Primary Outcomes (end points)
Our outcome measures will be extracted from the following sources:
A. SINAC (Subsistema de Información sobre Nacimientos)- This is a country-wide birth registry that is administratively recorded by the Health Ministry and made available through the Dirección General de Información en Salud. The following measures will be used:
1. Weight of baby at birth (g)
2. Length of baby at birth (mm)
3. APGAR score (1-10)
4. Silverman score (1-10)
5. ICD-10 catalogued congenital diseases or complications.
This registry is updated every two months. To evaluate potential indirect benefits, we will also use information from other births in the clinic. The information from SINAC will be collected at mid-2017 and again at the end of 2017.
B. Prospera- We will request from Prospera information about compliance with their health conditionalities at an individual level. If this information cannot be made readily available, we will use public administrative information about the total bimonthly monetary amount awarded to the families of pregnant beneficiaries in treatment and control. This information is released by Prospera every two months and is available to the general public by law. Such monetary amount will be used to proxy the general compliance of families in Prospera Digital with the conditionalities set by Prospera.
C. Primary-level Health Clinics- At the middle and end of the trial, medical records will be retrieved from all clinics in the trial for all beneficiaries in control and treatment arms. Such records will allow us to formulate the following outcome measures:
1. Total number of scheduled clinic visits
2. Attendance rate to scheduled clinic visits
3. Incidence of diseases during pregnancy and first two years of babies’ lives (by type of disease)
4. Percentage of women giving birth at clinics or hospitals
5. Percentage of women with full clinic record during pregnancy
6. Percentage of women with full battery of tests done during pregnancy (according to protocols)
7. Percentage of women with full (and incomplete) prenatal measurement follow-up (e.g. weight and height)
8. Percentage of women receiving pregnancy supplements
9. Incidence of specific health problems (malnutrition, anaemia, pre-eclampsia, gestational diabetes, post-natal sepsis, etc.)
10. Vaccination records
11. Delivery of lactation information
12. Percentage of babies that had the neonatal screening done
13. Incidence of premature babies
14. Maternal mortality rate
15. Infant mortality rate
16. Unplanned hospital or clinic visits.
This information is expected to be collected at July-August 2017 and again November-December 2017.
D. RapidPro- This is the system that captures all the interactions that beneficiaries have with the platform that automatically sends messages. This information will be constantly (weekly) gathered and analysed mainly to follow-up the fidelity of implementation of the main treatment arm. The outcome measures are only gathered for the treatment groups and the following indicators are produced:
1. Intensity of participation by looking at the proportion of two-way messages that a beneficiary answers
2. Response rate of messages
3. Mistake rates for different kind of responses required
4. Proportion of beneficiaries not participating.
5. Knowledge by answering some questions sent
E. Post-participation survey- A survey will be implemented to gather additional outcome measures that are either imperfectly measured in the other sources or non-existent:
1. Knowledge of pregnancy and newborn care
3. Supplement consumption
4. Breastfeeding practices (duration, problems, knowledge)
5. Planning for emergencies and birth
6. Women empowerment indicators
7. Health service satisfaction
8. Malnutrition and obesity rates in both the mother and the newborn
9. Size and weight of infants (measured, not self-reported)
10. Incidence of gastrointestinal diseases in infants
11. Incidence of risk conditions during pregnancy: tobacco and alcohol consumption
12. Self-reported development milestones reached, e.g. crawling, walking, babbling, etc. (date and success)
13. Use and trust in the content of the messages
14. Main source of information about pregnancy and baby care topics
15. Tests with children to measure different aspects of their development, such as gross and fine motor skills, language development, neurological development, signs of risk, etc. Tests such as MSCA, MacArthur and EDI (all of them already used in Mexico will be favored)