直接面向受益人的移动通信方案对生殖和儿童健康结局的影响：印度的一项随机对照试验。

The impact of a direct to beneficiary mobile communication program on reproductive and child health outcomes: a randomised controlled trial in India.

机构信息

University of Cape Town, School of Public Health and Family Medicine, Cape Town, South Africa

International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

出版信息

BMJ Glob Health. 2022 Jul;6(Suppl 5). doi: 10.1136/bmjgh-2022-008838.

BACKGROUND

Direct-to-beneficiary communication mobile programmes are among the few examples of digital health programmes to have scaled widely in low-resource settings. Yet, evidence on their impact at scale is limited. This study aims to assess whether exposure to mobile health information calls during pregnancy and postpartum improved infant feeding and family planning practices.

METHODS

We conducted an individually randomised controlled trial in four districts of Madhya Pradesh, India. Study participants included Hindi speaking women 4-7 months pregnant (n=5095) with access to a mobile phone and their husbands (n=3842). Women were randomised to either an intervention group where they received up to 72 Kilkari messages or a control group where they received none. Intention-to-treat (ITT) and instrumental variable (IV) analyses are presented.

RESULTS

An average of 65% of the 2695 women randomised to receive Kilkari listened to ≥50% of the cumulative content of calls answered. Kilkari was not observed to have a significant impact on the primary outcome of exclusive breast feeding (ITT, relative risk (RR): 1.04, 95% CI 0.88 to 1.23, p=0.64; IV, RR: 1.10, 95% CI 0.67 to 1.81, p=0.71). Across study arms, Kilkari was associated with a 3.7% higher use of modern reversible contraceptives (RR: 1.12, 95% CI 1.03 to 1.21, p=0.007), and a 2.0% lower proportion of men or women sterilised since the birth of the child (RR: 0.85, 95% CI 0.74 to 0.97, p=0.016). Higher reversible method use was driven by increases in condom use and greatest among those women exposed to Kilkari with any male child (9.9% increase), in the poorest socioeconomic strata (15.8% increase), and in disadvantaged castes (12.0% increase). Immunisation at 10 weeks was higher among the children of Kilkari listeners (2.8% higher; RR: 1.03, 95% CI 1.00 to 1.06, p=0.048). Significant differences were not observed for other maternal, newborn and child health outcomes assessed.

CONCLUSION

Study findings provide evidence to date on the effectiveness of the largest mobile health messaging programme in the world.

TRIAL REGISTRATION NUMBER

Trial registration clinicaltrials.gov; ID 90075552, NCT03576157.

背景

直接向受益人传播的移动程序是为数不多的在资源匮乏环境中广泛扩大规模的数字健康计划之一。然而，关于其规模影响的证据有限。本研究旨在评估在怀孕期间和产后接触移动健康信息电话是否改善了婴儿喂养和计划生育实践。

方法

我们在印度中央邦的四个地区进行了一项个体随机对照试验。研究参与者包括会讲北印度语、怀孕 4-7 个月（n=5095）且有手机的妇女及其丈夫（n=3842）。妇女被随机分配到干预组，她们接受了最多 72 次 Kilkari 消息，或对照组，她们没有收到任何消息。意向治疗（ITT）和工具变量（IV）分析均已进行。

结果

随机接受 Kilkari 的 2695 名妇女中，平均有 65%听取了≥50%的电话回答的累计内容。Kilkari 对主要结局（纯母乳喂养）没有显著影响（ITT，相对风险（RR）：1.04，95%CI 0.88 至 1.23，p=0.64；IV，RR：1.10，95%CI 0.67 至 1.81，p=0.71）。在研究组中，Kilkari 与现代可逆避孕措施使用率增加 3.7%相关（RR：1.12，95%CI 1.03 至 1.21，p=0.007），且自孩子出生以来接受绝育手术的男性或女性比例降低 2.0%（RR：0.85，95%CI 0.74 至 0.97，p=0.016）。可逆转方法的使用率增加主要归因于避孕套使用的增加，且在暴露于 Kilkari 的所有男性儿童（增加 9.9%）、最贫困的社会经济阶层（增加 15.8%）和弱势群体（增加 12.0%）中增加最为明显。在接受 Kilkari 消息的儿童中，10 周时的免疫接种率更高（增加 2.8%；RR：1.03，95%CI 1.00 至 1.06，p=0.048）。其他母婴、新生儿和儿童健康结局评估未观察到显著差异。