Evaluating Essential Coaching for Every Mother Tanzania (ECEM-TZ) as a postpartum text message digital health solution: A randomized controlled trial

BackgroundText messages are a low-cost digital health solution that can provide information directly to mothers. We aimed to evaluate a text message program, called Essential Coaching for Every Mother Tanzania (ECEM-TZ), designed to improve maternal access to essential newborn care education during the immediate 6-week postnatal period. MethodsA randomized controlled trial was conducted in Dar es Salaam, Tanzania. ECEM-TZ consists of standardized text messages from birth to 6 weeks postpartum that provided evidence-based information on newborn care and recognizing danger signs. The primary outcome was newborn care knowledge. Secondary outcomes included parenting self-efficacy, breastfeeding self-efficacy, postpartum depression and anxiety symptoms, attendance at the six-week postnatal check-up, and newborn morbidity and mortality. Data were analyzed using ANCOVAs and logistical regression. ResultsBetween June 13 and July 22, 2024, 143 mothers were randomized, 71 to the control group (standard care) and 72 to the intervention group (standard care plus ECEM-TZ), of which 139 completed both the baseline and follow-up at 6-8 weeks postpartum. Compared to the control group, mothers who received ECEM-TZ had significantly higher newborn care knowledge scores (MD=2.92, p<0.001) and fewer postpartum depression symptoms (MD=-1.55, p<0.001). Mothers who received ECEM-TZ were also three times more likely to attend a postnatal visit than those in the control group (OR=3.15, 95%CI [1.29, 7.72]). ConclusionText messaging, as a low-cost, accessible digital health solution, is an important asset to enhance education of mothers in low- and middle-income countries during the immediate 6-week postpartum period. Trial registrationClinicalTrials.gov (NCT05362305), submitted 22-April-2022.