Cherie Niguss, Wordofa Muluemebet Abera, Debelew Gurmesa Tura
Reproductive and Family Health Department, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Population and Family Health Department, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia.
Int Health. 2025 Sep 3;17(5):820-835. doi: 10.1093/inthealth/ihae080.
Despite global declines in child mortality rates, Africa's reduction is lagging behind other regions. Neonatal survival remains a key priority in the sustainable development agenda. Promoting neonatal care practices at the individual and community levels is essential, and technology-based interventions can effectively reach potential future mothers. This study aimed to evaluate the effect of an interactive mobile health intervention on improving community-based essential neonatal care practices among postpartum women in northeast Ethiopia.
This study was conducted in Dessie and Kombolcha city zones, in northeast Ethiopia. A cluster randomized controlled trial was implemented among 743 participants (376 intervention and 367 control) from 2 January to 15 June 2023. Pregnant women at 30-weeks' gestation in selected clusters were enrolled and followed up to 45 days after childbirth. Data were collected using Open Data Kit and analysed with Stata version 17. Structural equation modelling through confirmatory factor analysis was employed. Model fitness was evaluated using the χ2:degree of freedom ratio, root mean square error of approximation and standardized root mean square residual, indicating a good model fit. Statistical significance was declared at a level <0.05 with a 95% confidence interval.
The study revealed high narrow birth-to-pregnancy intervals of <24 months in both groups (48.5% control, 49.5% intervention). Awareness of neonatal care increased markedly in the intervention group, increasing from 62.0% to 85.9%, compared with an increase from 57.8% to 67.6% in the control group. Disagreement regarding immediate newborn bathing was more prevalent in the intervention group (73.9%) than in the control group (58.9%). Initiating breastfeeding within 1 h after birth was higher in the intervention group (85.4%) compared with the control group (74.4%). Postnatal visits to health facilities were more frequent in the intervention group (79.6%) than in the control group (54.8%). Mobile health intervention (β=0.393, p=0.007) and knowledge of neonatal care (β=0.347, p=0.012) had a significant positive effect on neonatal care practices. There were no significant indirect pathways between the variables analysed. Mobile health intervention and knowledge of neonatal care remain significant predictors with a total effect of β=0.382, p=0.009 and β=0.347, p=0.012, respectively, in enhancing neonatal care practices.
This study underscores the significant role of mobile health interventions and maternal knowledge in enhancing neonatal care practices. These findings should inform the design and implementation of maternal and child health programs, emphasizing the integration of technology and education to improve neonatal outcomes in resource-limited settings.
Protocol Registration and Results System Clinical Trial Registry, www.ClinicalTrials.gov, NCT05666050. Registered on 23 December 2022.
尽管全球儿童死亡率有所下降，但非洲的降幅落后于其他地区。新生儿存活仍然是可持续发展议程中的关键优先事项。在个人和社区层面推广新生儿护理做法至关重要，基于技术的干预措施能够有效地覆盖未来可能成为母亲的人群。本研究旨在评估交互式移动健康干预措施对改善埃塞俄比亚东北部产后妇女基于社区的基本新生儿护理做法的效果。
本研究在埃塞俄比亚东北部的德西和孔博尔查市辖区开展。于2023年1月2日至6月15日对743名参与者（376名干预组和367名对照组）实施了整群随机对照试验。选定群组中妊娠30周的孕妇被纳入研究，并随访至产后45天。使用开放数据工具包收集数据，并采用Stata 17版本进行分析。通过验证性因子分析采用结构方程模型。使用卡方与自由度比、近似均方根误差和标准化均方根残差评估模型拟合度，表明模型拟合良好。在95%置信区间下，显著性水平设定为<0.05。
研究显示两组中出生至再次怀孕间隔时间短于24个月的比例都很高（对照组为48.5%，干预组为49.5%）。干预组对新生儿护理的知晓率显著提高，从62.0%增至85.9%，而对照组从57.8%增至67.6%。干预组中对于立即给新生儿洗澡存在分歧的情况比对照组更为普遍（干预组为73.9%，对照组为58.9%）。干预组中产后1小时内开始母乳喂养的比例（85.4%）高于对照组（74.4%）。干预组产后到医疗机构就诊的频率（79.6%）高于对照组（54.8%）。移动健康干预（β=0.393，p=0.007）和新生儿护理知识（β=0.347，p=0.012）对新生儿护理做法有显著的正向影响。所分析的变量之间不存在显著的间接路径。在增强新生儿护理做法方面，移动健康干预和新生儿护理知识仍然是显著的预测因素，其总效应分别为β=0.382，p=0.009和β=0.347，p=0.012。
本研究强调了移动健康干预措施和母亲知识在增强新生儿护理做法方面的重要作用。这些研究结果应为母婴健康项目的设计和实施提供参考，强调技术与教育的整合，以改善资源有限环境下的新生儿结局。
方案注册与结果系统临床试验注册库，www.ClinicalTrials.gov，NCT05666050。于2022年12月23日注册。
