Assessment of the Willingness of the Pregnant Women to Pay for the SMS Texts or Phone
Calls for the Improvement of Prenatal and
Postnatal Health Care Services Dschang Health District, West Region, Cameroon
Nkemngu Blake Afutendem1,2, Claude Ngwayu Nkfusai2,3*, Vecheusi Zennobia Viyoff2,3, Franklin Nsai Sanyuy2,3, Terrence Beteck Epie2,4, Fala Bede2 and Samuel Nambile Cumber5,6,7
1Department of Public Health, Faculty of Science, University of Dschang, Cameroon
2Cameroon Baptist Convention Health Services (CBCHS), Cameroon
3Department of Microbiology and Parasitology, University of Buea, Cameroon
4Nuffield Department of Medicine, University of Oxford, United Kingdom
5Department of Public Health and Community Medicine, University of Gothenburg, Sweden
6Faculty of Health Sciences, University of Pretoria Private Bag X323, South African
7Faculty of Health Sciences, University of the Free State, South Africa
Submission: August 14, 2019; Published: September 10, 2019
*Corresponding author: Ngwayu Claude Nkfusai, Cameroon Baptist Convention Health Services (CBCHS), Cameroon
How to cite this article: Nkemngu Blake Afutendem, Claude Ngwayu Nkfusai, Vecheusi Zennobia Viyoff, Franklin Nsai Sanyuy, Terrence Beteck Epie etc all. Assessment of the Willingness of the Pregnant Women to Pay for the SMS Texts or Phone Calls for the Improvement of Prenatal and Postnatal Health Care Services Dschang Health District, West Region, Cameroon. J Gynecol Women’s Health. 2019: 16(4): 555941. DOI: 10.19080/JGWH.2019.16.555941
Background: The term E-Health refers to the use of modern information and communication technologies (ICT) to meet needs of citizens, patients, healthcare professionals, healthcare providers, as well as policy makers. Short message service (SMS), commonly referred to as “text messaging,” is a service for sending short messages of up to 160 characters (224 characters if using a 5-bit mode) to mobile devices, including cellular phones, smartphones and PDAs. This study therefore had as aim to assess of the willingness of the pregnant women to pay for the SMS texts or phone calls for the improvement of prenatal and postnatal health care services Dschang Health District, West Region, Cameroon.
Methods: This was a Cross sectional descriptive study in the Dschang Health District, West Region of Cameroon. We included all pregnant women aged 18years and above. A total of 372 pregnant women were included. This study was carried out from March to July 2016.
Result: Majority of the women that is 252 (67.74%) were married, 117 (31.45%) of the women affirmed being single, and 3 (0.81%) were devorced. 336 (90.32%) of the women were Christians, 28 (7.53%) were Muslim and 8 (2.15%) affirmed being pagans. 216 women out of the 335 (64.44%) that responded willing to receive SMS texts and phone calls affirmed being willing to pay for the service, against 35.52%.
Conclusion: This study shows that cell phones would be an acceptable approach to provide pregnancy and postpartum support to women in the Dschang health district, since most women interviewed had access to a cell phone and referred it as a desired and accepted means of communication. In this cell phone approach, free SMS messages and voice calls will be privileged over internet-based interventions.
Keywords: Pregnant women; Improvement; Prenatal and Postnatal care services; SMS; Dschang Health District; West Region; Cameroon
Abbreviations: MNCH: Maternal New-born and Child Health; DHD: Dschang Health District; PDA: Personal Digital Assistant; ANC: Antenatal Care; PNC: Postnatal Care; PMTCT: Prevention of Mother to Child Transmission; TRA: Telecommunications Regulatory Agency; SMS: Short Text Messages; ICT: Information and Communication Technologies; WHO: World Health Organization; ITN: Insecticide Treated Bed Nets; IPTp: Intermittent Preventive Treatment of Malaria During Pregnancy; STIs: Sexually transmitted infections; ATV: Anti Tetanic Vaccine; DHS: Demographic Health Survey; A2P M: Application-to-Peer Messaging; FNIH: Foundation for the National Institutes of Health; IHISM: Integrated Healthcare Information Service; AESSIMS: Acute Encephalitis Syndrome Surveillance Information Management System; PATH: Program for Appropriate Technology in Health.
The term Ehealth refers to the use of modern information
and communication technologies (ICT) to meet needs of citizens,
patients, healthcare professionals, healthcare providers, as well
as policy makers .
It’s a general term for the use of mobile phones and other
wireless technology in medical care. The most common application
of mHealth is the use of mobile phones and communication
devices to educate consumers about preventive health care services
Also known as antenatal care, is a type of preventive healthcare
with the goal of providing regular check-ups that allow doctors
or midwives to treat and prevent potential health problems
throughout the course of the pregnancy while promoting healthy
lifestyles that benefit both mother and child .
Commonly referred to as “text messaging,” is a service for
sending short messages of up to 160 characters (224 characters
if using a 5-bit mode) to mobile devices, including cellular
phones, smartphones and PDAs .
A telephone call is a connection over a telephone network
between the called party and the calling party .
In a study conducted in six West African countries, a third
of all pregnant women experienced illness during pregnancy, of
whom three percent required hospitalization . Certain pre-existing
conditions become more severe during pregnancy. Malaria,
HIV/AIDS, anaemia and malnutrition are associated with increased
maternal and new-born complications as well as death
where the prevalence of these conditions is high .
In sub-Saharan Africa, an estimated 900,000 babies die
as stillbirths during the last twelve weeks of pregnancy . It
is estimated that babies who die before the onset of labour, or
antepartum stillbirths, account for two-thirds of all stillbirths
in countries where the mortality rate is greater than 22 per
1,000 births nearly all African countries . Antepartum stillbirths
have several causes, including maternal infections notably
syphilis and pregnancy complications, but systematic global estimates
for causes of antepartum stillbirths are not available .
New-borns are affected by problems during pregnancy including
preterm birth and restricted foetal growth, as well as other factors
affecting the baby’s development such as congenital infections
and foetal alcohol syndrome .
The recruitment centre was the Dschang health district
hospital. This choice was made from convenience because they
account for a great number of prenatal consultations in the
Dschang health district. Investigators interviewed all eligible
women who had consented to participate in the study until the
minimum sample size number was reached.
Data was collected with the use of questionnaires (made
available in English and French) orally administered by the investigator
after prenatal consultations have been done to the
selected women who would have consented to participate in the
study. The period of data collection was & month 1 week (from
the 30th of May to the 7th of July), and was done in the Dschang district hospital. There are pre organised sessions of prenatal
consultations on every Mondays, so special emphasis and mobilisation
was doneevery Monday to administer questionnaires
to pregnant women. Sampling was performed by convenience.
Investigators recruited all eligible women who consented to participate
until the minimum sample size number was reached.
The questionnaires were then coded and entered in EPI Info
220.127.116.11 and thus analysed. Descriptive and inferential statistical
analysis was used.
Questionnaires will be checked by the principal investigator
for completeness daily by immediate supervisors. After checking
for consistency and completeness, the supervisor will submit
the filled questionnaire to the principal investigator. Incorrectly
filled or missed ones will be sent back to respective data collectors
for correction. The principal investigator will again recheck
the completed questionnaires to maintain the quality of data.
Given the fact that this research involves humans (participants,
investigator, data collectors) ethical consideration is mandatory.
It is for this reason that this protocol will be submitted to
the National Ethical Committee in Yaoundé for Ethical Clearance.
The participants of this research (community individuals
of all ages) have some potential risk link to this study which includes:
violation of autonomy, rupture of confidentiality on the
private data with regards to participants, exploitation of participants
and inequality in risk/benefit ratio and also rupture
of social equilibrium in community. Such potential risks will be
minimised by all the information mentioned in the information
notice. This includes:
a. Administering Informed Consent to participants before
b. Respecting the autonomy of participants.
c. The data collection tool (questionnaire) will be anonymous,
restricting access to data only to those concerned,
physical and electronic barriers.
d. Electronic Data will be stored in an apple cloud account
accessed only by the principal investigator and the physical
questionnaires burned after verification of data
e. Permission will be obtained from District Administration
and the hospital administration equally.
336 (90.32%) of the women were Christians, 28(7.53%)
were Muslim and 8(2.15%) affirmed being pagans. Willingness
of the pregnant women to pay for the SMS texts or phone calls
received, 216 women out of the 335 (64.44%) that responded
willing to receive SMS texts and phone calls affirmed being willing
to pay for the service, against 35.52%. (Figure 4) Distribution
of pregnant women willing to pay for service per educational level
(Figure 5) better illustrates the distribution of the interviewed
women that were willing to pay for the service according to their
educational levels while (Figure 6) their distribution per profession.
Distribution of the pregnant women that are willing to pay
for service according to their marital status. (Figure 7) illustrates
the distribution of the pregnant women that are willing to pay
for service according to their marital status.
The fact that 64.44% of the women that were interested in
the MHealth intervention, were willing to pay for the services,
26.03% of them from the 25-29-year-old age group. Also, 36% of
the women willing to pay for the services were students. These
results show us that in order to attain a maximum coverage of
women in the program, the health service should be free, and
toll-free numbers be used for phone calls and thus allow women
to freely express their concerns in matters of health.
This study shows that cell phones would be an acceptable approach
to provide pregnancy and postpartum support to women
in the Dschang health district, since most women interviewed
had access to a cell phone and referred it as a desired and accepted
means of communication. In this cell phone approach,
free SMS messages and voice calls will be privileged over internet-
based interventions. We recommend as follows:
a) Encourage similar studies to be done all over the country
and thus have a global view of the issue
b) Sends SMS text messages to pregnant women giving
them health information
c) Allows pregnant women to send free SMS text messages
to the call centre to ask for advice
d) Allows pregnant women to call toll free numbers to
seek health advice
e) Sends healthcare advice through SMS texts 3 times a
week and in the afternoon or evening.
f) For the uneducated women, use phone calls in local language
rather than SMS texts, because these women will likely
not read them.
NBA, CNN, VZV, FNS, TBE, FB and SNC conceived and designed
the study. NBA implemented the study. NBA conducted
data analysis. NBA, CNN, VZV, FNS, TBE, FB and SNC interpreted
study results: NBA and NCN wrote the first draft of the manuscript.
TBE, FB, NCN and SNC reviewed and corrected the draft
manuscript. All authors read and approved the final manuscript.
Cormick G, Kim NA, Rodgers A, Gibbons L, Buekens PM, et (2012) Interest of pregnant women in the use of SMS (short message service) text messages for the improvement of perinatal and postnatal care. Reprod Health 9(1): 9.