BACKGROUND:
Despite global declines in child mortality rates, Africa's reduction is lagging behind other regions. Neonatal survival remains a key priority in the sustainable development agenda. Promoting neonatal care practices at individual and community levels is essential, and technology-based interventions can effectively reach potential future mothers. However, there is a lack of evidence demonstrating that mobile health interventions improve community-based neonatal care practices in Ethiopia.

OBJECTIVES:
This study aimed to evaluate the impact of an interactive mobile health intervention on improving community-based essential neonatal care practices among postpartum women in Northeast Ethiopia.

METHODS:
The study was conducted in Dessie and Kombolcha city zones, Northeast Ethiopia. A cluster randomized controlled trial was implemented among 743 participants (376 intervention and 367 control) from Jan 15 to May 15, 2023. Pregnant women at 30 weeks gestation in selected clusters were enrolled and followed up to 45 days post-childbirth. Data were collected using Open Data Kit (ODK) and analyzed with STATA.17. Structural Equation Modelling (SEM) through confirmatory factor analysis (CFA) was employed. Model fitness was evaluated using the chi-square to degree of freedom ratio, root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR), indicating a good model fit. Statistical significance was declared at a level below 0.05 with a 95% confidence interval.

RESULTS:
The study revealed high narrow birth-to-pregnancy intervals less than 24 months in both groups (48.5% control, 49.5% intervention). Awareness of neonatal care increased markedly in the intervention group, rising from 62.0% to 85.9%, compared to an increase from 57.8% to 67.6% in the control group. Disagreement regarding immediate new-born bathing was more prevalent in the intervention group (73.9%) than in the control group (58.9%). Initiating breastfeeding within one hour after birth was higher in the intervention group (85.4%) compared to the control group (74.4%). Postnatal visits to health facilities were more frequent in the intervention group (79.6%) than in the control group (54.8%). Mobile health intervention (β = 0.393, p = 0.007) and knowledge of neonatal care (β = 0.347, p = 0.012) had a significant positive effect on neonatal care practices. There were no significant indirect pathways between the variables analyzed. Mobile health intervention and knowledge of neonatal care remain significant predictors with a total effect of (β = 0.382, p = 0.009) and (β = 0.347, p = 0.012), respectively, in enhancing neonatal care practices.

CONCLUSIONS:
This study underscores the significant role of mobile health interventions and maternal knowledge in enhancing neonatal care practices. These findings should inform the design and implementation of maternal and child health programs, emphasizing the integration of technology and education to improve neonatal outcomes in resource-limited settings. Trial Registration: Protocol Registration and Results System (PRS) Clinical Trial Registry, www.ClinicalTrials.gov, ClinicalTrials.gov ID: NCT05666050. Registered on December 23, 2022.