Date of Award


Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Brian W. Forsyth

Second Advisor

Errol R. Norwitz

Third Advisor

Howard Allen Pearson, Gerald Friedland


EVALUATING THE USE OF MOBILE PHONE TECHNOLOGY TO ENHANCE POSTNATAL CARE IN SOUTH AFRICA Kemunto Mokaya*, Elsie Etsane**, Jannie Hugo**, Jenny D. Makin**, Anne-Marie Bergh**, Robert C. Pattinson** and Brian W. Forsyth* *Department of Pediatrics, Yale University School of Medicine, New Haven, CT **Maternal and Infant Health Care Strategies Research Unit, University of Pretoria, Pretoria, South Africa. Maternal and child care in South Africa is sub-optimal, contributing to the maternal mortality and high infant mortality rates in the country. About a third of these deaths are due to modifiable factors, some of which are related to poor communication between healthcare providers and patients. A potential intervention that could reduce some of these modifiable factors is the incorporation of mobile phone technology. The goal of this study was to determine the feasibility and effectiveness of incorporating mobile phone technology in postnatal care. The specific objectives were: to determine patterns and preferences of cell phone use among mothers; to determine healthcare staff attitudes towards the use of mobile phone technology in postnatal care; to determine whether a mobile phone intervention using SMS and phone call reminders will increase rates of attendance in postnatal clinics; to determine the cost-effectiveness of these reminders; and to determine the patients satisfaction with their reminders. The study was divided into 3 sub-projects. (i) In sub-project A, cross-sectional questionnaires were used to determine patterns and preferences of mobile phone use among mothers. (ii) In sub-project B, cross-sectional questionnaires were used to determine staff attitudes regarding use of mobile phones to enhance communication. (iii) In sub-project C, a randomized controlled trial (RCT) was carried out to determine the impact of a mobile phone intervention on rates of postnatal clinic attendance. (i) 375 mothers participated in sub-project A. Of these, 98% had access to a mobile phone, and 83% owned personal mobile phones. 86% of the mothers had positive attitudes towards the use of mobile phones for patient: provider communication. (ii) 135 healthcare workers participated in sub-project B. Of these, 75% reported willingness to use a mobile phone to communicate with patients. (iii) In the RCT involving 415 mothers, the use of phone call/SMS reminder significantly increased rates of patient attendance at their 3-day appointment from 45% in controls to 72% and 81% in mothers who received phone calls and SMS reminders, respectively (p <0.001). SMS reminders were more cost-effective than phone calls. 94% of mothers who got reminders were satisfied with them. Mobile phone technology can effectively be used to enhance communication between healthcare providers and patients in South Africa due to its high reach and acceptability among patients and healthcare staff. Additionally, mobile phone technology is simple to use and cost-effective. Mobile phone technology may effectively be used not only for appointment reminders, but also in other areas such as health education/awareness, chronic disease management, and HIV medication monitoring and compliance.