短信服务通信可改善中低收入国家纯母乳喂养和产后早期避孕：一项随机试验。
Short message service communication improves exclusive breastfeeding and early postpartum contraception in a low- to middle-income country setting: a randomised trial.
机构信息
Department of Global Health, University of Washington, Seattle, WA, USA.
Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
出版信息
BJOG. 2018 Nov;125(12):1620-1629. doi: 10.1111/1471-0528.15337. Epub 2018 Aug 28.
OBJECTIVE
To assess the effect of short message service (SMS) communication on facility delivery, exclusive breastfeeding (EBF), and contraceptive use.
DESIGN
Mobile WACh was a three-arm unblinded individually randomised controlled trial.
SETTING
A public sector maternal child health (MCH) clinic in Nairobi, Kenya.
POPULATION
Three hundred women attending antenatal care were randomised, 100 to each arm, and followed for 24 weeks postpartum. Pregnant women, at least 14 years old with access to a mobile phone and able to read SMS were eligible for participation.
METHODS
Women were randomised (1:1:1) to receive one-way SMS versus two-way SMS with a nurse versus control. Weekly SMS content was tailored for maternal characteristics and pregnancy or postpartum timing.
MAIN OUTCOME MEASURES
Facility delivery, EBF, and contraceptive use were compared separately between each intervention arm and the control arm by Kaplan-Meier analysis and chi-square tests using intent-to-treat analyses.
RESULTS
The overall facility delivery rate was high (98%) and did not differ by arm. Compared with controls, probability of EBF was higher in the one-way SMS arm at 10 and 16 weeks, and in the two-way SMS arm at 10, 16, and 24 weeks (P < 0.005 for all). Contraceptive use was significantly higher in both intervention arms by 16 weeks (one-way SMS: 72% and two-way SMS: 73%; P = 0.03 and P = 0.02 versus 57% control, respectively); however, this difference was not significant when correcting for multiple comparisons.
CONCLUSION
One-way and two-way SMS improved EBF practices and early contraceptive use. Two-way SMS had an added benefit on sustained EBF, providing evidence that SMS messaging influences uptake of interventions that improve maternal and neonatal health.
SOURCE OF FUNDING
Funding was provided by the National Institutes of Health (K12HD001264 to JAU, R01HD080460, K24HD054314 to GJS, and K01AI116298 to ALD), the National Science Foundation (Graduate Research Fellowship to TP and BD), as well as the University of Washington Global Center for Integrated Health of Women Adolescents and Children (Global WACh).
TWEETABLE ABSTRACT
The Mobile WACh RCT demonstrates that SMS improved practice of exclusive breastfeeding and early postpartum contraception.
目的
评估短信服务（SMS）通讯对分娩设施利用、纯母乳喂养（EBF）和避孕措施使用的影响。
设计
Mobile WACh 是一项三臂非盲个体随机对照试验。
地点
肯尼亚内罗毕的一家公立部门母婴保健（MCH）诊所。
人群
300 名接受产前保健的妇女被随机分为 100 人一组，共 3 组，随访 24 周产后。符合条件的孕妇至少 14 岁，可使用手机并能阅读短信。
方法
对孕妇进行 1:1:1 的分组，分别接受单向 SMS 与护士双向 SMS 或对照干预。每周的短信内容根据产妇特征和妊娠或产后时间定制。
主要观察指标
通过 Kaplan-Meier 分析和意向治疗分析的卡方检验，分别比较每个干预组与对照组之间的分娩设施利用、EBF 和避孕措施使用情况。
结果
总体分娩设施利用率高（98%），且各组之间无差异。与对照组相比，单向 SMS 组在第 10 周和第 16 周、双向 SMS 组在第 10 周、第 16 周和第 24 周的 EBF 概率更高（所有 P<0.005）。在第 16 周时，两个干预组的避孕措施使用率均显著更高（单向 SMS：72%和双向 SMS：73%；分别与对照组 57%相比，P=0.03 和 P=0.02）；然而，当进行多次比较校正时，这种差异不再具有统计学意义。
结论
单向和双向 SMS 提高了 EBF 实践和早期避孕措施的使用。双向 SMS 对持续 EBF 有额外益处，这表明短信消息传递影响了改善母婴健康的干预措施的采用。
资金来源
本研究由美国国立卫生研究院（K12HD001264 给 JAU、R01HD080460、K24HD054314 给 GJS 和 K01AI116298 给 ALD）、美国国家科学基金会（TP 和 BD 获得研究生研究奖学金）以及华盛顿大学全球妇女青少年儿童综合健康中心（Global WACh）共同资助。
推文摘要
Mobile WACh RCT 表明，SMS 提高了纯母乳喂养的实践和产后早期的避孕措施使用。
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