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Abstract Background Mobile phone-based messaging for maternal education has shown promising outcomes in promoting maternal and child healthcare in low- and middle-income countries, where there is poor utilization of healthcare services. However, the success of a mobile phone messaging-based intervention depends on identifying and addressing the underlying factors that determine its utilization before implementation. Objective To assess pregnant mothers’ intention to use a mobile phone-based messaging intervention to improve maternal and newborn health in Jimma Zone, Ethiopia. Method This study employed a cross-sectional study design among randomly selected pregnant mothers residing in six primary health care units that were selected from three districts of Jimma Zone, Ethiopia. Data were collected using an interviewer-administered structured questionnaire. Descriptive statistics such as frequencies, percentages, mean, and standard deviation were calculated and presented using tables. Multivariable linear regression analysis was used to identify predictors of intention. Standardized regression coefficients were used to understand the effect of the independent variables and outcome variable. A 95% confidence interval and a p-value of

BackgroundEthiopia has high rates of maternal and neonatal mortality. In 2019 and 2020, the maternal and newborn mortality rates were estimated at 412 per 1,000,000 births and 30 per 10,000 births, respectively. While mobile health interventions to improve maternal and neonatal health management have shown promising results, there are still insufficient scientific studies to assess the effectiveness of mobile phone messaging–based message framing for maternal and newborn health. ObjectiveThis research aims to examine the effectiveness of mobile phone messaging–based message framing for improving the use of maternal and newborn health services in the Jimma Zone, Ethiopia. MethodsA 3-arm cluster-randomized trial design was used to evaluate the effects of mobile phone–based intervention on maternal and newborn health service usage. The trial arms were (1) gain-framed messages (2) loss-framed messages, and (3) usual care. A total of 21 health posts were randomized, and 588 pregnant women who had a gestational age of 16-20 weeks, irrespective of their antenatal care status, were randomly assigned to the trial arms. The intervention consisted of a series of messages dispatched from the date of enrolment until 6-8 months. The control group received existing care without messages. The primary outcomes were maternal health service usage and newborn care practice, while knowledge, attitude, self-efficacy, iron supplementation, and neonatal and maternal morbidity were secondary outcomes. The outcomes will be analyzed using a generalized linear mixed model and the findings will be reported according to the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement for randomized controlled trials. ResultsRecruitment of participants was conducted and the baseline survey was administered in March 2023. The intervention was rolled out from May 2023 till December 2023. The end-line assessment was conducted in February 2024. ConclusionsThis trial was carried out to understand how mobile phone–based messaging can improve maternal and newborn health service usage. It provides evidence for policy guidelines around mobile health strategies to improve maternal and newborn health. Trial RegistrationPan African Clinical Trials Registry PACTR202201753436676; https://tinyurl.com/ykhnpc49 International Registered Report Identifier (IRRID)DERR1-10.2196/52395

Abstract Background Intimate partner violence (IPV) during pregnancy is a global health problem with adverse consequences for mothers, infants and families. We hypothesise that information about IPV and safety behaviours during pregnancy has the potential to increase quality of life and the use of safety behaviours and prevent IPV. Methods A multicentre randomised controlled trial among culturally diverse pregnant women in Norway, to test the effect of a tablet-based video intervention about IPV and safety behaviours. Women attending routine antenatal check-ups alone (baseline) were screened for violence (Abuse Assessment Screen) by responding to questions on a tablet, and randomised (1:1) by computer to receive an intervention or a control video. The intervention video presented information about IPV and safety behaviours. The controls viewed a video promoting healthy pregnancy in general. Outcome measures were assessed three months post-partum: The World Health Organization Quality of Life-BREF, the Composite Abuse Scale on violence during the last 12 months and use of safety behaviours based on a 15-item checklist. A general linear model for repeated measures was used to examine the intervention’s effect. The analyses were conducted by intention to treat. Results Among 1818 eligible women, 317 reported IPV and were randomised to an intervention (157) or a control group (160). A total of 251 (79.2%) women completed the follow-up questionnaire: 120 (76.4%) in the intervention group and 131 (81.9%) in the control group. At follow-up, 115 (45.8%) women reported a history of IPV. Few women (n = 39) reported IPV during the last 12 months. No differences in quality-of-life domains and overall quality of life and health were found between the intervention and the control groups. We detected no differences between the use of safety behaviours or IPV frequency and severity during the last 12 months. Conclusion Our intervention did not improve women’s quality of life, use of safety behaviours or exposure to violence. Nevertheless, a tablet-based tool may motivate women experiencing IPV to seek help and support. More research is needed regarding tablet-based interventions for women experiencing IPV, particularly culturally sensitive interventions. Trial registration NCT03397277 registered in clinicaltrials.gov on 11/01/2018.

Porcine cysticercosis is endemic in Tanzania, especially in the Southern Highlands, Central areas and Northern Highlands regions of the country. It is a condition that reduces pork quality and suitability for human consumption and hence affecting public health and the pig industry. The prevalence and possible associated factors for porcine cysticercosis occurrence were investigated to assist in the planning for sustainable control measures. This study was conducted in three wards of Iringa region, southern Tanzania. A blood sample was collected from 346 pigs in 88 households and analysed using an enzyme-linked immunosorbent assay (ELISA), to detect Taenia solium antigens (Ag). A questionnaire administered to farmers and an observational checklist tool assisted the researcher in collecting household information on pig management, sanitation and hygiene practices. On average, 22.3±3.44 per cent of pigs was seropositive for porcine cysticercosis in the three wards, and 53.4 per cent of the surveyed households had at least one seropositive pig. Statistically, porcine cysticercosis was associated with the scavenging pig rearing method (OR=2.426; p≤0.05) and poor quality pig housing (OR=1.75; p≤0.05). This means that scavenging pigs and those living in poor-quality pens had two times higher chances of being infected. Having more than half studied pig units with positive case(s) indicates limited inputs in pig feeding and sheltering thus exposing them to infection vulnerability. The poor-quality pens allowed pigs to escape and/or scavenge on T. solium eggs contaminated environment. Training and sensitising on improved pig management using locally available resources is essential. Also emphasising regular latrine use, hygiene and sanitation practices can support control.

BackgroundCommunity health education is one of the most effective measures to increase health literacy worldwide and can contribute to the achievement of specific targets of the Sustainable Development Goal 3. Digitalized health education materials can improve health knowledge as a dimension of health literacy and play an important role in disease prevention in rural sub-Saharan settings. ObjectiveThe objective of this research is to assess the effect of a digital health education intervention on the uptake and retention of knowledge related to HIV/AIDS, tuberculosis (TB), and Taenia solium (neuro)cysticercosis and taeniosis in rural communities in Iringa, Tanzania. MethodsWe conducted a nonrandomized intervention study of participants aged 15 to 45 years, randomly selected from 4 villages in Iringa, Tanzania. The intervention consisted of 2 parts. After the baseline assessment, we showed the participants 3 animated health videos on a tablet computer. After a period of 6 months, free access to community information spots (InfoSpots) with an integrated digital health education platform was provided to the intervention villages. Participants in the control group did not receive the intervention. The primary outcome was the difference in disease knowledge between the intervention and control groups, 12 months after baseline. Data were collected using an open-ended questionnaire, with correct or incorrect answers before and after intervention. ResultsBetween April and May 2019, a total of 600 participants were recruited into the intervention (n=298, 49.7%) or control (n=302, 50.3%) groups. At baseline, no statistically significant differences in knowledge of the target diseases were observed. At 12 months after intervention, knowledge about HIV/AIDS, TB, and T. solium (neuro)cysticercosis and taeniosis was 10.2% (95% CI 5.0%-15.4%), 12% (95% CI 7.7%-16.2%), and 31.5% (95% CI 26.8%-36.2%) higher in the intervention group than in the control group, respectively. In all 4 domains (transmission, symptoms, treatment, and prevention), an increase in knowledge was observed in all the 3 diseases, albeit to varying degrees. The results were adjusted for potential confounders, and the significance of the primary results was maintained in the sensitivity analysis to assess dropouts. The participants who reported using the InfoSpots in the 12-month assessment further increased their knowledge about the target diseases by 6.8% (HIV/AIDS), 7.5% (TB), and 13.9% higher mean proportion of correct answers compared with the participants who did not use the InfoSpots. ConclusionsDigital health education based on animated health videos and the use of free InfoSpots has significant potential to improve health knowledge, especially in rural areas of low- and middle-income countries. Trial RegistrationClinicalTrials.gov NCT03808597; https://clinicaltrials.gov/ct2/show/NCT03808597 International Registered Report Identifier (IRRID)RR2-10.2196/25128

The concept of digital literacy has been defined in numerous ways over the last two decades to incorporate rapid technological changes, its versatility, and to bridge the global digital divide. Most approaches have been technology-centric with an inherent assumption of cultural and political neutrality of new media technologies. There are multiple hurdles in every stage of digital literacy implementation. The lack of solutions such as local language digital interfaces, locally relevant content, digital literacy training, the use of icons and audio excludes a large fraction of illiterate people. In this article, we analyse case studies targeted at under-connected people in sub-Saharan Africa and India that use digital literacy programmes to build knowledge and health literacy, solve societal problems and foster development. In India, we focus on notable initiatives undertaken in the domain of digital literacy for rural populations. In Sub-Saharan Africa, we draw from an original project in Kenya aiming at developing digital literacy for youth from low-income backgrounds. We further focus on Senegal, Mali, Burkina Faso and Tanzania, where field studies have been conducted on the use of digital technologies by low-literacy people and on how audio and icon-based interfaces and Internet lite standard could help them overcome their limitations. The main objective of this article is to identify key performance indicators (KPIs) in the context of digital literacy skills as one of the pillars for digital inclusion. We will learn how digital literacy programmes can be used to build digital literacy and how KPIs for sustainable development can be established. In the final discussion, we offer lessons learned from the case studies and further recommendation for stakeholders and decision-makers in the field of digital health literacy.

Digital health is considered an opportunity to engage a wider community in disease control for public health. It has been used in healthcare consultation, in medical treatments and in reporting emergencies. The current study developed digital health literacy content for public health education and assessed its effects on porcine cysticercosis prevalence, pig-keeping style and pig pen and latrine qualities. The intervention was designed and evaluated on the prevention and control of porcine cysticercosis in the Iringa District of southern Tanzania. A quasi-controlled field trial with pre-intervention and post-intervention assessments of porcine cysticercosis, pig-keeping style and pig pen and latrine qualities was conducted. A baseline cross-sectional study was followed immediately by digital health literacy intervention, which comprised educational messages on porcine cysticercosis shown on computer tablets or smartphones. Free internet access supported unsupervised community access. The 25-month post-intervention assessments revealed significantly increased pig confinement (20.1%) (p = 0.026) and pig pen quality (16.2%) (p = 0.025). However, the quality of household latrines (p = 0.453) was not improved, nor was there any significant effect on the prevalence of porcine cysticercosis (p = 0.231). The digital health literacy intervention suggests a strategy for wider and sustainable dissemination of educational messages for Taenia solium infection control.

BackgroundHealth workers have traditionally delivered health promotion and education to rural communities in the Global South in paper leaflet formats or orally. With the rise of digital technologies, health promotion and education can be provided in innovative and more effective formats, which are believed to have a higher impact on disease prevention and treatment. ObjectiveThe aim of this tutorial is to illustrate how a multi- and interdisciplinary approach can be applied in the design process of digital health messages for use in the Global South. MethodsThe multi- and interdisciplinary team of the Non-discriminating access for Digital Inclusion (DigI) project digitalized and customized available government-approved paper-based health promotion messages into a screen-suitable format. The team worked closely together and used its diverse expertise to develop digital health messages with disease-specific content in Tanzania’s national language (Swahili) as well as English. The development process included the following phases: a local needs assessment; identification of government-approved health promotion materials in a nondigital format; identification of key health messages; creation of a practical and engaging story, easy to understand for the general public; drafting of a storyboard for an animated video with review, feedback, and revisions; forward and backward translation; audio recording of the story in both languages; finalization and presentation of the animations; development of relevant questions related to the health messages in each domain; and development of web and mobile apps to access the digital health messages. ResultsBetween 2017 and 2019, we developed key health messages, quizzes, and animated health videos to address HIV/AIDS, tuberculosis, Taenia solium cysticercosis and taeniasis, and anthrax, all of which are of public health importance in Tanzania. Feedback from local stakeholders and test users was included in various phases of the process. The 4 videos and other content are available in local information spots on a digital health platform (DigI platform), established by the DigI project, in both Tanzanian Swahili and English. ConclusionsOur methodological multi- and interdisciplinary approach ensures that the digital health messages for the public are clear, high quality, and align with the government’s objectives for health promotion. It also demonstrates the diversity of scientific disciplines required when collaborating on a digital health project. We recommend this approach to be applied to the development of other digital health messages for a wide range of diseases. International Registered Report Identifier (IRRID)RR2-10.2196/25128

Abstract Background Intimate partner violence (IPV) around the time of pregnancy is a recognized global health problem with damaging consequences. However, little is known about the effect of violence assessment and intervention during pregnancy. We hypothesise that routine enquiry about IPV during pregnancy, in combination with information about IPV and safety behaviours, has the potential to increase the use of these behaviours and prevent and reduce IPV. Methods The Safe Pregnancy study is a randomised controlled trial (RCT) to test the effectiveness of a tablet-based intervention to promote safety behaviours among pregnant women. Midwives include women who attend routine antenatal care. The intervention consists of a screening questionnaire for violence and information about violence and safety behaviours through a short video shown on a tablet. The materials are available in different languages to ensure participation of Norwegian, Urdu, Somali and English-speaking women. Eligible women answer baseline questions on the tablet including the Abuse Assessment Scale (AAS). Women who screen positive on the AAS will be randomized to an intervention video that contains information about violence and safety behaviours and women in the control group to a video with general information about a healthy and a safe pregnancy. All women receive information about referral resources. Follow up will be at three months post-partum, when the woman attends the maternal and child health centre (MCHC) for the baby’s check-up. Outcome measures are: Use of safety behaviours and quality of life (primary outcomes), prevalence of violence, mental health measures and birth outcomes (secondary outcomes). Intention to treat analysis will be performed. Discussion The project will provide evidence on whether enquiry about violence and a short video intervention on a tablet is effective and feasible to prevent or reduce harm from IPV among women who attend antenatal care. Trial registration This study is registered in ClinicalTrials.gov. Identifier: NCT03397277 (Registered 11th January 2018).

Objective To assess the effect of the Pregnant+ app on the 2-hour glucose level of the routine postpartum oral glucose tolerance test (OGTT) among women with gestational diabetes mellitus (GDM). The Pregnant+ app was designed to provide information about GDM, and promote physical activity and a healthy diet.Design A multicentre, non-blinded randomised controlled trial.Setting Five diabetes outpatient clinics in the Oslo region.Participants Women ≥18 years old with a 2-hour OGTT blood glucose level ≥9 mmol/L who owned a smartphone; understood Norwegian, Urdu or Somali; and were

Video conferencing services based on web real-time communication (WebRTC) protocol are growing in popularity among Internet users as multi-platform solutions enabling interactive communication from anywhere, especially during this pandemic era. Meanwhile, Internet service providers (ISPs) have deployed fiber links and customer premises equipment that operate according to recent 802.11ac/ax standards and promise users the ability to establish uninterrupted video conferencing calls with ultra-high-definition video and audio quality. However, the best-effort nature of 802.11 networks and the high variability of wireless medium conditions hinder users experiencing uninterrupted high-quality video conferencing. This paper presents a novel approach to estimate the perceived quality of service (PQoS) of video conferencing using only 802.11-specific network performance parameters collected from Wi-Fi access points (APs) on customer premises. This study produced datasets comprising 802.11-specific network performance parameters collected from off-the-shelf Wi-Fi APs operating at 802.11g/n/ac/ax standards on both 2.4 and 5 GHz frequency bands to train machine learning algorithms. In this way, we achieved classification accuracies of 92–98% in estimating the level of PQoS of video conferencing services on various Wi-Fi networks. To efficiently troubleshoot wireless issues, we further analyzed the machine learning model to correlate features in the model with the root cause of quality degradation. Thus, ISPs can utilize the approach presented in this study to provide predictable and measurable wireless quality by implementing a non-intrusive quality monitoring approach in the form of edge computing that preserves customers’ privacy while reducing the operational costs of monitoring and data analytics.

Video on demand (VoD) services such as YouTube have generated considerable volumes of Internet traffic in homes and buildings in recent years. While Internet service providers deploy fiber and recent wireless technologies such as 802.11ax to support high bandwidth requirement, the best-effort nature of 802.11 networks and variable wireless medium conditions hinder users from experiencing maximum quality during video streaming. Hence, Internet service providers (ISPs) have an interest in monitoring the perceived quality of service (PQoS) in customer premises in order to avoid customer dissatisfaction and churn. Since existing approaches for estimating PQoS or quality of experience (QoE) requires external measurement of generic network performance parameters, this paper presents a novel approach to estimate the PQoS of video streaming using only 802.11 specific network performance parameters collected from wireless access points. This study produced datasets comprising 802.11n/ac/ax specific network performance parameters labelled with PQoS in the form of mean opinion scores (MOS) to train machine learning algorithms. As a result, we achieved as many as 93–99% classification accuracy in estimating PQoS by monitoring only 802.11 parameters on off-the-shelf Wi-Fi access points. Furthermore, the 802.11 parameters used in the machine learning model were analyzed to identify the cause of quality degradation detected on the Wi-Fi networks. Finally, ISPs can utilize the results of this study to provide predictable and measurable wireless quality by implementing non-intrusive monitoring of customers’ perceived quality. In addition, this approach reduces customers’ privacy concerns while reducing the operational cost of analytics for ISPs.