BACKGROUND:
In Tanzania, most women attend one antenatal visit, but only about half attend four or more. Women value antenatal care but their decision to attend subsequent visits is influenced by its content and how midwives treat them. Mobile solutions have the potential to facilitate more effective and acceptable care.

OBJECTIVES:
To assess the effectiveness of the Pregnancy and Newborn Diagnostic Assessment (PANDA) m-health system, incorporating respectful care prompts, to increase the number of antenatal contacts between women and midwives and reduce episodes of severe perinatal morbidity and mortality.

METHODS:
Ethical approvals gained. A cluster randomised controlled trial was conducted across 16 maternity facilities in Manyara, Tanzania, including 2000 women who commenced antenatal care (ANC) before 31 weeks gestation. The intervention, PANDA, includes a smartphone Android application with embedded respectful care prompts, point of care testing and a medical unit database (for review and referral). Facilities were publicly randomised in a 1:1 ratio to the PANDA package (intervention group) or routine care (control group). The dual primary outcomes were the proportion of women attending 4 or more ANC visits and a composite perinatal morbidity outcome. In parallel, a realist process evaluation and cost-effectiveness analysis were conducted.

RESULTS:
Trial recruitment was to target (n=2000) and ended February 2025. Follow-up is ongoing with data collection almost complete (n=1831; >90%). Follow-up will be finalised by October 2025, with results available early 2026.

CONCLUSIONS:
Findings will demonstrate whether the PANDA care package, incorporating respectful care prompts, can a) increase the number of antenatal visits, b) reduce severe perinatal morbidity and mortality, c) increase maternal engagement and satisfaction, d) increase midwife satisfaction, and e) be cost effective.

KEY MESSAGE:
This trial goes beyond exploring effectiveness of a mobile device, by illuminating the complexities of antenatal care provision in a resource-limited setting. Poster session 2 (Group A)