Bridging the Gap: Evaluating the Effectiveness of Mhealth Interventions in Improving Antenatal Care Uptake and Reducing Maternal Mortality in Rural Northern Nigeria
Abstract
This systematic review and meta-analysis evaluate the effectiveness of mobile health (mHealth) interventions in improving antenatal care (ANC) uptake and reducing maternal mortality in rural Northern Nigeria. Drawing from 50 studies involving over 85,000 participants, the findings reveal that mHealth interventions—particularly SMS-based solutions—significantly enhance attendance at ANC (OR 1.85), skilled birth attendance (OR 1.67), and utilisation of postnatal care (OR 1.94). Researchers found that educational text messages improved ANC uptake by up to 67%, with SMS interventions proving to be the most cost-effective. Despite these promising outcomes, barriers such as digital illiteracy, poor network infrastructure, and socio-cultural resistance remain. The study supports the integration of tailored mHealth strategies into maternal health policies for rural Nigerian contexts.
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1. World Health Organisation. (2023). Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Retrieved from https://www.who.int/publications/i/item/9789240068759
2. UNICEF. (2025). Levels and trends in child mortality. United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME), Report 2024. Retrieved from https://data.unicef.org/resources/levels-and-trends-in-child-mortality-2024/
3. Federal Ministry of Health and Social Welfare. (2024). Nigeria Demographic and Health Survey 2023–24. Key Indicators Report. Abuja: National Population Commission.
4. Federal Ministry of Health & Social Welfare. (2025). State of Health of the Nation Report 2024. Retrieved from https://fmohconnect.gov.ng/wp-content/uploads/2025/05/The-State-of-Health-of-the-Nation-Report-2024.pdf
5. Fagbamigbe, A. F., Abel, C., Mashabe, B., & Adebowale, A. S. (2019). Survival analysis and prognostic factors of the timing of first antenatal care visit in Nigeria. Advances in Integrative Medicine, 6(3), 110–119. doi: 10.1016/j.aimed.2018.12.002
6. Ahinkorah, B. O., Seidu, A., Agbaglo, E., Adu, C., Budu, E., Hagan, J. E., Schack, T., & Yaya, S. (2021). Determinants of antenatal care and skilled birth attendance services utilisation among childbearing women in Guinea: evidence from the 2018 Guinea Demographic and Health Survey data. BMC Pregnancy and Childbirth, 21(1). doi: 10.1186/s12884-020-03489-4
7. Kolo, M., Adamu, Y., Chutiyami, M., Mairiga, A., & Mshelia, B. (2017). Determinants of maternal mortality in North-Eastern Nigeria: a population-based study. Journal of Advances in Medicine and Medical Research, 24(10), 1–11. doi: 10.9734/jammr/2017/38070
8. Aminu, M., Unkels, R., Mdegela, M., Utz, B., Adaji, S., & Van Den Broek, N. (2014). Causes of and factors associated with stillbirth in low‐ and middle‐income countries: a systematic literature review. BJOG an International Journal of Obstetrics & Gynaecology, 121(s4), 141–153. doi: 10.1111/1471-0528.12995
9. Babalola, S., & Fatusi, A. (2009). Determinants of use of maternal health services in Nigeria - looking beyond individual and household factors. BMC Pregnancy and Childbirth, 9(1). doi: 10.1186/1471-2393-9-43
10. Bohren, M. A., Hunter, E. C., Munthe-Kaas, H. M., Souza, J. P., Vogel, J. P., & Gülmezoglu, A. M. (2014). Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reproductive Health, 11(1). doi: 10.1186/1742-4755-11-71
11. Carroli, G., Rooney, C., & Villar, J. (2001). How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatric and Perinatal Epidemiology, 15(s1), 1–42. doi: 10.1046/j.1365-3016.2001.0150s1001.x
12. Campbell, O. M., & Graham, W. J. (2006). Strategies for reducing maternal mortality: getting on with what works. The Lancet, 368(9543), 1284–1299. doi: 10.1016/s0140-6736(06)69381-1
13. Chukwuma, A., Wosu, A. C., Mbachu, C., & Weze, K. (2017). Quality of antenatal care predicts retention in skilled birth attendance: a multilevel analysis of 28 African countries. BMC Pregnancy and Childbirth, 17(1). doi: 10.1186/s12884-017-1337-1
14. Dankwah, E., Zeng, W., Feng, C., Kirychuk, S., & Farag, M. (2019). The Social Determinants of Health Facility Delivery in Ghana. Reproductive Health, 16(1). doi: 10.1186/s12978-019-0753-2
15. Déglise, C., Suggs, L. S., & Odermatt, P. (2012). SMS for disease control in developing countries: a systematic review of mobile health applications. Journal of Telemedicine and Telecare, 18(5), 273–281. doi: 10.1258/jtt.2012.110810
16. Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., Patel, V., & Haines, A. (2013). The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health care Consumers: A Systematic review. PLoS Medicine, 10(1), e1001362. doi: 10.1371/journal.pmed.1001362
17. Gatwood, J., Balkrishnan, R., Erickson, S. R., An, L. C., Piette, J. D., & Farris, K. B. (2015). The impact of tailored text messages on health beliefs and medication adherence in adults with diabetes: A randomised pilot study. Research in Social and Administrative Pharmacy, 12(1), 130–140. doi: 10.1016/j.sapharm.2015.04.007
18. Gurman, T. A., Rubin, S. E., & Roess, A. A. (2012). Effectiveness of MHealth Behavior Change Communication Interventions in Developing Countries: A Systematic Review of the literature. Journal of Health Communication, 17(sup1), 82–104. doi: 10.1080/10810730.2011.649160
19. Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (2019). Cochrane Handbook for Systematic Reviews of Interventions. In Wiley eBooks. doi: 10.1002/9781119536604
20. Kante, M., & Målqvist, M. (2025). Effectiveness of SMS-based interventions in enhancing antenatal care in developing countries: a systematic review. BMJ Open, 15(2), e089671. doi: 10.1136/bmjopen-2024-089671
21. Mishra, M., Parida, D., Murmu, J., Singh, D., Rehman, T., Kshatri, J.S., & Pati, S. (2023). Effectiveness of mHealth Interventions for Monitoring Antenatal Care among Pregnant Women in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. Healthcare, 11(19), 2635. doi: 10.3390/healthcare11192635
22. Chukwuma, A., Mbachu, C., McConnell, M., Bossert, T. J., & Cohen, J. (2019). The Impact of Monetary Incentives on Referrals by Traditional Birth Attendants for Postnatal Care in Nigeria. BMC Pregnancy and Childbirth, 19(1). doi: 10.1186/s12884-019-2313-8
23. Danborno, A. M., Nwankwo, M., Kure, J., & Eluwa, C. (2018). Prevalence of Premenstrual Syndrome and Changes in Blood Pressure with Menstrual Cycle Among University Students. Niger Journal of Physiol. Sci, 33
24. Egbe, C. I., Ugwuanyi, L. T., Ede, M. O., Agbigwe, I. B., Onuorah, A. R., Okon, O. E., & Ugwu, J. C. (2022). Cognitive Behavioural Play Therapy for Social Anxiety Disorders (SADs) in Children with Speech Impairments. Journal of Rational-Emotive & Cognitive-Behaviour Therapy, 41(1), 24–44. doi: 10.1007/s10942-022-00442-6
25. Dagunduro, M. E., Falana, G. A., Adewara, Y. M., & Busayo, T. O. (2023). Application of Artificial Intelligence and Audit Quality in Nigeria. Advances in Multidisciplinary & Scientific Research Journal Publication, 11(1), 39–56. doi: 10.22624/aims/humanities/v11n1p4
26. Isezuo, K. O., Sani, U., Garba, B., Waziri, U., Okwuolise, O., Adamu, A., Jiya, F., & Amodu-Sanni, M. (2020). Evaluation of Antibiotic Prescription and Utilisation amongst Hospitalised Children in a Tertiary Facility in Sokoto, North-Western Nigeria. Journal of Drug Delivery and Therapeutics, 10(4), 31–36. doi: 10.22270/jddt.v10i4.4158
27. Hassan, M., Patel, S., Sadaka, A. S., Bedawi, E. O., Corcoran, J. P., & Porcel, J. M. (2021). Recent Insights into the Management of Pleural Infection. International Journal of General Medicine, 14, 3415–3429. doi: 10.2147/ijgm.s292705
28. Aliyo, A., & Jibril, A. (2022). Anaemia and Associated Factors Among Under-Five-Year-Old Children Who Attended Bule Hora General Hospital in West Guji Zone, Southern Ethiopia. Journal of Blood Medicine, 13, 395–406. doi: 10.2147/jbm.s363876
29. Kano, M., Dupont, P., Aziz, Q., & Fukudo, S. (2018). Understanding Neurogastroenterology from Neuroimaging perspective: A Comprehensive review of functional and structural brain imaging in functional gastrointestinal disorders. Journal of Neurogastroenterology and Motility, 24(4), 512–527. doi: 10.5056/jnm18072
30. Mohammed, S. H., Habtewold, T. D., Birhanu, M. M., Sissay, T. A., Tegegne, B. S., Abuzerr, S., & Esmaillzadeh, A. (2019). Neighbourhood socioeconomic status and overweight/obesity: a systematic review and meta-analysis of epidemiological studies. BMJ Open, 9(11), e028238. doi: 10.1136/bmjopen-2018-028238
31. Nasir, B. F., Brennan‐Olsen, S., Gill, N. S., Beccaria, G., Kisely, S., Hides, L., Kondalsamy‐Chennakesavan, S., Nicholson, G., & Toombs, M. (2021). A community‐led design for an Indigenous Model of Mental Health Care for Indigenous people with depressive disorders. Australian and New Zealand Journal of Public Health, 45(4), 330–337. doi: 10.1111/1753-6405.13115
32. Olaniyan, O. S., & Hetland, H. (2024). Health Interventions to Improve Work and Well‐Being Among Child Welfare Workers: A scoping review. Asian Social Work and Policy Review, 18(3). doi: 10.1111/aswp.12330
33. Pate, R. R., Dishman, R. K., Dowda, M., McIver, K. L., Pfeiffer, K. A., Porter, D. E., Saunders, R. P., & Ward, D. S. (2022). A summary of one research team's contributions to understanding physical activity behaviour in children and youth. International Journal of Environmental Research and Public Health, 19(21), 14136. doi: 10.3390/ijerph192114136
34. Qadri, G., Alkilzy, M., Franze, M., Hoffmann, W., & Splieth, C. (2018). School-based oral health education increases caries inequalities. PubMed, 35(3), 153–159. doi: 10.1922/cdh_4145qadri07
35. Rabiu, A. G., Falodun, O. I., Dada, R. A., Afolayan, A. O., Akinlabi, O. C., Akande, E. T., & Okeke, I. N. (2025). Transmissible antimicrobial resistance in Escherichia coli isolated from household drinking water in Ibadan, Nigeria. PLoS ONE, 20(5), e0318969. doi: 10.1371/journal.pone.0318969
36. Sadiq, N., & Warsi, J. (2025). Factors associated with Erectile Dysfunction in Men: A Cross-Sectional Study from Balochistan, Pakistan. Cureus. doi: 10.7759/cureus.76928
37. Muhammad, A. D., Mann, A., Fadipe, L. A., Kabiru, A. Y., Tanko, E., & Yusuf, M. (2023). Cytotoxic correlation of selected Nigerian ethnomedicinal plants using the brine shrimp lethality test. Journal of Applied Science and Environmental Management, 27(9), 1965–1970. doi: 10.4314/jasem.v27i9.10
38. Umar, A., Ibrahim, S., Liman, I., Chama, C., Ijaiya, M., Mathai, M., & Ameh, C. (2022). Implementation and evaluation of obstetric early warning systems in tertiary care hospitals in Nigeria. PLOS Global Public Health, 2(7), e0000225. doi: 10.1371/journal.pgph.0000225
39. Wada, Y. H., Ogunyinka, I. A., Yusuff, K. B., Ochu, C. L., Yahaya, M., Khalid, G. M., Mutalub, Y. B., & Adeniye, S. B. (2022). Knowledge of Lassa fever, its prevention and control practices and their predictors among healthcare workers during an outbreak in Northern Nigeria: A multi-centre cross-sectional assessment. PLoS Neglected Tropical Diseases, 16(3), e0010259. doi: 10.1371/journal.pntd.0010259
40. Chen, Y., Madan, J., Welton, N., Yahaya, I., Aveyard, P., Bauld, L., Wang, D., Fry-Smith, A., & Munafò. (2012). Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis. Health Technology Assessment, 16(38). doi: 10.3310/hta16380
41. Zakaria, Z., H.M. Khairi, M.N. Somchit, Sulaiman, A.M. Mat Jais, I. Reezal, N.N. Mat Zaid, S.N.Z. Abdul Wahab, N.S. Fadzil, M. Abdullah, & C.A. Fatimah. (2006). The in vitro Antibacterial Activity and Brine Shrimp Toxicity of Manihot esculenta var. Sri Pontian (Euphorbiacea) Extracts. International Journal of Pharmacology, 2(2), 216–220. doi: 10.3923/ijp.2006.216.220
42. Ahmed, H. H., Tahaa, S. A., Khodrya, M. M., & Abdel-Lateifa, A. D. (2019). Outcome of Total laparoscopic hysterectomy in Qena University Hospital. SVU-International Journal of Medical Sciences, 2(2), 17-22
43. Hamel, C., Michaud, A., Thuku, M., Skidmore, B., Stevens, A., Nussbaumer-Streit, B., & Garritty, C. (2020). Defining Rapid Reviews: a systematic scoping review and thematic analysis of definitions and defining characteristics of rapid reviews. Journal of Clinical Epidemiology, 129, 74–85. doi: 10.1016/j.jclinepi.2020.09.041
44. Hampshire, K., Porter, G., Owusu, S. A., Mariwah, S., Abane, A., Robson, E., Munthali, A., DeLannoy, A., Bango, A., Gunguluza, N., & Milner, J. (2015). Informal m-health: How are young people using mobile phones to bridge healthcare gaps in Sub-Saharan Africa? Social Science & Medicine, 142, 90–99. doi: 10.1016/j.socscimed.2015.07.033
45. Kim, S. K., Park, S. Y., Hwang, H. R., Moon, S. H., & Park, J. W. (2023). Effectiveness of mobile health intervention in medication adherence: A systematic review and meta-analysis. Research Square. doi: 10.21203/rs.3.rs-3440357/v1
46. Effiong, M. E., Bella-Omunagbe, M., Afolabi, I. S., & Chinedu, S. N. (2025). Molecular Docking Appraisal of Pleurotus ostreatus Phytochemicals as Potential Inhibitors of PI3K/Akt Pathway for Breast Cancer Treatment. Bioinformatics and Biology Insights, 19. doi: 10.1177/11779322251316864
47. Yonrizon, Y., Fika, R., & Sari, A. S. (2023). Analysis of waiting time for prescription services at the outpatient pharmacy installation of hospital X, Pariaman city. Science Midwifery, 11(3)
48. Hingle, M., Nichter, M., Medeiros, M., & Grace, S. (2012). Texting for Health: The use of participatory methods to develop healthy lifestyle messages for teens. Journal of Nutrition Education and Behaviour, 45(1), 12–19. doi: 10.1016/j.jneb.2012.05.001
49. Haruna, H., Okoye, K., Zainuddin, Z., Hu, X., Chu, S., & Hosseini, S. (2021). Gamifying Sexual Education for Adolescents in a Low-Tech Setting: Quasi-Experimental Design Study. JMIR Serious Games, 9(4), e19614. doi: 10.2196/19614
50. Hirsch, M., Begum, Paniz, É., Barker, C., Davis, C., & Duffy, J. (2017). Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG an International Journal of Obstetrics & Gynaecology, 125(5), 556–564. doi: 10.1111/1471-0528.14838
51. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2010). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. International Journal of Surgery, 8(5), 336–341. doi: 10.1016/j.ijsu.2010.02.007
52. Kabir, H., Tonmon, T. T., Hasan, M. K., Biswas, L., Chowdhury, M. A. H., Islam, M. D., Rahman, M., & Mitra, D. K. (2022). Association between preference and e-learning readiness among the Bangladeshi female nursing students in the COVID-19 pandemic: a cross-sectional study. Bulletin of the National Research Centre/Bulletin of the National Research Centre, 46(1). doi: 10.1186/s42269-022-00697-0
53. Lawan, A., Aubertin, A., Mical, J., Hum, J., Graf, M. L., Marley, P., Bolton, Z., & Walton, D. M. (2024). Is educational attainment associated with the onset and outcomes of low back pain? A systematic review and meta-analysis. PLoS ONE, 19(8), e0308625. doi: 10.1371/journal.pone.0308625
54. Musa, N.R., et al. (2019). Electrocardiogram Pattern Before and After Potassium Correction in Hypokalemia. International Journal of Medical Reviews and Case Reports, 3, 711-716.
55. Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., & Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ, 349, g7647. doi: 10.1136/bmj.g7647
56. Oladele, D. A., Balogun, M. R., Odeyemi, K., & Salako, B. L. (2020). A comparative study of knowledge, attitude, and determinants of Tuberculosis-Associated stigma in rural and urban communities of Lagos State, Nigeria. Tuberculosis Research and Treatment, 1–14. doi: 10.1155/2020/1964759
57. Pius, C., Ahmad, H., Snowdon, R., Ashrafi, R., Waktare, J. E., Borbas, Z., Luther, V., Mahida, S., Modi, S., Hall, M., Gupta, D., & Todd, D. (2022). Impact of COVID-19 on patients awaiting ablation for atrial fibrillation. Open Heart, 9(1), e001969. doi: 10.1136/openhrt-2022-001969
58. Lefebvre, C., Glanville, J., Briscoe, S., Littlewood, A., Marshall, C., Metzendorf, M., Noel‐Storr, A., Rader, T., Shokraneh, F., Thomas, J., & Wieland, L. S. (2019). Searching for and selecting studies. Cochrane Handbook for Systematic Reviews of Interventions, 67–107. doi: 10.1002/9781119536604.ch4
59. Rufai, T., Aninagyei, E., Akuffo, K. O., Ayin, C. T., Nortey, P., Quansah, R., Cudjoe, F. S., Tei-Maya, E., Duah, I. O., Junior, & Danso-Appiah, A. (2023). Malaria and typhoid fever among patients presenting with febrile illnesses in Ga West Municipality, Ghana. PLoS ONE, 18(5), e0267528. doi: 10.1371/journal.pone.026752
60. Salisu, A., Penzin, D. J., & Hammed, Y. (2023). Health crisis and currency risk: Fresh evidence from new data sets. SSRN Electronic Journal. doi: 10.2139/ssrn.4612312
61. Ebenso, B., Okusanya, B., Okunade, K., Akeju, D., Ajepe, A., Akaba, G. O., Yalma, R. M., Dirisu, O., Tukur, J., Abdullahi, M. K., Okuzu, O., & Allsop, M. J. (2021). What are the contextual enablers and impacts of using digital technology to extend maternal and child health services to rural areas? Findings of a qualitative study from Nigeria. Frontiers in Global Women's Health, 2. doi: 10.3389/fgwh.2021.670494
62. Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109), 629–634. doi: 10.1136/bmj.315.7109.629
63. McGowan, J., Sampson, M., Salzwedel, D. M., Cogo, E., Foerster, V., & Lefebvre, C. (2016). PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. Journal of Clinical Epidemiology, 75, 40–46. doi: 10.1016/j.jclinepi.2016.01.021
64. Yakubu, O. F., Adebayo, A. H., Famakinwa, T. O., Adegbite, O. S., Ishola, T. A., Imonikhe, L. O., Adeyemi, O. A., Awotoye, O. A., & Iweala, E. J. (2018). Antimicrobial And Toxicological Studies Of Ricinodendron Heudelotii (Baill.). Asian Journal of Pharmaceutical and Clinical Research, 11(1), 299. doi: 10.22159/ajpcr.2018.v11i1.21251
65. Greenhalgh, T., & Peacock, R. (2005). Effectiveness and Efficiency of Search Methods in Systematic Reviews of Complex Evidence: An Audit of Primary Sources. BMJ, 331(7524), 1064–1065. doi: 10.1136/bmj.38636.593461.68
66. Abdullahi, L., Onyango, J. J., Mukiira, C., Wamicwe, J., Githiomi, R., Kariuki, D., Mugambi, C., Wanjohi, P., Githuka, G., Nzioka, C., Orwa, J., Oronje, R., Kariuki, J., & Mayieka, L. (2020). Community interventions in Low—And Middle-Income Countries to inform COVID-19 control implementation decisions in Kenya: A rapid systematic review. PLoS ONE, 15(12), e0242403. doi: 10.1371/journal.pone.0242403
67. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ, 339, b2700. doi: 10.1136/bmj.b2700
68. Head, K. J., Noar, S. M., Iannarino, N. T., & Harrington, N. G. (2013). Efficacy of text messaging-based interventions for health promotion: A meta-analysis. Social Science & Medicine, 97, 41–48. doi: 10.1016/j.socscimed.2013.08.003
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