Cost-effectiveness of a direct to beneficiary mobile communication programme in improving reproductive and child health outcomes in India.

Introduction: Kilkari is the largest maternal messaging programme of its kind globally. Between its initiation in 2012 in Bihar and its transition to the government in 2019, Kilkari was scaled to 13 states across India and reached over 10 million new and expectant mothers and their families. This study aims to determine the cost-effectiveness of exposure to Kilkari as compared with no exposure across 13 states in India.

Can we design the next generation of digital health communication programs by leveraging the power of artificial intelligence to segment target audiences, bolster impact and deliver differentiated services? A machine learning analysis of survey data from rural India.

Objectives: Direct to beneficiary (D2B) mobile health communication programmes have been used to provide reproductive, maternal, neonatal and child health information to women and their families in a number of countries globally. Programmes to date have provided the same content, at the same frequency, using the same channel to large beneficiary populations. This manuscript presents a proof of concept approach that uses machine learning to segment populations of women with access to phones and their husbands into distinct clusters to support differential digital programme design and delivery.

Key learnings from an outcome and embedded process evaluation of a direct to beneficiary mobile health intervention among marginalised women in rural Bihar, India.

Introduction: Mobile Vaani was implemented as a pilot programme across six blocks of Nalanda district in Bihar state, India to increase knowledge of rural women who were members of self-help groups on proper nutrition for pregnant or lactating mothers and infants, family planning and diarrhoea management. Conveners of self-help group meetings, community mobilisers, introduced women to the intervention by giving them access to interactive voice response informational and motivational content. A mixed methods outcome and embedded process evaluation was commissioned to assess the reach and impact of Mobile Vaani.

Exploring terminology for puerperal sepsis and its symptoms in urban Karachi, Pakistan to improve communication, care-seeking, and illness recognition.

Puerperal sepsis is an important cause of maternal morbidity and mortality in developing countries. Awareness of local terminology for its signs and symptoms may improve communication about this illness, what actions to take when symptoms appear, timely care seeking, and clinical outcomes. This formative research aimed to improve recognition and management of postpartum sepsis in Pakistan by eliciting local terms used for postpartum illnesses and symptoms.

Optimising the reach of mobile health messaging programmes: an analysis of system generated data for the Kilkari programme across 13 states in India.

Kilkari is an outbound service that makes weekly, stage-based, prerecorded calls about reproductive, maternal, neonatal and child health directly to families' mobile phones, starting from the second trimester of pregnancy and until the child is 1 year old. Since its initiation in 2012-2013, Kilkari has scaled to 13 states across India. In this analysis article, we explored the subscriber's journey from entry to programme to engagement with calls.

The impact of a direct to beneficiary mobile communication program on reproductive and child health outcomes: a randomised controlled trial in India.

Background: Direct-to-beneficiary communication mobile programmes are among the few examples of digital health programmes to have scaled widely in low-resource settings. Yet, evidence on their impact at scale is limited. This study aims to assess whether exposure to mobile health information calls during pregnancy and postpartum improved infant feeding and family planning practices.

'[We] learned how to speak with love': a qualitative exploration of accredited social health activist (ASHA) community health worker experiences of the Mobile Academy refresher training in Rajasthan, India.

Introduction: Mobile Academy is a mobile-based training course for India's accredited social health activist (ASHA) community health workers (CHW). The course, which ASHAs access by dialling a number from their phones, totals 4 hours of audio content. It consists of 11 chapters, each with their own quiz, and provides a cumulative pass or fail score at the end.

Assessing the reliability of phone surveys to measure reproductive, maternal and child health knowledge among pregnant women in rural India: a feasibility study.

Objectives: Efforts to understand the factors influencing the uptake of reproductive, maternal, newborn, child health and nutrition (RMNCH&N) services in high disease burden low-resource settings have often focused on face-to-face surveys or direct observations of service delivery. Increasing access to mobile phones has led to growing interest in phone surveys as a rapid, low-cost alternatives to face-to-face surveys. We assess determinants of RMNCH&N knowledge among pregnant women with access to phones and examine the reliability of alternative modalities of survey delivery.

At the frontlines of digitisation: a qualitative study on the challenges and opportunities in maintaining accurate, complete and timely digital health records in India's government health system.

Objectives: To understand factors underpinning the accuracy and timeliness of mobile phone numbers and other health information captured in India's government registry for pregnant and postpartum women. Accurate and timely registration of mobile phone numbers is necessary for beneficiaries to receive mobile health services.

Setting: Madhya Pradesh and Rajasthan states in India at the community, clinical, and administrative levels of the health system.

Validation of community health worker identification of maternal puerperal sepsis using a clinical diagnostic algorithm in Bangladesh and Pakistan.

Background: Puerperal sepsis (PP sepsis) is a leading cause of maternal mortality globally. The majority of maternal sepsis cases and deaths occur at home and remain undiagnosed and under-reported. In this paper, we present findings from a nested case-control study in Bangladesh and Pakistan which sought to assess the validity of community health worker (CHW) identification of PP sepsis using a clinical diagnostic algorithm with physician assessment and classification used as the gold standard.

Evaluation of a community-based mobile video breastfeeding intervention in Khayelitsha, South Africa: The Philani MOVIE cluster-randomized controlled trial.

Background: In South Africa, breastfeeding promotion is a national health priority. Regular perinatal home visits by community health workers (CHWs) have helped promote exclusive breastfeeding (EBF) in underresourced settings. Innovative, digital approaches including mobile video content have also shown promise, especially as access to mobile technology increases among CHWs.

Freedom within a cage: how patriarchal gender norms limit women's use of mobile phones in rural central India.

Introduction: India has one of the highest gender gaps in mobile phone access in the world. As employment opportunities, health messaging (mHealth), access to government entitlements, banking, civic participation and social engagement increasingly take place in the digital sphere, this gender gap risks further exacerbating women's disadvantage in Indian society. This study identifies the factors driving women's unequal use of phones in rural Madhya Pradesh, India.

Examining the reach and exposure of a mobile phone-based training programme for frontline health workers (ASHAs) in 13 states across India.

Mobile phones are increasingly used to facilitate in-service training for frontline health workers (FLHWs). Mobile learning (mLearning) programmes have the potential to provide FLHWs with high quality, inexpensive, standardised learning at scale, and at the time and location of their choosing. However, further research is needed into FLHW engagement with mLearning content at scale, a factor which could influence knowledge and service delivery.

Another voice in the crowd: the challenge of changing family planning and child feeding practices through mHealth messaging in rural central India.

Introduction: Kilkari is one of the world's largest mobile phone-based health messaging programmes. Developed by BBC Media Action, it provides weekly stage-based information to pregnant and postpartum women and their families, including on infant and young child feeding (IYCF) and family planning, to compliment the efforts of frontline health workers. The quantitative component of a randomised controlled trial (RCT) in the Indian state of Madhya Pradesh found that exposure to Kilkari increased modern contraceptive uptake but did not change IYCF practices.

Can health information through mobile phones close the divide in health behaviours among the marginalised? An equity analysis of Kilkari in Madhya Pradesh, India.

Kilkari is one of the largest maternal mobile messaging programmes in the world. It makes weekly prerecorded calls to new and expectant mothers and their families from the fourth month of pregnancy until 1-year post partum. The programme delivers reproductive, maternal, neonatal and child health information directly to subscribers' phones.

Does exposure to health information through mobile phones increase immunisation knowledge, completeness and timeliness in rural India?

Introduction: Immunisation plays a vital role in reducing child mortality and morbidity against preventable diseases. As part of a randomised controlled trial in rural Madhya Pradesh, India to assess the impact of Kilkari, a maternal messaging programme, we explored determinants of parental immunisation knowledge and immunisation practice (completeness and timeliness) for children 0-12 months of age from four districts in Madhya Pradesh.

Methods: Data were drawn from a cross-sectional survey of women (n=4423) with access to a mobile phone and their spouses (n=3781).

Connecting the dots: Kerala's use of digital technology during the COVID-19 response.

Digital tools are increasingly being applied to support the response to the ongoing COVID-19 pandemic in India and elsewhere globally. This article draws from global frameworks to explore the use of digital tools in the state of Kerala across the domains of communication, surveillance, clinical management, non-clinical support, and core health system readiness and response. Kerala is considered India's first digital state, with the highest percentage of households with computers (24%) and the internet (51%) in India, 95% mobile phone penetration, 62% smartphone penetration and 75% digital literacy.

Ten lessons learnt: scaling and transitioning one of the largest mobile health communication programmes in the world to a national government.

There has been exponential growth in the numbers of 'digital development' programmes seeking to leverage technology to solve systemic challenges. However, despite promising results and a shift from pilots to scale-ups, many have failed to realise their full potential. This paper reflects on lessons learnt from scaling and transitioning one of the largest mobile health programmes in the world to the Indian government.

SMS feedback system as a quality assurance mechanism: experience from a household survey in rural India.

The increasing use of digital health solutions to support data capture both as part of routine delivery of health services and through special surveys presents unique opportunities to enhance quality assurance measures. This study aims to demonstrate the feasibility and acceptability of using back-end data analytics and machine learning to identify impediments in data quality and feedback issues requiring follow-up to field teams using automated short messaging service (SMS) text messages. Data were collected as part of a postpartum women's survey (n=5095) in four districts of Madhya Pradesh, India, from October 2019 to February 2020.

Assessing exposure to Kilkari: a big data analysis of a large maternal mobile messaging service across 13 states in India.

The Kilkari programme is being implemented by the Government of India in 13 states. Designed by BBC Media Action and scaled in collaboration with the Ministry of Health and Family Welfare from January 2016, Kilkari had provided mobile health information to over 10 million subscribers by the time BBC Media Action transitioned the service to the government in April 2019. Despite the reach of Kilkari in terms of the absolute number of subscribers, no longitudinal analysis of subscriber exposure to health information content over time has been conducted, which may underpin effectiveness and changes in health outcomes.

A tale of 'politics and stars aligning': analysing the sustainability of scaled up digital tools for front-line health workers in India.

Introduction: India has become a lighthouse for large-scale digital innovation in the health sector, particularly for front-line health workers (FLHWs). However, among scaled digital health solutions, ensuring sustainability remains elusive. This study explores the factors underpinning scale-up of digital health solutions for FLHWs in India, and the potential implications of these factors for sustainability.

mCARE, a digital health intervention package on pregnancy surveillance and care-seeking reminders from 2018 to 2027 in Bangladesh: a model-based cost-effectiveness analysis.

Objective: We estimated the cost-effectiveness of a digital health intervention package (mCARE) for community health workers, on pregnancy surveillance and care-seeking reminders compared with the existing paper-based status quo, from 2018 to 2027, in Bangladesh.

Interventions: The mCARE programme involved digitally enhanced pregnancy surveillance, individually targeted text messages and in-person home-visit to pregnant women for care-seeking reminders for antenatal care, child delivery and postnatal care.

Study Design: We developed a model to project population and service coverage increases with annual geographical expansion (from 1 million to 10 million population over 10 years) of the mCARE programme and the status quo.

Reported infant feeding practices and contextual influences on breastfeeding: qualitative interviews with women registered to MomConnect in three South African provinces.

Background: Global guidelines recommend exclusive breastfeeding (EBF) for the first 6 months of life. South African EBF rates have steadily increased but still only average 32% for infants below 6 months of age. Malnutrition and developmental delays continue to contribute substantially to the morbidity and mortality of South African children.

Using Machine Learning to Optimize the Quality of Survey Data: Protocol for a Use Case in India.

Background: Data quality is vital for ensuring the accuracy, reliability, and validity of survey findings. Strategies for ensuring survey data quality have traditionally used quality assurance procedures. Data analytics is an increasingly vital part of survey quality assurance, particularly in light of the increasing use of tablets and other electronic tools, which enable rapid, if not real-time, data access.