***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems . Antenatal care has the potential to reduce maternal morbidity and improve newborns ’ survival but this benefit may not be realized in sub-Saharan Africa where the attendance and quality of care is declining . We evaluated the association between a mobile phone intervention and antenatal care in a re source -limited setting . We aim ed to assess antenatal care in a comprehensive way taking into consideration utilisation of antenatal care as well as content and timing of interventions during pregnancy . Methods This study was an open label pragmatic cluster-r and omised controlled trial with primary healthcare facilities in Zanzibar as the unit of r and omisation . 2550 pregnant women ( 1311 interventions and 1239 controls ) who attended antenatal care at selected primary healthcare facilities were included at their first antenatal care visit and followed until 42 days after delivery . 24 primary health care facilities in six districts were r and omized to either mobile phone intervention or st and ard care . The intervention consisted of a mobile phone text-message and voucher component . Primary outcome measure was four or more antenatal care visits during pregnancy . Secondary outcome measures were tetanus vaccination , preventive treatment for malaria , gestational age at last antenatal care visit , and antepartum referral . Results The mobile phone intervention was associated with an increase in antenatal care attendance . In the intervention group 44 % of the women received four or more antenatal care visits versus 31 % in the control group ( OR , 2.39 ; 95 % CI , 1.03 - 5.55 ) . There was a trend towards improved timing and quality of antenatal care services across all secondary outcome measures although not statistically significant . Conclusions The  wired mothers ’ mobile phone intervention significantly increased the proportion of women receiving the recommended four antenatal care visits during pregnancy and there was a trend towards improved quality of care with more women receiving preventive health services , more women attending antenatal care late in pregnancy and more women with antepartum complications identified and referred . Mobile phone applications may contribute towards improved maternal and newborn health and should be considered by policy makers in re source -limited setting s . Trial registration Clinical Trials.gov , NCT01821222 In northern Nigeria , interventions are urgently needed to narrow the large gap between international breastfeeding recommendations and actual breastfeeding practice s. Studies of integrated microcredit and community health interventions documented success in modifying health behaviors but typically had uncontrolled design s. We conducted a cluster-r and omized controlled trial in Bauchi State , Nigeria , with the aim of increasing early breastfeeding initiation and exclusive breastfeeding among female microcredit clients . The intervention had 3 components . Trained credit officers led monthly breastfeeding learning sessions during regularly scheduled microcredit meetings for 10 mo . Text and voice messages were sent out weekly to a cell phone provided to small groups of microcredit clients ( 5 - 7 women ) . The small groups prepared songs or dramas about the messages and presented them at the monthly microcredit meetings . The control arm continued with the regular microcredit program . R and omization occurred at the level of the monthly meeting groups . Pregnant clients were recruited at baseline and interviewed again when their infants were aged ≥6 mo . Logistic regression models accounting for clustering were used to estimate the odds of performing recommended behaviors . Among the clients who completed the final survey ( n = 390 ) , the odds of exclusive breastfeeding to 6 mo ( OR : 2.4 ; 95 % CI : 1.4 , 4.0 ) and timely breastfeeding initiation ( OR : 2.6 ; 95 % CI : 1.6 , 4.1 ) were increased in the intervention vs. control arm . Delayed introduction of water explained most of the increase in exclusive breastfeeding among clients receiving the intervention . In conclusion , a breastfeeding promotion intervention integrated into microcredit increased the likelihood that women adopted recommended breastfeeding practice s. This intervention could be scaled up in Nigeria , where local organizations provide microcredit to > 500,000 clients . Furthermore , the intervention could be adopted more widely given that > 150 million women , many of childbearing age , are involved in microfinance globally This study reports on the evaluation of the feasibility , cost , and cost-effectiveness of a proactively provided telephone-based motivational smoking cessation intervention to an underserved population of pregnant smokers who may or may not receive ongoing prenatal care . As part of the New Engl and SCRIPT r and omized clinical trial comparing the efficacy of three types of smoking cessation interventions for pregnant smokers , one-third of the women ( n = 358 ) received a motivational telephone counseling intervention ( MI ) delivered by trained counselors using a semistructured protocol . Although this population was very mobile , the MI counselors were able to reach 86 % of the women with at least one call and 46 % received all three calls . The group receiving three MI calls had a cotinine-confirmed quit rate of 23 % . Cost-effectiveness analyses for those women receiving telephone counseling supported the net benefit in favor of the three phone calls compared with the women who did not receive any telephone calls , with an effectiveness to cost ratio of 1:US dollars 84 . Our results suggest that telephone-based motivational smoking cessation counseling may be a feasible and cost-effective method for low-income pregnant smokers enrolled in prenatal care BACKGROUND Exclusive breastfeeding rates in Malaysia remains low despite the implementation of the Baby Friendly Hospital Initiative ( BFHI ) policy in government hospitals . It has been suggested that any form of postnatal lactation support will lead to an increase in exclusive breastfeeding rates . OBJECTIVE To study the effectiveness of telephone lactation counselling on breastfeeding practice s. DESIGN Single blinded , r and omised controlled trial ( RCT ) . SETTING Maternity wards in a public hospital in Kuala Lumpur , Malaysia . PARTICIPANTS 357 mothers , each of whom had delivered a full term , healthy infant via spontaneous vaginal delivery . METHODS Mothers were followed up for 6 months . The intervention group ( n=179 ) received lactation counselling via telephone twice monthly by certified lactation counsellors in addition to receiving the current conventional care of postnatal breastfeeding support . The control group ( n=178 ) received the current conventional care of postnatal breastfeeding support . Definitions of breastfeeding practice s were according to World Health Organization ( WHO ) definitions . Participants answered a self-administered question naire during recruitment and were later followed up at one , four and 6-month intervals during the postpartum period via a telephone-based question naire . RESULTS At 1 month , a higher percentage of mothers in the intervention group practice d exclusive breastfeeding , compared to the control group ( 84.3 % vs. 74.7 % , OR 1.825 95 % , p=0.042 , CI=1.054 , 3.157 ) . At 4 and 6 months postpartum , similar percentages of mothers from the two groups practice d exclusive breastfeeding ( 41.98 % vs. 38.99 % ; 12.50 % vs. 12.02 % , no significant differences , both p>0.05 ) . Slightly higher numbers of mothers in the control group had completely stopped breastfeeding at the 1 , 4 and 6 month marks , compared to the intervention group ( 7.4 % vs. 5.4 % ; 12.6 % vs. 9.9 % ; 13.9 % vs. 9.4 % ; all p>0.05 ) . The reason cited by most mothers who had completely stopped breastfeeding during the early postpartum period was a low breast milk supply , while returning to work was the main reason for stopping breastfeeding later in the postpartum period . CONCLUSIONS Telephone lactation counselling provided by certified lactation counsellors from the nursing profession was effective in increasing the rate of exclusive breastfeeding for the first postpartum month but not during the 4 and 6month postpartum intervals Background Adequate antenatal care is important to both the health of a pregnant woman and her unborn baby . Given South Africa ’s high rate of cellphone penetration , mobile health interventions have been touted as a potentially powerful means to disseminate health information . This study aim ed to increase antenatal health knowledge and awareness by disseminating text messages about clinic procedures at antenatal visits , and how to be healthy during pregnancy . Methods Participants recruited were pregnant women attending a primary health care facility in Cape Town . A controlled clinical trial was carried out where the intervention group ( n = 102 ) received text messages staggered according to the week of pregnancy at the time of recruitment . The control group ( n = 104 ) received no text messages . These text messages contained antenatal health information , and were delivered in English , Xhosa or Afrikaans , according to the preference of each participant . A baseline knowledge question naire with nine questions was administered prior to the intervention . The same question naire was used with added health-related behaviour questions for the intervention group at exit . A modified intention-to-treat analysis was done . To compare the control and intervention group ’s knowledge , Fisher ’s exact tests and two- sample t-tests tests were carried out for binary and continuous outcomes , respectively . A focus group of seven participants from the intervention group was then conducted to gain more insight into how the text messages were perceived . Results There was substantial loss to follow-up during the study with only 57 % of the participants retained at exit . No statistically significant difference was detected between the control and intervention group in any of the nine knowledge questions at exit ( all p > 0.05 ) . Responses from the focus group indicated that the text messages acted as a welcome reminder and a source of positive motivation , and were perceived as extended care from the health care provider . Conclusions While the intervention failed to improve antenatal health knowledge , evidence from self-reported behaviour and the focus group suggests that text messages have the potential to motivate change in health-seeking behaviour . One should be mindful of loss to follow-up when rolling out mobile health interventions in developing country setting s . Trial registration Pan African Clinical Trials Registry PACTR201406000841188 . Registered 3 June 2014 Background Providing women with contraceptive methods following abortion is important to reduce repeat abortion rates , yet evidence for effective post-abortion family planning interventions are limited . This protocol outlines the evaluation of a mobile phone-based intervention using voice messages to support post-abortion family planning in Cambodia . Methods / Design A single blind r and omised controlled trial of 500 participants . Clients aged 18 or over , attending for abortion at four Marie Stopes International clinics in Cambodia , owning a mobile phone and not wishing to have a child at the current time are r and omised to the mobile phone-based intervention or control ( st and ard care ) with a 1:1 allocation ratio . The intervention comprises a series of six automated voice messages to remind clients about available family planning methods and provide a conduit for additional support . Clients can respond to message prompts to request a phone call from a counsellor , or alternatively to state they have no problems . Clients requesting to talk to a counsellor , or who do not respond to the message prompts , receive a call from a Marie Stopes International Cambodia counsellor who provides individualised advice and support regarding family planning . The duration of the intervention is 3 months . The control group receive existing st and ard of care without the additional mobile phone-based support . We hypothesise that the intervention will remind clients about contraceptive methods available , identify problems with side effects early and provide support , and therefore increase use of post-abortion family planning , while reducing discontinuation and unsafe method switching . Participants are assessed at baseline and at 4 months . The primary outcome measure is use of an effective modern contraceptive method at 4 months post abortion . Secondary outcome measures include contraception use , pregnancy and repeat abortion over the 4-month post-abortion period . Risk ratios will be used as the measure of effect of the intervention on the outcomes , and these will be estimated with 95 % confidence intervals . All analyses will be based on the ‘ intention to treat ’ principle . Discussion This study will provide evidence on the effectiveness of a mobile phone-based intervention using voice messages to support contraception use in a population with limited literacy . Findings could be generalisable to similar population s in different setting s . Trial registration Clinical Trials.gov Identifier : Background Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care . However , despite widespread support for the use of mobile health technologies , evidence for its role in health care is sparse . Objective We aim ed to evaluate the association between a mobile phone intervention and perinatal mortality in a re source -limited setting . Methods This study was a pragmatic , cluster-r and omized , controlled trial with primary health care facilities in Zanzibar as the unit of r and omization . At their first antenatal care visit , 2550 pregnant women ( 1311 interventions and 1239 controls ) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery . Twenty-four primary health care facilities in six districts were r and omized to either mobile phone intervention or st and ard care . The intervention consisted of a mobile phone text message and voucher component . Secondary outcome measures included stillbirth , perinatal mortality , and death of a child within 42 days after birth as a proxy of neonatal mortality . Results Within the first 42 days of life , 2482 children were born alive , 54 were stillborn , and 36 died . The overall perinatal mortality rate in the study was 27 per 1000 total births . The rate was lower in the intervention clusters , 19 per 1000 births , than in the control clusters , 36 per 1000 births . The intervention was associated with a 
    Output:
    
mHealth interventions targeted at pregnant women increased maternal and neonatal service utilization shown through increased antenatal care attendance , facility-service utilization , skilled attendance at birth , and vaccination rates .
CONCLUSION mHealth interventions may be effective solutions to improve maternal and neonatal service utilization .
The emerging trend of strong experimental research design s with r and omized controlled trials , combined with feasibility research , government involvement and integration of mHealth interventions into the healthcare system is encouraging and can pave the way to improved decision making on best practice implementation of mHealth interventions