Introduction: Sustainable Development Goal 3 targets to improve the health and wellbeing of all people across the globe with deployment of information and communication technologies in the delivery of health services. Maternal health has been prioritized in the global agenda, the 2030 target is to reduce the maternal mortality ratio to 70/100000 live births with ICT support systems. The 2014 National ICT policy of Uganda encourages the adoption of ICTs to improve and extend health care and health information systems to remote and underserved areas and vulnerable populations, recognizing women’s roles as health providers in their families and communities. Despite the estimated 69% mobile telephone subscription among women across the country, the use of the handy mobile telephone ICT options among expectant mothers in the acquisition of maternal health services has remained very low culminating into a mere 42% utilization of antenatal care services across the country. The districts of Kyotera and Rakai register only 30% utilization of antenatal care services which is far below the national target of 47.5%. This implies that expectant mothers in the districts of Kyotera and Rakai and more exposed to risk of maternal morbidity and mortality. The study therefore, purposed to evaluate the effect of using mobile telephone communication in providing maternal health information on the utilization of antenatal care services during pregnancy in the districts of Kyotera and Rakaia in Uganda. Methods: A cluster Randomized Controlled Trial was adopted by the study. A total of 28 health centers (clusters) were selected using simple random sampling and allocated into the intervention and control study arms on a ratio of 1:1. Overall, 2143 expectant mothers were recruited into the study using systematic sampling at each health centre with an average cluster enrollment of 80 expectant mothers per cluster. In the intervention arm, fortnightly mobile telephone phone-based text and voice messages comprising of information about the usefulness of maternal health services’ such as ANC, PNC and institutional delivery; and reminders of next scheduled ANC appointment were sent to expectant mothers and VHT’s hailing from villages serviced by health centres in the intervention arm. On the other hand, expectant mothers and VHTs sampled into the control arm did not receive any maternal health information on their mobile phones as well as reminders for scheduled ANC visits. Results: Study findings showed that the use of mobile telephone communication to provide maternal health information and reminders for scheduled ANC visits to expectant mother caused statistically significant differences in the utilization of ANC services during pregnancy with a recorded OR=1.72 and p<.05. In the intervention group, 75.3% of the expectant mothers utilized ANC services at least 8 times as recommended by the MoH compared to a mere 34.3% recorded in the control group. Findings further indicated that the utilization of ANC services was influenced by the marital status of an expectant mother with OR=1.56 and p<.05, the house hold income with OR=0.619 and p<.05, time taken to reach the health facility with OR=0.52 and p<.05and pregnancy related complications with OR=1.33 and p<.05. Conclusion: Use of mobile telephone communication to provide maternal health information and reminders for scheduled ANC visit is an effective intervention in enhancing the utilization of ANC service among expectant mothers. Optimization of text messages and adoption of the Mobile Optimistic Interconnectivity Telephone Utilitarian Communication (MOITUC) model in all maternal health programs would significantly enhance the utilization of ANC services among expectant mothers in Uganda and the world in general.

Submitted to the School of Postgraduate Studies and Research in Fulfillment of the Requirement for the Award of the Degree of Doctor of Philosophy in Public Health of Nkumba University