The Post-2015 Development Agenda: Progress Towards Sustainable Development Goal Target On Maternal Mortality And Child Mortality In Limited Resource Settings With mHealth Interventions: A Systematic Review In Sub-Saharan Africa And Southern Asia

Abstract

In resource-constrained areas, mostly the low-income countries, mortality rates continue to remain higher than in high-income countries in spite of the ongoing efforts to make progress and improve maternal and child health. During the fifteen-year period of the Millennium Development Goals (MDGs), we witnessed a significant decline in child and maternal mortality rates despite their inability to harness the 75% reduction in maternal mortality and to reduce the under-five mortality by two-thirds as stipulated in the MDG5 and MDG4 respectively. Another fifteen-year plan was necessitated to achieve these targets by 2030, as captured in the United Nations Sustainable Development Goal (SDG) 3. Prior to the introduction of the MDGs in the year 2000, the annual rate of maternal mortality reduction was 1.2%, which significantly rose to 3% in the MDG era. To achieve the global goal in 2030 will require at least a 7.5% annual reduction between 2016 and 2030. Health interventions delivered through mobile technologies have been implemented in low-income countries to address the challenges in maternal and child health by supporting pregnant women, mothers and health workers behavior and introducing decision support functionalities. The rational for this study was to conduct a systematic review of the literature to ascertain the progress made by mHealth interventions toward SDGs 3.1 and 3.2 in Sub-Saharan Africa and Southern Asia, where the global burden of maternal and child mortality is high. The primary outcomes of interests were maternal mortality and under-five / neonatal mortality. Secondary outcomes were increasing coverage and utilization of antenatal care (ANC), postnatal care (PNC), skilled birth attendance/ facility delivery and childhood immunizations through behavior change. Thirty-six quantitative full-text articles were reviewed, 19 of which met the inclusion criteria. Most studies used SMS or voice message reminders to influence patient behavior change and were conducted in Sub-Saharan Africa. All studies showed at least some evidence that mHealth contributed to support behavior change of participants and training of health workers and to improve antenatal care attendance, postnatal care attendance, childhood immunization coverage/ rates and skilled delivery attendance. The findings from this review show that mHealth interventions implemented in Sub-Saharan Africa and Southern Asia can support the global effort towards SDG 3.1 and 3.2 to improve neonatal and maternal deaths. More good-quality studies addressing the role of mHealth in reducing maternal and child health outcomes are needed, especially in Southern Asia