| dc.description.abstract | Maternal mortality ratio (MMR) is still high in Kenya at 362, stifling the achievement of the Sustainable Development Goal (SDG) 3.1, which aims to reduce MMR to less than 70 per 100,000 live births by 2030. With MMR of 565 out of 100,000 live births and 73.6% of home deliveries, according to the Kenya Demographic Health Survey (KDHS, 2014), West Pokot County is ranked among the counties contributing to the slow progress. Despite high mobile penetration in Kenya (>100%), evidence is lacking on the use of this technology to improve maternal health outcomes. The purpose of this study was to establish the efficacy of Short Messaging Service (SMS) reminders on improving antenatal care (ANC) and skilled delivery attendance (SDA) among pregnant women in West Pokot County. Specifically, the study was exploring the demographic variables associated with ANC and SDA, comparing outcomes between the study arms, and identifying challenges experienced by women, while seeking maternal health services. A prospective cohort quasi-experimental study design was applied among 462 eligible consenting women, in the control (231) and intervention (231) arms for 3 years from 2017. Upon exit from the first ANC service delivery point at Kapenguria County Referral Hospital, participants were sampled systematically into the study. Only women in the intervention group received SMS reminders 24 hours before appointment dates. Structured questionnaires and Focus Group Discussion (FGD) guides were used for collection of both quantitative and qualitative data respectively. Ministry of Health (MOH), ANC and maternity registers, were used together with study-designed appointment registers to track scheduled appointments. Chi-square test of association and binomial logistics regression were used to test variable relationships while relative risks and relative effects were used to compare study outcomes. Framework analysis was used for qualitative data. Marital status, gravidae, and parity had a statistically significant association with ANC across all the levels: first to the fourth plus ANC appointment. Parity was not statistically significant only at the fourth ANC appointment. Gestation age at first ANC, marital status, education level, mobile phone ownership, gravidae and parity had a statistically significant association with SDA. SMS reminders increase ANC appointment adherence by 61.9% (RR=1.6190); 78.3% (RR=1.7830) and 147.7% (RR=2.477) for 2nd, 3rd and 4th ANC appointments. For more than four ANC appointments, adherence was increased by 284% (p-value 0.000, RR=3.84). SDA is increased by 125.6% (RR=2.256). The null hypotheses are rejected, and the study concludes that there is a significant difference between women who receive SMS reminders and those who do not for both ANC and SDA. Financial constraints, distance from the health facilities and lack of general awareness on the importance of seeking health facility care were among the leading challenges experienced by women in the county. SMS reminders are an effective way to improve ANC and SDA, in conjunction with community education, women empowerment and enhanced male involvement, in West Pokot County | en_US |
