Population and Family Health Department, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia.
Reproductive and Family Health Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
PLoS One. 2024 Nov 14;19(11):e0310124. doi: 10.1371/journal.pone.0310124. eCollection 2024.
Women in the early postpartum period face substantial unmet needs in contraception to encourage birth intervals and reduce unintended pregnancies. The widespread ownership of mobile devices offers an opportunity to employ mobile health strategies for enhancing communication between healthcare providers and clients. However, little is known about the effectiveness of mobile health interventions to improve early adoption of contraceptive methods after childbirth in Ehiopia.
This study aimed to evaluate the effectiveness of a mobile health intervention in enhancing the uptake of modern contraceptive methods in the early postpartum period in Dessie and Kombolcha cities, northeast Ethiopia.
The research was conducted in Dessie and Kombolcha cities zones located in the Amhara region of Northeast Ethiopia from 15th January to 15th June, 2023. Pregnant women with a confirmed gestation of 30 weeks were enrolled and followed up to the 45-day postpartum period. The study employed a cluster randomized control trial involving 764 participants (381 controls and 383 in the intervention group). The intervention group received a new mobile health intervention in addition to the existing healthcare practices, while the control group solely adhered to the current healthcare practices. Data were collected using the Open Data Kit (ODK) and exported to STATA 17 for analysis. The marginal model Generalized Estimating Equations (GEE) through the application of an exchangeable working correlation was applied. The effect of the intervention on the outcome was measured using the odds ratio with a 95% confidence interval at a p-value less than 0.05 significant level.
The study found that 78.7% of participants in the control group and 77.3% in the intervention group had sexual practice after childbirth. The proportion of early postpartum contraceptive uptake in the intervention group (51.6%) was significantly higher than in the control group (38%). The odds of adopting modern contraceptive methods during the early postpartum period were 1.6 times higher among mothers who received the mHealth intervention compared to those in the control group (AOR: 1.6, 95% CI: 1.249-2.123). The study identified significant predictors for the uptake of contraceptive methods during the early postpartum period, including having a live newborn (AOR: 3.7, 95% CI: 1.034-13.353), parity (AOR: 1.7, 95% CI: 1.069-2.695), and previous experience with contraceptive initiation (AOR: 0.5, 95% CI: 0.358-0.912).
This study findings demonstrated that the potential effectiveness of mobile health interventions in promoting timely contraceptive adoption during early postpartum period. The mobile health intervention, combined with factors such as timing of previous contraceptive initiation, newborn status, and maternal parity, significantly enhances the likelihood of early contraceptive adoption. These nuanced insights provide a strong foundation for developing targeted health interventions and policies aimed at improving early postpartum contraception.
The trial was registered on December 23, 2022, in the Protocol Registration and Results System (PRS) Clinical Trial Registry, www.ClinicalTrials.gov, ID: ClinicalTrials.gov ID: NCT05666037.
处于产后早期的女性在避孕方面存在大量未满足的需求，这有助于控制生育间隔并减少意外怀孕。移动设备的广泛普及为利用移动健康策略加强医疗保健提供者与客户之间的沟通提供了机会。然而，对于移动健康干预措施在提高埃塞俄比亚产后早期采用避孕方法方面的有效性，我们知之甚少。
本研究旨在评估移动健康干预措施在提高德西和孔波乔克拉城市（位于埃塞俄比亚东北部的阿姆哈拉地区）产后早期现代避孕方法使用率方面的有效性。
本研究于 2023 年 1 月 15 日至 6 月 15 日在埃塞俄比亚东北部的德西和孔波乔克拉城市地区进行。纳入妊娠 30 周并确认妊娠的孕妇，并随访至产后 45 天。研究采用了一项包括 764 名参与者（对照组 381 名，干预组 383 名）的集群随机对照试验。干预组除了现有的医疗保健实践外，还接受了新的移动健康干预，而对照组仅遵循现有的医疗保健实践。使用 Open Data Kit（ODK）收集数据，并将其导出到 STATA 17 进行分析。通过应用可交换工作相关系数的广义估计方程（GEE）应用边际模型。使用具有 95%置信区间的优势比（OR）和 p 值<0.05 的显著性水平来衡量干预对结果的影响。
研究发现，对照组中有 78.7%的参与者和干预组中有 77.3%的参与者在产后有性行为。干预组中早期产后避孕使用率（51.6%）明显高于对照组（38%）。与对照组相比，接受移动健康干预的母亲在早期产后采用现代避孕方法的可能性高 1.6 倍（OR：1.6，95%置信区间：1.249-2.123）。研究确定了早期产后采用避孕方法的显著预测因素，包括有活产新生儿（OR：3.7，95%置信区间：1.034-13.353）、产次（OR：1.7，95%置信区间：1.069-2.695）和以前有避孕起始经验（OR：0.5，95%置信区间：0.358-0.912）。
本研究结果表明，移动健康干预在促进产后早期及时采用避孕方法方面具有潜在的有效性。移动健康干预，结合以前避孕起始时间、新生儿状况和产妇产次等因素，显著提高了早期避孕采用的可能性。这些细致入微的见解为制定以改善产后早期避孕为目标的针对性健康干预措施和政策提供了坚实的基础。
该试验于 2022 年 12 月 23 日在 Protocol Registration and Results System（PRS）临床试验注册系统（www.ClinicalTrials.gov）上注册，注册号为：ClinicalTrials.gov ID：NCT05666037。
