Background: Digital health interventions can strengthen coverage and quality of care. Our aim was to assess the effectiveness of targeted client communication (TCC) to pregnant women via text messages, healthcare provider communication via a quality improvement dashboard (QID), and the combination of TCC and QID – generated and delivered from a digital maternal and child health registry (MCH eRegistry), running on the District Health Information Software 2 (DHIS2) platform in West Bank and Gaza. The control was the regular MCH eRegistry.
Methods: We included 137 clusters in a four-arm cluster randomized controlled trial. Primary outcomes were appropriate screening and management of anemia, hypertension, and diabetes during pregnancy, and timely attendance to routine antenatal care (ANC).
Results: The COVID-19 pandemic interrupted the trail, which failed to achieve the estimated sample size. Between 01.12.2019 and 23.03.2020, 4138 women attended ANC in the TCC, 3553 in the QID, 4223 in the TCC & QID, and 3324 in the control arm. In the TCC arm, 76.5% of the visits were attended timely versus 73.4 % in the control arm, (adjusted OR 1.2; 95% CI 0.90 to 1.61). We found no difference between QID and control, or between TCC & QID control in the proportion of visits where anemia, hypertension and diabetes were appropriately screened and managed.
Conclusion: The routine individual level data of the MCH eRegistry enabled the implementation of theory driven TCC and QID. However, the COVID-19 pandemic interrupted this trial of TCC and QID, and we were unable to observe any significant effect.