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

Abstract Background Text 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. Methods A randomized controlled trial was conducted in Dar es Salaam, Tanzania. E CEM-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. Results Between 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