***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 Background Home visits by Community Health Workers [ In Ug and a Community Health Workers are given the collective term of Village Health Teams ( VHTs ) . Hereafter referred to as VHTs ] is recommended to improve maternal and newborn care . We investigated perceived maternal and newborn benefits of home visits made by VHTs , combined with mobile phone consultations with professional health workers for advice . Methods A qualitative study was conducted in Masindi and Kiry and ongo districts , Ug and a , in December-2013 to March-2014 . Study participants were drawn from the intervention arm of a r and omised community-intervention trial .  In-depth interviews were conducted with 20 prenatal and 16 postnatal women who were visited by VHTs ;  5 group discussion s and 16 key informant interviews were held with VHTs and 10 Key Informant Interviews with professional health workers . Data were analysed using latent content analysis techniques . Results Majority women and VHTs contend that the intervention improved access to maternal and newborn information ; reduced costs of accessing care and facilitated referral . Women , VHTs and professional health workers acknowledged that the intervention induced attitudinal change among women and VHTs towards adapting recommended maternal and newborn care practice s. Mobile phone consultations between VHTs and professional health workers were considered to reinforce VHT knowledge on maternal newborn care and boosted the social status of VHTs in community . A minority of VHTs perceived the implementation of recommended maternal and newborn care practice s as difficult . Some professional health workers did not approve of the transfer of promotional maternal and newborn responsibility to VHTs . For a range of reasons , a number of professional health workers were not always available on phone or at the health centre to address VHT concerns . Conclusions Results suggest that home visits made by VHTs for maternal and newborn care are reasonably well accepted . Our study highlights potential benefits of combining home visits with phone consultations between VHTs and professional health workers . However , the challenge of attitudinal change among VHTs towards certain strongly culturally-embedded behavioural post-partum practice s , resistance from part of the professional health workforce to collaborate with VHTs and the problematic availability of professional health workers are important systemic problems that need to be addressed . Trial registration Current Controlled Trials NCT02084680.Registered 14 March 2014 Introduction The World Health Organisation recommends home visits conducted by Community Health Workers ( in Ug and a known as Village Health Teams — VHTs ) in order to improve maternal and newborn health . This study measured the effect of home visits combined with mobile phone consultations on maternal and newborn care practice s. Method In a community intervention trial design 16 health centres in Masindi and Kiry and ongo districts , Ug and a were r and omly and equally allocated to one of two arms : control and intervention arms . Eight control health centres received the usual maternal and newborn educational messages offered by professional health workers and eight intervention health centres that received an intervention package for maternal care and essential newborn care practice s. In the intervention arm VHTs made two prenatal and one postnatal home visit to households . VHTs were provided with mobile phones to enable them make regular telephone consultations with health workers at the health centre serving the catchment area . The primary outcome was health facility delivery . Other outcomes included antenatal attendances , birth preparedness , cord and thermal care and breastfeeding practice s. Analysis was by intention-to-treat . Results A total of 1385 pregnant women were analysed : 758 and 627 in the control and intervention arms respectively . Significant post-intervention differences were : delivery place [ adjusted Odds Ratio aOR : 17.94(95%CI : 6.26–51.37 ) ; p<0.001 ] , cord care [ aOR : 3.05(95%CI : 1.81–5.12 ) ; p<0.001 ] thermal care [ aOR : 7.58(95%CI : 2.52–22.82 ) ; p<0.001 ] , and timely care-seeking for newborn illness [ aOR : 4.93(95%CI : 1.59–15.31 ) ; p = 0.006 ] . Conclusion VHTs can have an effect in promoting proper cord and thermal care for the newborn and improve timely care-seeking for health facility delivery and newborn illness , because they could answer questions and refer patients correctly . However , VHTs should be supported by professional health workers through the use of mobile phones . Trial Registration Clinical Trials.gov Background Although there are studies showing that mobile phone solutions can improve health service delivery outcomes in the developed world , there is little empirical evidence that demonstrates the impact of mHealth interventions on key maternal health outcomes in low income setting s. Methods A non-r and omized controlled study was conducted in the Amhara region , Ethiopia in 10 health facilities ( 5 intervention , 5 control ) together serving around 250,000 people . Health workers in the intervention group received an and roid phone ( 3 phones per facility ) loaded with an application that sends reminders for scheduled visits during antenatal care ( ANC ) , delivery and postnatal care ( PNC ) , and educational messages on dangers signs and common complaints during pregnancy . The intervention was developed at Addis Ababa University in Ethiopia . Primary outcomes were the percentage of women who had at least 4 ANC visits , institutional delivery and PNC visits at the health center after 12 months of implementation of the intervention . Findings Overall 933 and 1037 women were included in the cross-sectional surveys at baseline and at follow-up respectively . In addition , the medical records of 1224 women who had at least one antenatal care visit were followed in the longitudinal study . Women who had their ANC visit in the intervention health centers were significantly more likely to deliver their baby in the same health center compared to the control group ( 43.1 % versus 28.4 % ; Adjusted Odds Ratio ( AOR ) : 1.98 ( 95%CI 1.53–2.55 ) ) . A significantly higher percentage of women who had ANC in the intervention group had PNC in the same health center compared to the control health centers ( 41.2 % versus 21.1 % : AOR : 2.77 ( 95%CI 2.12–3.61 ) ) . Conclusions Our findings demonstrated that a locally customized mHealth application during ANC can significantly improve delivery and postnatal care service utilization possibly through positively influencing the behavior of health workers and their clients Objective : Many sub-Saharan African countries report high postpartum loss to follow-up of mother – baby pairs . We aim ed to determine whether interactive text messages improved rates of clinic attendance and early infant HIV testing in the Nyanza region of Kenya . Design : Parallel-group , unblinded , r and omized controlled trial . Methods : HIV-positive pregnant women at least 18 years old and enrolled in the prevention of mother-to-child transmission of HIV programme were r and omized to receive either text messages ( SMS group , n = 195 ) or usual care ( n = 193 ) . Messages were developed using formative focus group research informed by constructs of the Health Belief Model . The SMS group received up to eight text messages before delivery ( depending on gestational age ) , and six messages postpartum . Primary outcomes included maternal postpartum clinic attendance and virological infant HIV testing by 8 weeks postpartum . The primary analyses were intention-to-treat . Results : Of the 388 enrolled women , 381 ( 98.2 % ) had final outcome information . In the SMS group , 38 of 194 ( 19.6 % ) women attended a maternal postpartum clinic compared to 22 of 187 ( 11.8 % ) in the control group ( relative risk 1.66 , 95 % confidence interval 1.02–2.70 ) . HIV testing within 8 weeks was performed in 172 of 187 ( 92.0 % ) infants in the SMS group compared to 154 of 181 ( 85.1 % ) in the control group ( relative risk 1.08 , 95 % confidence interval 1.00–1.16 ) . Conclusions : Text messaging significantly improved maternal postpartum visit attendance , but overall return rates for these visits remained low . In contrast , high rates of early infant HIV testing were achieved in both arms , with significantly higher testing rates in the SMS compared to the control infants BACKGROUND Missed scheduled HIV appointments lead to increased mortality , resistance to antiretroviral therapy , and suboptimum virological response . We aim ed to assess whether reminders sent to carers by text message , mobile phone call , or concomitant text message and mobile phone call increase attendance at medical appointments for HIV care in a population of children infected with or exposed to HIV in Cameroon . We also aim ed to ascertain the most cost-effective method of mobile-phone-based reminder . METHODS MORE CARE was a multicentre , single-blind , factorial , r and omised controlled trial in urban , semi-urban , and rural setting s in Cameroon . Carers of children who were infected with or had been exposed to HIV were r and omly assigned electronically in blocks of four and allocated ( 1:1:1:1 ) sequentially to receive a text message and a call , a text message only , a call only , or no reminder ( control ) . Investigators were masked to group assignment . Text messages were sent and calls made 2 or 3 days before a scheduled follow-up appointment . The primary outcomes were efficacy ( the proportion of patients attending a previously scheduled appointment ) and efficiency ( attendance/ [ measures of staff working time × cost of the reminders ] ) , as a measure of cost-effectiveness . The primary analysis was by intention to treat . This study is registered with the Pan African Clinical Trials Register , number PACTR201304000528276 . FINDINGS The study took place between Jan 28 and May 24 , 2013 . We r and omly assigned 242 adult-child ( carer-patient ) pairs into four groups : text message plus call ( n=61 ) , call ( n=60 ) , text message ( n=60 ) , and control ( n=61 ) . 54 participants ( 89 % ) in the text message plus call group , 51 ( 85 % ) in the call group , 45 ( 75 % ) in the text message group , and 31 ( 51 % ) in the control group attended their scheduled appointment . Compared with control , the odds ratios for improvement in the primary efficacy outcome were 7·5 ( 95 % CI 2·9 - 19·0 ; p<0·0001 ) for text message plus call , 5·5 ( 2·3 - 13·1 ; p=0·0002 ) for call , and 2·9 ( 1·3 - 6·3 ; p=0·012 ) for text message . No significant differences were seen in comparisons of the three intervention groups with each other , and there was no synergism between text messages and calls . For the primary efficiency outcome , the mean difference for text message versus text message plus call was 1·5 ( 95 % CI 0·7 to 2·4 ; p=0·002 ) , for call versus text message plus call was 1·2 ( 0·7 to 1·6 ; p<0·0001 ) , and for call versus text message was 0·4 ( -1·3 to 0·6 ; p=0·47 ) . INTERPRETATION Mobile-phone-based reminders of scheduled HIV appointments for carers of paediatric patients in low-re source setting s can increase attendance . The most effective method of reminder was text message plus phone call , but text messaging alone was the 
    Output:
    
mHealth communication influenced  mothers ’ intentions , skills , and environmental constraints associated with uptake of PNC .
Intentions were influenced by attitudes , perceived norms and self-efficacy .
Positive attitudes , as well as changed attitudes toward PNC practice s were observed .
Perceived norms that were enhanced were delivery at a health facility with immediate PNC , seeking of reinforcement and professional health support of newborn care practice s , and male partner support .
Improved self-efficacy was demonstrated by mothers who attended scheduled appointments and they were confident with regard to newborn care practice s. Skills for PNC that were improved included cord care , thermal care , appropriate breastfeeding and problem-solving .
The environmental constraints faced and which were addressed in the studies included inaccessibility , unavailability and unaffordability of PNC services in rural areas .
Conclusions Results from the literature included in this study show that one-way mobile phone messaging is the common type of mHealth communication used to strengthen PNC in rural areas .
mHealth communication can influence intentions , skills and environmental constraints as determinants of PNC uptake .