explain in part the variations seen across care-seeking behaviors and possible influence of exogenous factors. Introduction of mHealth services for demand generation require attention.

Scale Matters: A Cost-Outcome Analysis of an m-Health Intervention in Malawi

September 8, 2015
Telemedicine and eHealth

Despite promising evidence on the benefits of such mHealth technologies, considerable gaps exist in the economic evaluations of m-health interventions. In a global survey on m-health solutions conducted by the World Health Organization, lack of cost-effectiveness data was identified. In order to strengthen the knowledge base for the assessment of m-health technology, the authors have undertaken a cost outcome analysis of an m-health intervention.Published in the Journal of Telemedicine and eHealth, the primary objectives of this study are to determine cost per user and cost per contact with users of a mobile health (m-health) intervention. Authors: Larsen-Cooper Erin, Bancroft Emily, Rajagopal Sharanya, O’Toole Maggie, and Levin Ann.

Where there is no phone: The benefits and limitations of using intermediaries to extend the reach of mHealth to individuals without personal phones in Malawi

June 10, 2015
African Population Studies

Study Published in African Population Studies Vol 29, No 1 (2015): Supplement on Leveraging Mobile Technology to Reduce Barriers to Maternal, Newborn And Child Health Care. The purpose of this study is to identify the benefits and limitations associated with intermediaries to provide access to and increase utilization of an mHealth intervention amongst people without personal phones in Balaka District, Malawi. A mixed-methods approach was utilized including quantitative data on usage and focus groups and interviews with users and volunteers. Community volunteers equipped with mobile phones served as intermediaries and were critical access points to the service for users without personal phones.

SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience

January 28, 2014
Global Health: Science and Practice

SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience. Read the full article published in Global Health: Science and Progress..

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