Birth and death notification via mobile devices: a mixed methods systematic review

Summary of findings 1. Primary objective: Summary of findings

Coverage of birth notification
Birth notification via mobile device compared to standard practice
Patient or population: Health Care Workers (HCWs), Village Health Volunteers (VHVs), newborn children Setting: Lao People’s Democratic Republic Intervention: Provision of mobile phone and credit to HCWs and VHVs to facilitate birth notification Comparison: Standard practice, i.e. no provision of mobile phone or credit to HCWs and VHVs to facilitate birth notification
Outcomes	Birth notification via mobile phone versus standard practice	No of Participants (studies)	Certainty of the evidence (GRADE)	What happens?
Proportion of VHVs who reported notifying a HCW about deliveries or births using mobile phones (post‐intervention comparison)	12% more VHVs in the intervention group reported notifying a HCW using mobile phones compared to the comparison group	101 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4	We are uncertain of the effect of the intervention on coverage of birth notification because the certainty of the evidence is very low.
Proportion of HCWs who reported receiving a notification from VHV about deliveries or birth using mobile phones (post‐intervention comparison)	38% more HCWs in the intervention group reported receiving a notification using mobile phones compared to the comparison group	30 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4
Timeliness of birth notification
Proportion of VHVs who reported notifying HCWs either during labour or within 1 day of birth using mobile phones	18% moreVHVs in the intervention group reported notifying HCWs of imminent deliveries within 1 day of birth via mobile phones compared to the comparison group	101 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4	We are uncertain of the effect of the intervention on the timeliness of birth notification because the certainty of the evidence is very low.
Proportion of HCWs who reported receiving a notification from VHV about imminent deliveries or within 1 day of birth using mobile phones	15% moreHCWs in the intervention group reported being notified by VHVs of imminent deliveries within 1 day of birth via mobile phones compared to the comparison group	30 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4
Proportion and timeliness of legal birth registrations
No studies were identified that reported on this outcome.
Coverage of newborn or child health services
Proportion of births where HCW made postnatal care visit to home	There were 10% more postnatal care home visits by HCW in the intervention group compared to the comparison group.	1339 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4	We are uncertain of the effect of the intervention on coverage of newborn or child health services because the certainty of the evidence is very low
Proportion of births for which Hepatitis B birth dose vaccination was provided within 30 days	There were 23% more children who received the Hepatitis B birth dose vaccination within 30 days of birth in the intervention group compared to the comparison group	1525 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4
Timeliness of newborn or child health services
Proportion of births where Hepatitis B birth dose vaccination was administered within 0‐1 day	There was a 0% change in the number of newborns receiving Hepatitis B birth dose vaccination within the first day after birth in the intervention group compared to comparison group.	1525 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4	We are uncertain of the effect of the intervention on timeliness of newborn or child health services because the certainty of the evidence is very low
Proportion of births where Hepatitis B birth dose vaccination was administered within 2‐7 days	5% fewer children received Hepatitis B birth dose vaccination between days 2 and 7 in the intervention group compared to the comparison group.	1525 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4
Proportion of births where the HCW made a postnatal care home visit within 24 hours of notification	18% fewer children received a postnatal care visit at least 50% of the time by the HCW in the intervention group within 24 hours of birth compared to the comparison group.	30 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio; CBA: Controlled Before‐After study; VHV: Village Health Volunteer; HCW: Health Care Worker
GRADE Working Group grades of evidence High = This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different^† is low. Moderate = This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different^† is moderate. Low = This research provides some indication of the likely effect. However, the likelihood that it will be substantially different^† is high. Very low = This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different^† is very high. ^† Substantially different = a large enough difference that it might affect a decision
¹Xeuatvongsa 2016 Explanations for certainty rating: ² Initial rating of low certainty assigned due to non‐randomised study design, resulting in high or unclear risk of bias ³ The initial rating was downgraded one level to very low certainty for outcomes related to the coverage and timeliness of birth notification due to small sample sizes and small numbers of events. ⁴ The initial rating was downgraded one level to very low certainty for outcomes related to the coverage and timeliness of post‐notification health services due to concerns related to indirectness. It is unclear how many of the post‐notification service events were directly in response to the notification. Abbreviations: VHV, Village Heath Volunteer; HCW, Health Care Worker.

Summary of findings 2. Secondary objectives: Summary of qualitative findings

Summary of review finding		Studies contributing to the review finding	Overall GRADE‐CERQual assessment of confidence in the evidence	Explanation for assessment
A. Health system constraints in the implementation of birth and death notification via mobile devices
A.1	Geographic barriers hamper timeliness of birth and death notification conducted via mobile devices, as well as post‐notification services or processes (e.g. certification of birth or death).	Xeuatvongsa 2016; ANISA 2016; Pascoe 2012; MOVE‐IT 2013; Ngabo 2012; MBRT 2016, mVRS 2017	Moderate confidence	Serious concerns related to methodological limitations. Few or no concerns related to coherence, relevance and adequacy
A.2	Birth and death data collected using mobile devices can help health and civil registration systems identify problems and introduce appropriate quality improvements.	Moshabela 2015; MBRT 2016; RapidSMS 2012; MVH 2017; NIMDS 2019	Low confidence	Serious concerns related to methodological limitations and adequacy. Few or no concerns with coherence and relevance
A.3	Health workers who lack familiarity with, or prior experience in, using mobile technologies may need rigorous training as well as post‐training support.	Andreatta 2011; Gisore 2012; Ngabo 2012; mSIMU 2017; Yugi 2016 mTika 2016; Xeuatvongsa 2016; MBRT 2016; Van Dam 2015; MBRL 2011; MOVE‐IT 2013; NIMDS 2019	Moderate confidence	Moderate concerns related to methodological limitations. Few or no concerns related to coherence, relevance, and adequacy
A.4	Local capacity to train future cadres of notifiers may be strengthened though 'train the trainer' approaches.	Ngabo 2012; MBRL 2011	Low confidence	Serious concerns related to methodological limitations and adequacy. Few or no concerns with coherence and relevance
A.5	Mechanisms for continuous monitoring and supportive supervision are important for ensuring the quality and timeliness of birth and death data collected via mobile devices.	Andreatta 2011; mTika 2016; Ngabo 2012; MOVE‐IT 2013; Yugi 2016; Pascoe 2012	Moderate confidence	Moderate concerns related to methodological limitations and adequacy. Few or no concerns with coherence and relevance
A.6	Inadequate attention is paid to legal frameworks governing civil registration. These may need to be modified to allow notification via mobile device and the inclusion of new cadres of notifiers (low confidence finding).	eCRVS‐Mozambique 2017; mVRS 2017; MBRP 2015	Low confidence	Serious concerns related to methodological limitations and adequacy. Few or no concerns with coherence and relevance
A.7	The availability of adequate human resources to conduct birth and death notification via mobile devices may be facilitated by hiring new cadres of notifiers or recruiting existing cadres of health workers to undertake notification.	Andreatta 2011; MBRL 2011; Gisore 2012; Pascoe 2012; MOVE‐IT 2013; Xeuatvongsa 2016; Yugi 2016; ANISA 2016; mVRS 2017; eCRVS‐Mozambique 2017; MBRT 2016	Moderate confidence	Serious concerns related to methodological limitations. Few or no concerns with coherence, relevance, and adequacy
A.8	Implementing birth and death notification via mobile devices may be influenced by underlying health and civil registration system infrastructure, resources, and processes.	Ngabo 2012; MBRL 2011; MOVE‐IT 2013; Moshabela 2015; ANISA 2016; mVRS 2017; Gisore 2012;MVH 2017	Low confidence	Serious concerns related to methodological limitations. Minor concerns related to adequacy. Few or no concerns with coherence, and relevance
B. Factors related to individuals providing birth and death notification via mobile devices
B.1	Costs incurred by health workers sending notification using personal mobile phones may need to be reimbursed to facilitate sustained use of these technologies for notification.	Ngabo 2012; Pascoe 2012; mSIMU 2017; Yugi 2016; Xeuatvongsa 2016; Gisore 2012	Moderate confidence	Moderate concerns related to methodological limitations and adequacy. Few or no concerns related to coherence or relevance
B.2	The use of mobile phones for notification is acceptable to health workers, and helps them to undertake their job responsibilities.	Ngabo 2012; Pascoe 2012; mSIMU 2017, Van Dam 2015; Yugi 2016; NIMDS 2019	Moderate confidence	Moderate concerns related to methodological limitations and adequacy. Few or no concerns related to coherence and relevance
B.3	Health workers’ adoption of mobile birth and death notification strategies may be affected by competing priorities and the availability of adequate incentives.	MOVE‐IT 2013; mSIMU 2017; mTika 2016; MVH 2017	Moderate confidence	Minor concerns related to methodological limitations. Serious concerns related to adequacy. Few or no concerns related to coherence and relevance
C. Factors related to families for whom birth and death is notified via mobile devices
C.1	For some families, costs may be a barrier to completing birth and death registration post‐notification.	MOVE‐IT 2013, MBRP 2015, MBRT 2016	Low confidence	Serious concerns related to methodological limitations and adequacy. Few or no concerns related to coherence, relevance, and adequacy
C.2	There may be a need for targeted demand generation activities in communities with low awareness of the need of birth and death registration, alongside the use of mobile phones for birth and death notification.	MOVE‐IT 2013; MBRG 2014; mVRS 2017; MBRT 2016;	Low confidence	Serious concerns related to methodological limitations. Moderate concerns related to adequacy. Few or no concerns related to coherence and relevance
C.3.	Sociocultural norms may influence the timely identification of births and deaths, and should be taken into consideration when developing mobile phone interventions for notification.	MOVE‐IT 2013; MBRG 2014; MBRP 2015; ANISA 2016	Low confidence	Serious concerns related to methodological limitations and adequacy. Few or no concerns related to coherence and relevance
C.4	Birth and death notification may increase access to these services for some families. However, they may also increase inequities in access related to low availability of supportive infrastructure (network coverage, roads, human resources), human factors (age, gender, literacy, poverty), and selective funding priorities of donors.	Gisore 2012; MBRP 2015; MBRT 2016; Andreatta 2011; Ngabo 2012; MOVE‐IT 2013; mSIMU 2017; mTika 2016; Yugi 2016; Xeuatvongsa 2016; mVRS 2017	Moderate confidence	Serious concerns related to methodological limitations. Few or no concerns related to coherence, relevance, and adequacy
D. Factors related to government involvement in birth and death notification via mobile devices
D.1	Strong government commitment is a key factor in the successful implementation of birth and death notification via mobile devices.	MBRL 2011; Ngabo 2012; Yugi 2016; mVRS 2017; eCRVS‐Mozambique 2017; MBRT 2016; MBRP 2015	Low confidence	Serious concerns related to methodological limitations. Moderate concerns related to adequacy. Few or no concerns related to coherence or relevance
E. Factors related to technologies used for birth and death notification via mobile devices
E.1	Cost is an important consideration in the purchase, set‐up, and scaling up of mobile technologies needed for birth and death notification.	Ngabo 2012; Xeuatvongsa 2016; Gisore 2012; mTika 2016; Pascoe 2012; Van Dam 2015; Yugi 2016; mVRS 2017	Low confidence	Serious concerns related to methodological concerns. Moderate concerns related to adequacy. Few or no concerns related to coherence and relevance
E.2	Challenges when notifying births and deaths via mobile devices include poor access to electricity and incompatibility with existing systems.	Ngabo 2012; MBRL 2011; Pascoe 2012; Gisore 2012; MBRP 2015; MBRT 2016	Low confidence	Serious concerns related to methodological concerns. Moderate concerns related to adequacy. Few or no concerns related to coherence and relevance
E.3	The availability of network connectivity is a key factor in the successful implementation and scale‐up of birth and death notification via mobile devices.	Ngabo 2012; Pascoe 2012; Yugi 2016; ANISA 2016; mSIMU 2017; mVRS 2017; MBRT 2016,	Moderate confidence	Serious concerns related to methodological limitations. Few or no concerns with coherence, relevance, and adequacy
E.4	Data security and encryption measures are needed to preserve confidentiality of birth and death information notified via mobile devices.	Van Dam 2015; MBRT 2016; Ngabo 2012; MVH 2017	Low confidence	Serious concerns with methodological limitations and adequacy. Few or no concerns with coherence and relevance

Background

Globally, the birth of nearly 230 million children under the age of five, and two‐thirds of all deaths have not been officially registered (UNICEF 2016; WHO 2017a; World Bank 2014). Birth registration is a child’s right, and serves as the foundation for establishing legal identity, equitable access to basic services such as healthcare and education, and protection from exploitation (UNHCR & UNICEF 2017; UNICEF 2013). Similarly, death registration, including identification of cause of death, enables public health systems to develop and implement programmes to improve the health of populations, as well as rapidly deal with outbreaks (WHO 2013a; WHO 2017a; World Bank 2014). In the context of the post‐2015 development agenda, timely, accurate, and complete statistics on births and deaths, gained through the act of registration, are fundamental for tracking progress towards sustainable development goals and achievement of universal health coverage (WHO 2017b).

Description of the condition

Well‐functioning Civil Registration and Vital Statistics systems provide the most reliable and up‐to‐date data on births, deaths, and population size (UN‐DECA 2014). Civil registration is defined as the "'universal, continuous, permanent, and compulsory recording of vital events (live births, deaths, fetal deaths, marriages, and divorces) provided through decree or regulation in accordance with the legal requirements of each country" (UN‐DECA 2002; UNHCR & UNICEF 2017). Vital statistics are the compilation, processing, and dissemination of civil registration data in statistical form (Setel 2007; UN‐DECA 2014; UN‐DECA 2017). Statistics on births and deaths are used to generate population health indicators (e.g. fertility rate, birth rate, and life expectancy), data on mortality (e.g. maternal and infant mortality rates), and disease burden (e.g. using details of cause of death (UN‐DECA 2014)). Hence, birth and death statistics are a valuable source of data for policymakers, to guide the development of global, national, and regional health policy, programme planning, and appropriate resource‐allocation (Setel 2007; UN‐DECA 2014).

Over 100 developing countries lack functional or adequate civil registration systems for capturing vital events (World Bank 2014). The majority of individuals missed by civil registration systems reside in South Asia and sub‐Saharan Africa (AbouZahr 2015; Setel 2007; UNICEF 2016). Birth and deaths of individuals living in rural areas, or lower socioeconomic status households, are more likely to be unregistered, compared to their urban and wealthier counterparts (UNICEF 2013). There is also a link between birth registration and health outcomes (Phillips 2015). For example, children who are unregistered are more likely to miss out on essential health services, such as immunisations (Apland 2014; Fagernas 2013). Lack of accurate and timely death statistics, including cause of death, leads to weak disease surveillance, and threatens the ability of public health systems to prevent or rapidly deal with outbreaks (UN‐DECA 2017). From the health system perspective, the paucity of accurate statistics on births and deaths poses a key challenge in the estimation of programme needs (e.g. number of children eligible for health services), appropriate resource allocation, and monitoring (e.g. for calculation of indicators of health system coverage or performance (AbouZahr 2015; AbouZahr 2015a; Mahapatra 2007)).

Several challenges to civil registration have been identified in the literature, including geographic barriers (UNICEF 2013), low demand or lack of incentives for registration (Apland 2014; UNICEF 2013; WHO 2013b; World Bank 2014), use of paper‐based systems for reporting and recording births (Oomman 2013; World Bank 2014), and lack of, or incorrect, cause of death coding and documentation (Mikkelsen 2015; Rampatige 2013). Poor integration of Civil Registration and Vital Statistics systems with other government or citizen databases leads to missed opportunities, for instance, where data on births and deaths captured by the health system are not linked to civil registration systems (World Bank 2014). Even when integration between the health and civil registration system may exist, home births or deaths may not be reported where formal community‐level notification processes are deficient (World Bank 2014).

A global scale‐up plan for strengthening civil registration systems has been developed by the World Health Organization and the World Bank, with the aim to "achieve universal civil registration of births, deaths, and other vital events, including reporting cause of death, and access to legal proof of registration for all individuals by 2030” (World Bank 2014). A cornerstone of this plan is the prioritisation and strengthening of the linkages between health and Civil Registration and Vital Statistics systems (Muzzi 2010; WHO 2013a; World Bank 2014). This includes a push to modernise data systems associated with civil registration through the use of digital information systems, and to improve coverage of registration services among underserved populations such as those residing in rural areas (Oomman 2013; World Bank 2014). In these respects, the global proliferation of mobile phones and cellular network connectivity is increasingly being leveraged, especially in resource‐limited settings, to drive development and use of digital civil registration applications (ITU 2016; Labrique 2012; Labrique 2013; Oomman 2013). Official notifiers include health workers or other cadres of workers permitted under law to carry out notifications. With growing access to mobile phones, community‐based individuals, such as vaccination programme workers, community health workers, and village elders can serve as 'notifiers', helping to increase the reach of civil registration systems to underserved rural and remote regions (World Bank 2014). Such an approach may help to reduce delays in identification and reporting of births and deaths to health systems, local civil registration authorities, or both (World Bank 2014).

Description of the intervention

Civil registration involves four major activities: recording, notification, registration, and certification (see Figure 1 (Setel 2007; WHO 2013a)).

Figure 1

Linkage between CRVS and health system
Adapted fromSetel 2007and World Bank and World Health Organization 2014 (World Bank 2014).

Recording entails capturing details related to a vital event at the point of the event. For example, details of a birth may be recorded on a paper form at the health facility or at home.
This is followed by notification, wherein details of the recorded event are communicated to the local civil registration office by lawful notifiers. In official terms, a notification is defined as the capture and onward transmission of minimum essential information on the fact of birth or death by a designated informant, agent or official of the CRVS system using a CRVS authorised notification form (paper or electronic) with that transmission of information being sufficient to support eventual registration and certification of the vital event.
Upon receiving a notification, the civil registrar registers the event, by verifying event details, and recording them in a civil register.
Subsequently, a legally valid certificate of registration is issued. The certificate serves as proof that the birth or death has been registered in a civil register.
Registered events are aggregated by the national authorities to produce vital statistics on key health and development indicators.

Since notification is the key step that triggers registration, many strategies to improve the coverage and timeliness of birth or death registration are focussed on reducing delays in notification, especially by using mobile devices to notify local officials. The scope of this review is limited to the notification of births and deaths conducted via mobile devices.

By birth notification, we mean the transmission of information via a mobile device to a centralised system or focal individual(s) to report a birth event.
- In addition to the formal notification process, which leads to birth registration as it occurs within the context of Civil Registration and Vital Statistics systems, we included informal notification of births in this definition. By this, we mean that individuals, other than those defined under the law as official notifiers, may be involved in notifying with mobile devices. It may also mean that the notification is directed to focal individuals other than the civil registrar, or communicated directly to a digital system, and transmitted for purposes other than civil registration.
By death notification, we mean the transmission of information via a mobile device to a centralised system or focal individual(s) to report a death event. Death notification may include information on the cause of death.
- As in the case of birth notification, we also included informal notifications of death in this definition. By this, we mean that individuals, other than those defined under the law as official notifiers, may be involved in providing a notification. It may also mean that the notification is directed to focal individuals other than the civil registrar, or communicated directly to a digital system, and may be transmitted for purposes other than civil registration.
By mobile devices, we mean mobile phones of any kind (but not analogue land line telephones), as well as tablets, personal digital assistants, and smartphones. Laptops are not included in this list.

How the intervention might work

For birth notifications, information related to the birth may be transmitted via mobile phones as phone calls, inputs to an interactive voice response, or an unstructured supplementary service data (USSD) system, as short messaging service (SMS), from mobile device‐based applications (apps), or to publicly known short codes or access numbers. The content of the birth notification may vary by country or implementation, but may include the name of the child born, name and address of the parents, place and date of birth, and details of birth outcomes.

An example of a formal birth notification sent via a mobile device, is when a community‐based notifier uses his or her mobile phone to relay notification about a home‐based birth to a digital civil registration system via USSD (NIRA 2017). The notification may be received and reviewed for accuracy and completeness by the local civil registration office before a birth certificate is issued. Direct notification to the civil registrar by lawful notifiers is considered an active notification. Passive notification occurs in cases where a notification form is provided by health authorities to families and when family members bear the onus of reporting the birth or death event to the civil registrar.
An example of an informal birth notification sent via a mobile device, is when a village elder sends information about a birth, via SMS, to a central digital server, for the purpose of enroling the child in a longitudinal vaccination tracking system. The enrolment of the child in the tracking system may be used to initiate vaccination services for the child, and to track their subsequent vaccinations.

For death notifications, information related to the death may be transmitted via mobile phones as phone calls, inputs to an interactive voice response or USSD system, as SMS, from apps, or to publicly known short codes or access numbers. The content of the death notification may vary by country or implementation, but may include name of the deceased, name and address of relatives (for example, spouse), place and date of death, and details of the cause of death.

An example of a formal death notification, sent via mobile device, is when a health worker uses a mobile phone app to transmit information about a death, including cause of death, to a digital civil registration system. The notification may be received and reviewed for accuracy and completeness by the local civil registration office before a death certificate is issued.
An example of an informal death notification sent via a mobile device, is when a community health worker sends a message about a death, via SMS, to a central digital server, for the purpose of disease surveillance.

Why it is important to do this review

Ministries of health, donors, and decision‐makers face expanding opportunities to harness the ubiquity and penetration of mobile technology to address longstanding challenges related to acquiring accurate and timely statistics on births and deaths. There is high demand from these stakeholders for evidence‐based guidance on the value of digital tools to strengthen linkages between civil registration and health systems, as a mechanism to improve the timeliness and accuracy of birth and death statistics. In response to this global need, the World Health Organization has developed guidelines to inform investments on digital health approaches that use mobile phones for birth and death notifications (WHO Guidelines 2019).

There is growing evidence on the use of mobile devices for birth and death notification. A previous systematic review on digital interventions for Civil Registration and Vital Statistics was published in 2013 (WHO 2013a). It examined literature from 23 countries, but found limited peer‐reviewed evidence for the use of mobile devices to notify birth and death events. This review, focussed entirely on low‐ and middle‐income countries, did not report quantitative outcomes, or examine factors that influenced the use of mobile phones to notify officials of birth and death events. Since this review was published, several new studies describing birth or death notification via mobile devices have emerged. Hence, it is important to conduct a systematic review to assess these new studies. Preliminary findings from this systematic review were used to directly inform WHO guidelines on the effectiveness of digital strategies to improve data on births and deaths (WHO Guidelines 2019).

Objectives

Primary objectives

To assess the effects of birth notification via a mobile device, compared to standard practice.
To assess the effects of death notification via a mobile device, compared to standard practice.

Secondary objectives

To describe the range of strategies used to implement birth and death notification via mobile devices.
To identify factors influencing the implementation of birth and death notification via mobile devices.

Methods

Criteria for considering studies for this review

Types of studies

To address the primary objectives, we included the following study designs:

Individual and cluster‐randomised trials;
Cross‐over and stepped‐wedge study designs;
Controlled before‐after studies, provided they had at least two intervention sites and two control sites; and
Interrupted time series studies, if there was a clearly defined time point when the intervention occurred and at least three data points before and three after the intervention.

To address the secondary objectives, we included any study design, either quantitative, qualitative, or descriptive, that aimed to:

Describe current strategies for birth and death notification via mobile devices; or
Explore factors that influence the implementation these strategies, including studies of acceptability or feasibility.

To address both the primary and secondary objectives, we included published studies, conference abstracts, and unpublished data. We included studies regardless of their publication status and language of publication.

Types of participants

The following participants were included in this review:

All cadres of healthcare providers, including professionals, paraprofessionals, and lay health workers (LHWs);
Administrative, managerial, and supervisory staff at health facilities;
Administrative, managerial, and supervisory staff, including registrars, associated with civil registration units;
Focal individuals at the village‐ or community‐level (e.g. village leaders);
Parents or other caregivers (e.g. grandparents) of children whose birth is being notified; and
Relatives or caregivers of deceased individuals.

Types of interventions

To address the primary objectives, we included studies that compared birth and death notification via mobile devices with standard practice. We defined standard practice as non‐digital and non‐mobile, paper‐based processes and workflows for notifying birth and death events.

The comparisons for this review were:

birth notification via mobile devices compared with standard practice; and
death notification via mobile devices, compared with standard practice.

We included:

studies in which birth or death notification was sent by parents, caregivers, other family members, administrative, managerial or supervisory staff, focal individuals in the community, or health workers, via mobile devices, to alert a central system, organisation, or civil registration agency that a birth or death has taken place;
studies in which notified births were enrolled into a digital health record for tracking provision of newborn and child health services;
studies in which birth notification was part of a pregnancy digital health record, and where outcomes were reported for the postnatal period onward;
studies in which notified deaths, including cause of death, were reported to a disease surveillance system; and
studies in which birth and death notifications were delivered as part of a wider package, if we judged the birth or death notification to be the major component of the intervention.

To address the secondary objectives, in addition to the above inclusion criteria, we included:

studies in which birth and death notifications were delivered as part of a wider package:

- even if birth and death notifications were judged not to be the major component of the intervention; and
- as long as we could extract data on the birth and death notification components that were relevant to the secondary objectives.

When addressing both the primary and secondary objectives, we excluded:

studies in which birth and death notification was conducted on stationary computers or laptops alone;
studies that compared different specifications of technology systems (e.g. software, communication channels) for birth or death notification;
studies in which birth notification was part of a pregnancy digital health record, and where outcomes were only reported for the pregnancy period. Such studies were excluded from this review because we would not be able to link the effect of the mobile birth notification to outcomes that occurred during pregnancy. While such studies were excluded from this review, outcomes related to the pregnancy period from such studies were extracted and included in a separate review.
studies that only described interventions to improve attribution of cause of death (e.g. digital verbal autopsy tools), without a notification component; and
feasibility or pilot studies (for the primary objectives only. These study designs were included for the secondary objectives).

Types of outcome measures

Primary objective: Types of outcome measures

To address the primary objectives, we included studies that reported outcomes related to birth and death notification via mobile devices. When birth and death notifications were described in the same study, we extracted and reported outcome data for birth and death notifications separately. Specific outcomes of interest are listed below.

For birth notification via mobile device

coverage (e.g. proportion) of births notified via mobile devices;
timeliness of birth notification via mobile device (e.g. time between birth and birth notification via mobile device);
proportion of legal birth registrations in response to birth notifications via mobile device, where legal birth registration is defined as the recording, within the civil registry, of the occurrence and characteristics of births in accordance with the legal requirements of a country. Legal birth registration is conducted by a civil registrar.
timeliness of legal birth registrations in response to birth notification via mobile device (e.g. time between birth notification and legal birth registration);
coverage of (e.g. proportion of children receiving) newborn or child health services (e.g. immunisations) in response to birth notification via mobile device;
timeliness of receipt of newborn or child health services (e.g. immunisations) in response to birth notification via mobile device (i.e. time between birth and receipt of services).

For death notifications via mobile device

coverage (e.g. proportion) of deaths notified via mobile devices;
timeliness of death notification via mobile device (i.e. time between death and death notification via mobile device);
proportion of legal death registrations in response to death notifications via mobile device, where legal death registration is defined as the recording, within the civil registry, of the occurrence and characteristics of death in accordance with the legal requirements of a country. Legal death registration is conducted by a civil registrar.
timeliness of legal death registrations in response to death notification via mobile device (i.e. time between death notification and legal death registration);
proportion of deaths where causes of death were ascertained, reported, or both, to a disease surveillance system in response to death notifications via mobile device;
timeliness of causes of death ascertainment, reporting to a disease surveillance system, or both, in response to death notifications via mobile device (i.e. time between death and cause of death ascertainment).

For both birth and death notifications via mobile device

quantitative measures of notifiers’ acceptability or satisfaction (or both) with birth and death notifications via mobile device;
resource use (e.g. human resources and time, including additional time spent by notifiers when managing and transitioning from paper to digital reporting systems, training, supplies, and equipment);
unintended consequences (e.g. transmission of inaccurate data, for instance, by incorrect data entry, privacy and disclosure issues, failure or delay in message delivery, interrupted workflow due to infrastructure constraints for recharging batteries and network coverage, and impact on equity).

Secondary objectives: Topics of interest

To address the secondary objectives, we extracted data about strategies for the notification of births and deaths via mobile devices, and data about factors that influenced the implementation of these strategies.

Search methods for identification of studies

An independent information specialist (JE) developed the search strategies in consultation with the review authors. We only included studies published after 2000. This decision was based on the increased availability and penetration of mobile devices in low‐ and middle‐income countries starting in 2000 (ITU 2016). Search strategies were comprised of titles, abstracts, and keywords, including controlled vocabulary terms. We did not apply any limits on language.

We used a study design search filter used by Cochrane Effective Practice and Organisation of Care (EPOC) to retrieve both randomised and non‐randomised studies. See Appendix 1 for all search strategies used.

Electronic searches

To address the primary and secondary objectives, we searched the following databases:

Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (Issues 8, 2019, searched on August 2, 2019)
MEDLINE and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations and Daily 1946 to August 01, 2019, Ovid (searched on August 2, 2019)
Embase 1974 to 2019 Week 30, Ovid (searched on August 2, 2019)
Global Index Medicus/Global Health Library, WHO (searched on August 2, 2019)
POPLINE K4Heath (searched on August 2, 2019)

Searching other resources

To address both the primary and the secondary objectives, we also searched the following sources:

Trial registries

World Health Organization International Clinical Trials Registry Platform (WHO ICTRP; www.who.int/ictrp, searched on August 2, 2019);
US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (www.clinicaltrials.gov, searched on August 2, 2019).

Systematic review registry

We searched Epistemonikos (www.epistemonikos.org) on September 27, 2019 for related systematic reviews and potentially eligible primary studies.

Grey literature

We conducted a grey literature search to identify studies not indexed in the databases listed above, and to capture the broader range of study designs to be included for the secondary objectives. Because this review is focussed on birth and death notifications using mobile devices, we reviewed mhealthevidence.org on August, 15, 2017 for contributed content that is not referenced in MEDLINE Ovid. In addition, the WHO issued a call for papers through popular digital health communities of practice, such as the Global Digital Health Network and Implementing Best Practices, to identify additional primary studies and grey literature. Results from the grey literature were only incorporated in the first round of the search since the mhealthevidence.org database was no longer being curated at the time of subsequent searches.

Other resources

We reviewed reference lists of all included studies and relevant systematic reviews for potentially eligible studies.
We contacted authors of included studies and reviews to clarify reported published information, and to seek unpublished results and data.
We conducted citation searches of included studies in Web of Science, Clarivate Analytics; and in Google Scholar (searched on May 15, 2020).

Data collection and analysis

Selection of studies

We downloaded all titles and abstracts retrieved by electronic searching to a reference management database, and removed duplicates. Two review authors independently screened titles and abstracts for inclusion. We retrieved the full‐text study reports and publications, and two review authors independently screened the full texts, identified studies for inclusion, and identified and recorded reasons for excluding ineligible studies. We resolved any disagreement through discussion or, if required, we consulted a third review author. For one study in French, we consulted with a review author with appropriate fluency.

We listed studies that initially appeared to meet the inclusion criteria, but that we excluded after reviewing the full‐text report, in the Characteristics of excluded studies table. We collated multiple reports of the same study so that each study, rather than each report, was the unit of interest in the review. We also recorded any information that we could obtain about relevant ongoing studies. We recorded the selection process in sufficient detail to complete a PRISMA flow diagram (Liberati 2009).

Data extraction and management

We used the EPOC standard data collection form and adapted it for study characteristics and outcome data (EPOC 2017a); we piloted the form on at least one study in the review.

To address the primary objectives, two review authors independently extracted the study characteristics from the included studies, including:

General information: title, reference details, author contact details, publication type, funding source, conflicts of interest of study authors;
Methods: study design, number of study sites and location, study setting, withdrawals, date of study, follow‐up;
Participants: number, mean age, age range, gender, severity of condition, inclusion criteria, exclusion criteria, other relevant characteristics;
Interventions: intervention components, comparison, intervention purpose, mode, timing, frequency, and duration of intervention delivery, content of the intervention, type of mobile device used (smartphone, tablet, feature phone, basic phone), interoperability, compliance with national guidelines, data security, fidelity assessment;
Outcomes: main and other outcomes specified and collected, time points reported;
Notes: funding for trial, notable conflicts of interest of trial authors, ethical approval, interoperability, data security, compliance with national guidelines, limitations for delivery at scale.

Two review authors independently extracted outcome data from included studies. We noted in the Characteristics of included studies table if outcome data were reported in an unusable way. We resolved disagreements by consensus or by involving a third review author.

To address the first of the secondary objectives on describing the range of strategies to used to implement birth and death notification via mobile devices, one review author extracted descriptive data where applicable and available, including the details of the intervention/s used, groups or stakeholders involved in implementing the intervention, pathway of action (how they thought it would work), context of implementation, type of evaluation (study design), and outcome measures assessed. A second review author checked the extracted data.

To address the second of the secondary objectives on assessing the factors affecting the implementation of birth and death notifications via mobile device, one review author used the SURE (Supporting the Use of Research Evidence) framework (Appendix 2), which provides a comprehensive list of possible factors that may influence the implementation of health system interventions (Glenton 2017; SURE 2011). A second review author checked the extracted data. We extracted data on:

health system constraints (e.g. accessibility of care, financial resources, human resources, educational and training system, including recruitment and selection, clinical supervision, support structures and guidelines, internal communication, external communication, allocation of authority, accountability, community participation, management or leadership (or both), information systems, facilities, client processes, distribution systems, incentives, bureaucracy, relationship with norms and standards)
individual characteristics (e.g. knowledge and skills, attitudes regarding programme acceptability, appropriateness and credibility, motivation to change or adopt new behaviour)
social and political constraints (e.g. ideology, governance, short‐term thinking, contracts, legislation or regulation, donor policies, influential people, corruption, political stability and commitment)

In addition, we included any emergent codes which were not captured within the SURE framework but that described implementation challenges.

Assessment of risk of bias in included studies

Assessment of risk of bias in included studies for the primary objective

For studies addressing the primary objectives, two review authors independently assessed risk of bias, using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011), and the guidance from the EPOC group (EPOC 2017b). Any disagreements were resolved by discussion, or by involving a third review author. We assessed the risk of bias according to the following domains:

random sequence generation;
allocation concealment;
baseline outcomes measurements similar;
baseline characteristics similar;
incomplete outcome data;
knowledge of the allocated interventions adequately prevented during the study;
protection against contamination;
selective outcome reporting;
other risks of bias;
intervention independent of other changes (interrupted time series studies only);
shape of the intervention effect if prespecified (interrupted time series studies only);
intervention unlikely to affect data collection (interrupted time series studies only).

We judged each potential source of bias as high, low, or unclear, and provided a quote from the study report together with a justification for our judgement in the Risk of bias in included studies table. We summarised the 'Risk of bias' judgements for each of the domains listed. We considered blinding separately for different key outcomes where necessary (e.g. for unblinded outcome assessment, risk of bias for all‐cause mortality may be very different than for a patient‐reported pain scale). Where information on risk of bias related to unpublished data or correspondence with a trialist, we noted this in the Risk of bias in included studies table. We did not exclude studies on the grounds of their risk of bias, but clearly reported the risk of bias when presenting the results of the studies.

When considering intervention effects, we took into account the risk of bias of the studies that contributed to that outcome.

We conducted the review according to this published protocol and have reported any deviations form it in the Differences between protocol and review section of this review.

Assessment of methodological limitations of included studies for the secondary objectives

For the secondary objectives, the included studies comprised a multitude of study designs and study aims, including case studies that were primarily descriptive. We were unable to find an accepted tool designed to appraise methodological limitations that could accommodate this variation in study design. We, therefore, piloted a newly developed tool for assessing the limitations of sources, such as programme reports, that do not use typical empirical research designs. One review author assessed the limitations of the studies using the Ways of Evaluating Important and Relevant Data (WEIRD) Tool (Lewin 2019) and a second review author checked the assessments. The tool, which is currently being piloted in EPOC and other systematic reviews, is available in Appendix 3.

For each item/question in the tool, the review author selected one of the following response options:

Yes ‐ the item was addressed adequately in the source
Unclear ‐ it is not clear if the item was addressed adequately in the source
No ‐ the item was not addressed adequately in the source
Not applicable ‐ the item is not relevant to the source being assessed

Based on the assessments for each WEIRD tool item, an overall assessment of the limitations of the source was made as follows:

Where the assessments for most items in the tool were 'Yes' ‐ no or few limitations
Where the assessments for most items in the tool were 'Yes' or 'Unclear' ‐ minor limitations
Where the assessments for one or more questions in the tool were 'No' ‐ major limitations

The overall assessment for each source was then used as part of the GRADE‐CERQual assessment of how much confidence to place in each secondary objective finding.

Measures of treatment effect

For the analyses of the primary objectives, we reported means and proportions, where appropriate. When applicable, we estimated the effect of the intervention using risk ratio or risk difference for dichotomous data, together with the associated 95% confidence interval, and mean difference or standardised mean difference for continuous data, together with the associated 95% confidence interval. We ensured that an increase in scores for continuous outcomes could be interpreted in the same way for each outcome, explained the direction to the reader, and reported where the directions were reversed, if this was necessary.

Unit of analysis issues

For the analyses of the primary objectives, we performed data analysis at the same level as the allocation to avoid unit of analyses errors. We did not identify any cluster‐randomised trials for inclusion in the review. See Appendix 4 for methods specified in the protocol (Vasudevan 2019) but not used in the review.

Dealing with missing data

For the analyses of the primary objectives, we intended to contact investigators in order to verify key study characteristics and request missing outcome data (e.g. when a study was identified as abstract only), but this was not an issue.

Assessment of heterogeneity

For the analyses of the primary objectives, we intended to assess the heterogeneity of studies, but due to insufficient numbers of studies identified, we did not conduct the assessment. See Appendix 4 for methods specified in the protocol (Vasudevan 2019) but not used in the review.

Assessment of reporting biases

For the analyses of the primary objectives, we did not explore the impact of including studies with missing data since this was not an issue. See Appendix 4 for methods specified in the protocol (Vasudevan 2019) but not used in the review.

Data synthesis

For the analyses of the primary objectives, we proposed to undertake meta‐analyses only where this was meaningful, i.e. if the treatments, participants, and the underlying clinical question were similar enough for pooling to make sense. See Appendix 4 for methods specified in the protocol (Vasudevan 2019) but not used in the review.

To address the first of the secondary objectives (to describe the range of strategies used to implement birth‐death notification via mobile device), we presented the range of strategies that we identified in a table format.

To address the second of the secondary objectives (to identify factors influencing the implementation of birth‐death notification via mobile device), one review author familiarised themself with the extracted data and then applied the SURE framework, moving between the data and the themes covered in the framework, but also searching for additional themes until all the extracted data had been assessed. Two review authors then assessed, discussed and agreed upon the definitions and boundaries of each of the emerging themes.

To develop the implications for practice, one review author went through each finding, identified factors that may influence the implementation of the intervention, and developed prompts for future implementers. These prompts were reviewed by at least one other review author. These prompts are not intended to be recommendations, but are instead phrased as questions to help implementers consider the implications of the review findings in their context. The questions are presented in the ‘Implications for practice’ section.

Subgroup analysis and investigation of heterogeneity

If meaningful, we planned to carry out the following subgroup analyses:

by study setting (e.g. high‐income versus low‐ and middle‐income countries; urban versus rural);
by whether there was an existing CRVS (paper‐based) system in place versus no CRVS system in place at all;
by whether the notification was formal (i.e. for civil registration) versus informal (for purposes other than civil registration).

We proposed to use the following outcomes in subgroup analysis.

For birth notifications via mobile device

coverage (e.g. proportion) of births notified via mobile device;
timeliness of birth notifications via mobile device (e.g. time between birth and birth notification via mobile device);
timeliness of receipt of newborn or child health services (e.g. immunisations) in response to birth notifications via mobile device (i.e. time between birth and receipt of services).

For death notifications via mobile device

coverage (e.g. proportion) of deaths notified via mobile device;
timeliness of death notifications via mobile device (i.e. time between death and death notification via mobile device);
timeliness of cause of death ascertainment, reporting to a disease surveillance system, or both, in response to death notifications via mobile device (i.e. time between death and cause of death ascertainment).

Sensitivity analysis

See Appendix 4 for methods related to subgroup analysis and investigation of heterogeneity for the primary objectives that were specified in the protocol (Vasudevan 2019) but not used in the review.

Summary of findings and assessment of the certainty of the evidence

For the primary objectives, two review authors independently assessed the certainty of the evidence (high, moderate, low, and very low), using the five GRADE considerations (risk of bias, consistency of effect, imprecision, indirectness, and publication bias (Guyatt 2008)). We used methods and recommendations described in Section 8.5 and Chapter 12 of the Cochrane Handbook for Systematic Reviews of interventions (Higgins 2011), and the EPOC worksheets (EPOC 2017d), and GRADEpro software (GRADEpro GDT). We resolved disagreements on certainty ratings by discussion and have provided justification for decisions to down‐ or upgrade the ratings, using footnotes in the table. We used plain language statements to report these findings in the review (EPOC 2017e).

We summarised our findings in 'Summary of findings' tables (EPOC 2017d) for the main intervention comparisons, and included the most important outcomes and the certainty of the evidence for these outcomes.

For the secondary objectives, one review author used the GRADE‐CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding (Lewin 2018) and a second review author checked the assessments. GRADE‐CERQual assesses confidence in the evidence, based on the following four key components: methodological limitations of included studies; coherence of the review finding; adequacy of the data contributing to a review finding; and relevance of the included studies to the review question. After assessing each of the four components, we made a judgement about the overall confidence in the evidence supporting the review finding. We assessed confidence as high, moderate, low, or very low. The final assessment was based on consensus among the two review authors. All findings started as high confidence and were then graded down if there were important concerns regarding any of the GRADE‐CERQual components.

We presented summaries of the findings and our assessments of confidence in these findings in summary of findings Table 2. We also presented detailed descriptions of our confidence assessment in Appendix 5.

Results

Description of studies

Results of the search

We included 21 studies in the review. We also found three ongoing studies and one study awaiting classification. Figure 2 summarises the study selection process as a PRISMA flowchart. For an overview of the included studies, see the Characteristics of included studies table. For an overview of the studies that we excluded during full‐text review, see the Characteristics of excluded studies table.

Figure 2

Study flow diagram.

From the 21 included studies, we identified one study that met the inclusion criteria for the primary objectives. This study described a birth notification intervention (Xeuatvongsa 2016). We did not find any studies that described a death notification intervention and that met the inclusion criteria for the primary objectives. We identified three ongoing studies that appeared to meet the inclusion criteria for the primary objectives and that are described in the Characteristics of ongoing studies table. The study awaiting classification is reported in the Characteristics of studies awaiting classification.

All 21 included studies addressed the secondary objectives (Andreatta 2011; ANISA 2016; eCRVS‐Mozambique 2017; Gisore 2012; MBRG 2014; MBRL 2011; MBRP 2015; MBRT 2016; Moshabela 2015; MOVE‐IT 2013; mSIMU 2017; mTika 2016; MVH 2017; mVRS 2017; Ngabo 2012; NIMDS 2019; Pascoe 2012; RapidSMS 2012; Van Dam 2015; Xeuatvongsa 2016; Yugi 2016).

Included studies

Study design and comparisons

The study addressing the primary objectives employed a controlled before‐after study design. (Xeuatvongsa 2016). The comparison was standard of care. This study measured the following outcomes: coverage and timeliness of birth notification, and coverage and timeliness of post‐notification health services.

Many studies addressing the secondary objectives were descriptive reports of programmes rather than formal qualitative or quantitative studies (Characteristics of included studies). The three studies that used rigorous study designs were controlled before‐after studies (mTika 2016; Xeuatvongsa 2016) and a cluster‐randomised trial (mSIMU 2017). One of these studies was also included in relation to the primary review objectives (Xeuatvongsa 2016), while the other two did not report the necessary outcomes for inclusion in relation to the primary review objectives. For all studies addressing the secondary objectives (including the before‐after studies and the randomised trial), most of the data we extracted were based on operational data. In many cases, the data were taken from the discussion section or other sections of the report, and were often based on the report authors’ own observations.

Setting

The study that addressed the primary objectives was conducted in Lao People’s Democratic Republic (Xeuatvongsa 2016).

The studies that addressed the secondary objectives were also conducted in low‐ or middle income settings. Five studies took place in Asia: Lao People’s Democratic Republic (Xeuatvongsa 2016), Bangladesh (mTika 2016), Pakistan (ANISA 2016; MBRP 2015; NIMDS 2019), and India (ANISA 2016). Fifteen studies took place in sub‐Saharan Africa: Kenya (Gisore 2012; mSIMU 2017), Mozambique (eCRVS‐Mozambique 2017), Tanzania (MBRT 2016; MOVE‐IT 2013; Pascoe 2012), Zambia (Van Dam 2015), Liberia (MBRL 2011), Ghana (Andreatta 2011; MBRG 2014), Uganda (mVRS 2017), Rwanda (Ngabo 2012), South Sudan (Yugi 2016), Nigeria (RapidSMS 2012) and Senegal (Moshabela 2015). One study took place in the Middle East: Syria (MVH 2017). There were no studies in high‐income settings.

With the exception of the eRegister platform (Van Dam 2015) in Lusaka, Zambia, all included studies focussed on identification of births and deaths in rural, remote, or marginalised populations who are typically under‐represented in civil registration processes or traditionally seen as having poor access to health services. The mTika study implemented a birth notification intervention in Dhaka, but focussed on populations in urban slums (mTika 2016).

Participants

We classified individuals providing notifications into one of four categories: lay health workers, family members, healthcare organisations, and community‐based informants.

In the study addressing the primary objectives, birth notification was conducted by healthcare workers and a cadre of lay health workers called village health workers (Xeuatvongsa 2016).

In most of the studies addressing the secondary objectives, notification of births and deaths was conducted by lay health workers.

Lay health workers included community‐based and facility‐based workers such as traditional birth attendants, immunisation providers, community health workers (e.g. Lady Healthcare Worker, Accredited Social Health Activists), and village heath volunteers. (Andreatta 2011; MBRL 2011; MBRT 2016; Moshabela 2015; mTika 2016; Ngabo 2012; NIMDS 2019; RapidSMS 2012; Van Dam 2015; Xeuatvongsa 2016; Yugi 2016)
In one of these studies, individuals from healthcare organisations and NGOs (non‐governmental organisations) that were part of the Syria Response Turkey Health Cluster used the Monitoring Violence against Health Care (MVH) tool to notify deaths (MVH 2017).
Eight of these 21 studies included community‐based informants such as village elders, village chiefs, community volunteers, village reporters, marriage registrars, telecom agents, village executive officers, or village residents with access to a mobile phone (ANISA 2016; eCRVS‐Mozambique 2017; Gisore 2012; MBRG 2014; MBRP 2015; MOVE‐IT 2013; mSIMU 2017; mVRS 2017).
In two of the 21 studies, mothers or other family members were provided instructions or resources to directly report births to a centralised server (ANISA 2016; mTika 2016)

Interventions for notification of births and deaths via mobile devices

The study addressing the primary objectives only implemented birth notification.

Among the 22 studies addressing the secondary objectives:

Nine implemented birth notification only (ANISA 2016; MBRL 2011; MBRP 2015; MBRT 2016; mSIMU 2017; mTika 2016; mVRS 2017; RapidSMS 2012; Xeuatvongsa 2016).
Five implemented death notification only (MVH 2017; NIMDS 2019; Pascoe 2012; Van Dam 2015; Yugi 2016).
Seven implemented both birth and death notification via mobile devices (Andreatta 2011; eCRVS‐Mozambique 2017; Gisore 2012; MBRG 2014; Moshabela 2015; MOVE‐IT 2013; Ngabo 2012).

Eight studies described efforts to increase birth or death notification in conjunction with the national civil registration authority (eCRVS‐Mozambique 2017; MBRG 2014; MBRL 2011; MBRP 2015; MBRT 2016; MOVE‐IT 2013; mVRS 2017; RapidSMS 2012), while the remaining studies used birth or death notification to increase the coverage or timeliness of health services (Andreatta 2011; ANISA 2016; Gisore 2012; Moshabela 2015; mSIMU 2017; mTika 2016; Ngabo 2012; NIMDS 2019; Van Dam 2015; Xeuatvongsa 2016), and disease surveillance programs (Pascoe 2012; Yugi 2016). One study collected data on mortality resulting from attacks on healthcare organisations to assess violations of international humanitarian laws during war (MVH 2017).

The majority of the studies used basic mobile phones with voice and SMS capabilities. Birth notification was typically relayed as a text message (Andreatta 2011; MBRT 2016; MOVE‐IT 2013; mSIMU 2017; Ngabo 2012; mTika 2016; RapidSMS 2012), via phone call (ANISA 2016; Xeuatvongsa 2016), or via USSD (eCRVS‐Mozambique 2017; mVRS 2017). In one study in Kenya, each pair of village elder and registry administrator determined their modality of mobile phone communication (Gisore 2012). For birth notification, several studies used smartphone‐based apps. (MBRG 2014; MBRL 2011; MBRP 2015; MBRT 2016; Moshabela 2015) Most common modalities of death notification were SMS (Andreatta 2011; Ngabo 2012; NIMDS 2019; Yugi 2016) or smartphone‐based apps (Moshabela 2015; MVH 2017; Pascoe 2012; Van Dam 2015).

Some studies used open source data collection platforms such as RapidSMS (Ngabo 2012; RapidSMS 2012), Nokia Data Gathering (MBRL 2011), CommCare (Van Dam 2015), ChildCount+ (Moshabela 2015) and District Health Information Software 2 (DHIS2) (Pascoe 2012). System interoperability with national‐level health information systems was described poorly in the included sources. Only three studies described linkages of birth or death notification information to national‐level systems: DHIS2 in Tanzania (Pascoe 2012), a national Data Health Information System (DHIS) in South Sudan (Yugi 2016), and the Bangladesh Ministry of Health and Family Welfare’s Management Information System (mTika 2016).

Funding and conflicts

Sixteen studies listed their sources of funding (Andreatta 2011; ANISA 2016; Gisore 2012; MBRG 2014; MBRL 2011; MBRP 2015; MBRT 2016; MOVE‐IT 2013; mSIMU 2017; mTika 2016; MVH 2017; Ngabo 2012; RapidSMS 2012; Van Dam 2015; Xeuatvongsa 2016; Yugi 2016). Conflict of interest statements were available in reports of 12 studies (Andreatta 2011; ANISA 2016; Gisore 2012; MBRL 2011; Moshabela 2015; mTika 2016; MVH 2017; Ngabo 2012; NIMDS 2019; Van Dam 2015; Xeuatvongsa 2016; Yugi 2016).

Excluded studies

We excluded 242 studies from the review following full‐text screening. Studies were excluded because they did not describe an intervention for birth or death notification (n = 160); notification was not conducted via mobile devices or the use of mobile devices for notification was poorly described (n = 26); they did not report a centralised system or focal individuals for birth or death notification (n = 5); the studies used existing sources of data (n = 36); or the publications were not of relevant design (n = 15) (see Characteristics of excluded studies).

Risk of bias in included studies

Risk of bias in included studies addressing the primary objective

The study that met the eligibility criteria for addressing the primary objective (Xeuatvongsa 2016) used a controlled before‐after study design. We judged the study as having high or unclear risk across various criteria, as described in Table 1.

Table 1. Risk of bias in the included study for the primary objective (Xeuatvongsa 2016)

Bias	Authors' judgement^a	Support for judgement
Random sequence generation (selection bias)	High risk	Not a randomised controlled trial
Allocation concealment (selection bias)	High risk	Not a randomised controlled trial
Differences in baseline characteristics (selection bias)	High risk	(pg 5779) Participants different at baseline between intervention and control groups with respect to religion, ethnicity, maternal education, and HepB‐birth dose receipt
Baseline outcome measurements similar (selection bias)	Low risk	Similar outcomes measured at baseline
Blinding of participants and personnel (performance bias)	High risk	Blinding not possible
Blinding of outcome assessment (detection bias)	Unclear risk	Not reported
Incomplete outcome data (attrition bias)	High risk	Certain villages excluded due to lack of cold chain, large proportion of villages not visited. No details on the number of births registered, timeliness, only survey results from small proportion of HCWs
Selective reporting (reporting bias)	Unclear risk	Study protocol not available
Protection against contamination	High risk	Health workers in intervention and control groups using mobile phones
Other bias	Low risk	No other bias

^aJudgement specifies whether there is a low, unclear, or high risk of bias.

Methodological limitations of included studies addressing the secondary objective

There was variation in the overall assessment of the limitations of the studies addressing the secondary objectives (Table 2).

Table 2. Methodological limitations of the included studies for the secondary objectives a

Study ID

Clearly stated aim, objective or purpose?

Clear description of the source of the information (transparency)?

Clear description of the programme,intervention, policy or reform?

Clear description of the context/s?

Is the information accurate?

Is the evidence representative?

Any limitations of the information and/or methods discussed?

Is evidence provided to support any findings or conclusions made?

Relevant rights and ethics considerations described (empirical studies only)

Interests declared and any potential conflicts of interest noted?

Overall assessment^b

Explanation of WEIRD assessment

Yes

Unclear ‐ limited details on context presented

Unclear ‐ some details of data analysis not presented

Unclear ‐ small sample size

Yes

Unclear ‐ limited evidence to support implementation outcomes

Yes

Yes ‐ authors have no conflicts to declare

Minor limitations

Concerns about details of the context, accuracy, representativeness of evidence, and evidence to support findings and conclusions made.

Yes

Unclear ‐ only some sub‐assessment criteria described

Unclear ‐ insufficient information to assess accuracy

Unclear ‐ insufficient information to assess representativeness

Unclear ‐ insufficient information to assess limitations

Unclear ‐ insufficient details on evidence to support findings.

Yes

Yes ‐ authors have no conflicts to declare

Minor limitations

Concerns about description of source information, context, accuracy of information, representativeness, limitations, and evidence to support conclusions.

Unclear ‐ stated aim does not include assessment of implementation factors

No ‐ No description of source of information

Yes

Unclear ‐ Source material does not describe efforts to ensure that the information is complete and accurate

Yes

No ‐ not a study

Not applicable

Significant/major limitations

Concerns about relevance of study aims, methods, study limitations or conflicts of interest information presented with respect to review objectives. Source material did not describe any efforts to ensure that the information presented was complete and reliable.

Yes

Yes ‐ authors have no conflicts to declare

No or few limitations

Unclear ‐ Stated aim does not include assessment of implementation factors.

Unclear ‐ some sources are referenced but others potentially missed

Unclear ‐ only some sub‐assessment criteria described

Unclear ‐ Source material does not describe efforts to ensure that the information is complete and accurate

No ‐ not a study

No ‐ not described

No ‐ describes implementation but there is no associated evidence or empirical study

Not applicable

Significant/major limitations

Concerns about relevance of study aims, methods, study limitations and information presented with respect to review objectives. Source material did not describe any efforts to ensure that the information presented was complete and reliable.

Yes

Unclear ‐ Source material does not describe efforts to ensure that the information is complete and accurate

Yes

No ‐ not described

No‐not described

Significant/major limitations

Concerns about accuracy of evidence, ethical considerations, and reporting of conflicts of interest

Unclear ‐ Stated aim does not include the assessment of implementation factors

No ‐ not described

Yes

Unclear ‐ Source material does not describe efforts to ensure that the information is complete and accurate

No ‐ not an empirical study

Unclear ‐ some limitations described but others potentially missed.

No ‐ describes implementation but there is no associated evidence or empirical study

Not applicable

Significant/major limitations

Concerns about accuracy of source materials, study limitations and information presented with respect to review objectives. Source material did not describe any efforts to ensure that the information presented was complete and reliable.

Yes ‐ Purpose of the source material is not stated but can be derived as follows: To describe the implementation of a mobile birth registration programme in Tanzania

No ‐ Some quotes presented but no description of the source of information

Yes

Unclear ‐ Source material does not describe efforts to ensure that the information is complete and accurate

No ‐ not an empirical study

Unclear ‐ Lessons learned are presented but not phrased as limitations

No ‐ describes implementation but there is no associated evidence or empirical study

Not applicable

Significant/major limitations

Concerns about accuracy of evidence, its representativeness, and description of study limitations

Yes

Unclear ‐ small sample size

Yes

Not applicable

Yes ‐ authors have no conflicts to declare

Minor limitations

Concerns about representativeness of evidence

Yes

Unclear ‐ sources of lessons learned not described

Yes

Unclear ‐ sources of lessons learned not described

Not applicable

Unclear ‐ funding source described but no other conflicts declared.

Minor limitations

Concerns about description of source of information, representativeness of evidence, limitations, declarations of conflict of interest, and evidence related to findings

Yes

Unclear ‐ not described

Unclear ‐ funding source listed but no conflict of interest statement available

Minor limitations

Lack of information on ethical considerations and conflict of interest declaration

Yes

Unclear ‐ Details of the qualitative data analysis are sparse

Yes

Unclear ‐ Limitations of qualitative interviews not discussed

Unclear ‐ No quotes or underlying evidence presented for qualitative interviews

Yes

Yes ‐ authors have no conflict of interest to declare

Minor limitations

Concerns about accuracy of the evidence, evidence to support findings and description of study limitations.

Yes

Unclear ‐ not described

Yes ‐ authors have no conflicts to declare

No or few limitations

Yes

Unclear ‐ insufficient information to assess whether ethical approval was necessary in the study settings.

No or few limitations

Yes

Unclear ‐ only some sub‐assessment criteria described

Yes

Not applicable

Yes ‐ authors have no conflicts to declare

No or few limitations

Yes

No‐Not described

Yes ‐ authors have no conflicts to declare

No or few limitations

Yes

Unclear ‐ only some sub‐assessment criteria described

Unclear ‐ small sample size

Yes

No ‐ not described

Significant/major limitations

Concerns about accuracy of evidence, small sample size, lack of conflict of interest disclosure and ethical considerations

Yes ‐ Purpose of the source material is not stated but can be derived as follows: To describe the implementation of the RapidSMS programme for birth registration in Nigeria

No ‐ not described

Unclear ‐ Some assessment sub‐criteria are not fully described. There is no description of the materials used in the programme, infrastructure and resources required, or mechanisms to ensure that the programme was implemented as intended.

Unclear ‐ Some assessment sub‐criteria are not fully described. There is no description of the historical, sociocultural, socioeconomic or ethical context, the political, legal, governance, policy context, including relevant key events or policy initiatives, or a clear description of how different stakeholders were involved in the programme.

Unclear ‐ Source material does not describe efforts to ensure that the information is complete and accurate

Unclear ‐ The description is not based on a sampling approach and there is no rationale or description of how generalizations to wider populations or settings were made.

No ‐ Not described

No ‐ not described

Not applicable

Significant/major limitations

Concerns about the descriptions of transparency, methods, accuracy of evidence, study limitations presented in the source materials

Yes

Unclear ‐ only some sub‐assessment criteria described

Yes

Unclear ‐ small sample size

Yes

Not applicable

Yes ‐ author affiliations which may be perceived as conflict of interest are disclosed

Minor limitations

Concerns about description of context, accuracy of information, and representativeness of evidence

Yes

Unclear ‐ small sample size

Yes

Yes ‐ authors have no conflicts to declare

Minor limitations

Concerns about representativeness of evidence

See: Summary of findings 1 Primary objective: Summary of findings; Summary of findings 2 Secondary objectives: Summary of qualitative findings

Yes

Unclear ‐ small sample size

Yes

Not applicable

Yes ‐ authors have no conflicts to declare

Minor limitations

Concerns about description of source of information, representativeness and evidence related to findings

^aDetails of the WEIRD tool assessment criteria and prompts are available in Appendix 3.

^bNo or few limitations: when the answer to most questions in the tool is YES
Minor limitations: when the answer to most questions in the tool is YES or UNCLEAR
Significant / major limitations: when the answer to one or more questions in the tool is NO

Five studies were assessed as having no or few limitations (Gisore 2012; MVH 2017; mVRS 2017; Ngabo 2012; NIMDS 2019)
Nine studies were assessed as having minor limitations (Andreatta 2011; ANISA 2016; Moshabela 2015; MOVE‐IT 2013; mSIMU 2017; mTika 2016; Van Dam 2015; Xeuatvongsa 2016; Yugi 2016)
Seven studies were assessed as having significant/major limitations (eCRVS‐Mozambique 2017; MBRG 2014; MBRL 2011; MBRP 2015; MBRT 2016; Pascoe 2012; RapidSMS 2012)

Effects of interventions

Primary objective: Effect of birth‐death notification by mobile device

Comparison 1: Birth notification via mobile devices compared with standard practice

One controlled before‐after study was included in this comparison (Xeuatvongsa 2016). This study aimed to improve the coverage of postnatal home visits within 24 hours of birth, specifically for provision of the birth dose of the Hepatitis B vaccination. In this study, Village Health Volunteers (VHVs) used mobile phones to communicate with Health Care Workers (HCWs) and notify them of impending deliveries as well as births. During study implementation, the VHVs and HCWs in the intervention sites, but not the control sites, received mobile phones and mobile phone credit.

1.1 Coverage of births notified via mobile devices

The study assessed the proportion of VHVs who reported notifying a HCW about deliveries or births using mobile phones and the proportion of HCWs who reported receiving a notification from VHV about deliveries or birth using mobile phones. We are uncertain if birth notification via mobile device improves the coverage of birth notification as the certainty of the evidence was very low (summary of findings Table 1).

1.2 Timeliness of birth notification via mobile devices

The study assessed the proportion of VHVs who reported notifying HCWs either during labor or within one day of birth using mobile phones and the proportion of HCWs who reported receiving a notification from VHV about imminent deliveries or within one day of birth using mobile phones. We are uncertain if birth notification via mobile device improves the timeliness of birth notification as the certainty of the evidence was very low (summary of findings Table 1).

1.3 Legal birth registrations in response to birth notifications via mobile device

The study did not assess this outcome.

1.4 Timeliness of legal birth registrations in response to birth notification via mobile device

The study did not assess this outcome.

1.5 Coverage of newborn or child health services in response to birth notification via mobile device

The study assessed the proportion of births where HCWs made postnatal care visits to homes and the proportion of births for which a Hepatitis B birth dose vaccination was provided within 30 days. We are uncertain if birth notification via mobile device improves coverage of newborn or child health services as the certainty of the evidence was very low (summary of findings Table 1).

1.6 Timeliness of receipt of newborn or child health services in response to birth notification via mobile device

The study assessed the proportion of births where Hepatitis B birth dose vaccination was administered within zero to one days; the proportion of births where Hepatitis B birth dose vaccination was administered within two to seven days; and the proportion of births where the HCW made a postnatal care home visit with 24 hours of notification. We are uncertain whether birth notification via mobile device improves the timeliness of or receipt of newborn or child health services as the certainty of the evidence was very low (summary of findings Table 1).

Comparison 2: Death notification via mobile devices compared with standard practice

No studies were included that addressed this comparison.

Secondary objectives: Strategies used to implement birth and death notification via mobile devices, and factors that influence this implementation

1. Strategies used to implement birth and death notification via mobile devices

For an overview of the strategies that were used in the included studies to implement birth‐death notification via mobile device, please see Table 3.

Table 3. Strategies used to implement birth and death notification via mobile devices

Study + setting

Notifier

Description of strategy

Tanzania (Mbeya and Mwanza regions)

Health workers in government clinics

Birth notification:

Health workers enter birth information using a mobile phone, either via a smartphone app interface or via SMS prompts on a basic phone.
Data are transferred via an SMS protocol to a central database in the Registration, Insolvency and Trusteeship agency (RITA)
Once the server at RITA returns a confirmation that the birth information is received, a birth certificate for the child is issued on the spot.

Pakistan (Panjab and Sindh provinces)

Community 'gatekeepers' (marriage registrars, lady health workers, and Telenor (telecom) agents)

Birth notification:

Gatekeepers enter birth information using an android app, and capture images of any supporting documents using the phone’s camera.
Data are transferred via internet or mobile USB to the Union Council (UC) secretary, who is responsible for civil registration records for residents of the union.
The UC secretary checks details of information received on a tablet device and creates a unique birth record in the paper‐based UC register and the National Database and Registration Authority (NADRA) database.
A confirmation SMS is sent upon registration to the parents.
Birth certificate is issued after completion of formalities at the UC.

Ghana

Community volunteers

Birth and death notification:

Community volunteers use android app to collect child’s details (name, gender, date of birth, other family details), and send data to a central database managed by the Ghana Births and Deaths Registry.
Data are stored and an automated response is sent to the Births and Deaths Registry official in the field to issue a certificate for the child.

Kenya (Nyanza province)

Village reporters working with the Health and Demographic Surveillance System (HDSS) programme

Birth notification:

Village reporters send birth notification via SMS to Rapid‐SMS server.
Server notifies field‐based community workers to screen and enrol infants in m‐SIMU study.

Kenya (Western Province)

Village Elders; registry administrator

Birth and death notification:

Village elders use mobile phones to notify registry administrator of birth outcomes (including stillbirths and early neonatal deaths), and birth weight within 7 days post‐delivery.
Village elder and registry administrator determine modality of mobile phone communication.

Zambia (Lusaka)

Health workers

Death notification:

Health workers used the eRegister system created using CommCare and deployed on Samsung Galaxy 2 tablet devices to enter information related to date and cause of death for Rheumatic Heart Disease patients.

Pakistan (Matiari district) and India

Families of pregnant women, Lady Health Workers (LHWs), Traditional Birth attendants (TBAs), or residents of the village with mobile phone access

Birth notification:

Prepaid phone cards worth 100 Pakistani Rupees provided to families of pregnant women, LHWs, and TBAs for birth notification.
In areas with no LHWs/TBAs, residents of the village reimbursed for phone calls to study staff for notifying births.

Bangladesh

Mothers

Birth notification:

During pregnancy, mothers receive unique code and instructions on sending SMS with birth details to the mTika server.

Lao People’s Democratic Republic (Luang and Xayabuly provinces)

Village Health Workers (VHVs); Health Care Workers (HCWs)

Birth notification:

VHVs and HCWs in intervention areas provided with mobile phones and airtime.
VHVs notify HCWs of imminent deliveries and new births to trigger postnatal care home visits and HepB birth dose vaccination by HCWs.

Tanzania (Pwani region)

Health workers

Death notification:

Health workers use the District Health Information System2 (DHIS2) mobile app for weekly reporting of cases and deaths per the WHO Integrated Disease Surveillance and Response (ISDR) strategy.

South Sudan (Eastern Equatoria state)

Health facility staff, county Health Department staff

Death notification:

Health facility staff use personal phones to send SMS to a county health department Android phone for weekly reporting of cases and deaths as per the WHO Integrated Disease Surveillance and Response (ISDR) strategy.
Data from the Android phone are submitted to the national Data Health Information System (DHIS) via an interface that decodes the SMS data.

Ghana (Sene district)

Birth attendants

Death notification:

For each delivery attended, birth attendants use a predefined SMS protocol to send data on maternal demographics, post‐partum haemorrhage status, maternal death outcome, neonatal death outcome, and prenatal service delivery statistics.
The SMS is sent to a central study phone, and the data are later transferred to a database.

Rwanda (Northern province)

Community Health Workers

Birth and death notification:

CHWs use RapidSMS system to report pregnancy outcomes including maternal and child deaths.

Senegal (Northwest)

Community Health Workers

Birth and death notification:

CHWs use Childcare+ to report births and cases of deaths of children under five, and women ages 12‐49 years.

Tanzania (Rufiji district)

Village Executive Officers (VEOs)

Birth and death notification:

VEOs record birth or death information in facility registers and use mobile phones to send the information as a structured SMS to a central database linked to the district civil registry.
VEOs provide copy of notification form to household members.
Household members visit the District Civil Registrar’s office to complete birth or death registration, pay the fee, and collect the birth or death certificate.

Mozambique

Village chiefs

Birth and death notification:

Village chiefs use USSD via mobile phone to notify the national e‐civil registration and vital statistics system regarding births or child deaths in their village.
In response to the notification, the village chief receives a personal number (single citizen’s identification number) for the child.
Families receive SMS when the birth or death certificate is ready.

Liberia (Bomi county)

Health workers

Birth notification:

Health workers use the Nokia Data Gathering software to enter data related to births and send to a centralised server.

Uganda

Village chiefs

Birth notification:

Birth notification is issued by the hospital administration or community notifier via mobile phone (USSD) to the Mobile Vital Registration System (mVRS).
Upon online verification by the National Identification and Registration Authority (NIRA), the notifier is able to print, sign and issue the notification to parents or other family members.

Syria, Turkey

Staff at all Turkey health cluster organisations (internal partners)

Death notification:

An internal or external partner posts information to a 293‐member WhatsApp group.
Members with physically verified information (via site visit or presence during incident) complete anonymous and confidential online alert form.
Form includes location, attack type, facility type, extent of damage, who is affected, injuries and deaths.
Triangulated, key data (location, type of service, modality of attack, deaths, and casualties) from forms distributed within 24 hours to all partners and donors.

Nigeria

Registrars

Birth notification:

Registrars with unique identification numbers send birth information using SMS to the RapidSMS server.

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Pakistan (Punjab district)

Lady Health Supervisors (LHSs)

Death notification:

Neonatal Infant and Maternal Deaths E‐surveillance System (NIMDS)
Lady Health Workers (LHWs) and community midwives (CMWs) report neonatal, infant, or maternal deaths that have occurred by informing the respective Lady Health Supervisors (LHSs).
LHS confirms death and sends a SMS with complete neonatal, infant, or maternal death string to the system from her registered mobile number.
If the SMS reporting format is correct, then the system sends an auto confirmation message with a unique Case Number of that death.
If the SMS reporting format is incorrect, the system generates an error message with an auto reply to the sender about the specific error string.

ASHA: Accredited Social Health Activists
CHW: Community Health Worker
CMW: Community Midwife
DHIS2: District Health Information System2 (DHIS2)
HCW: Health Care Worker
HDSS: Health and Demographic Surveillance System
ISDR: Integrated Disease Surveillance and Response (ISDR) strategy
LHS: Lady Health Supervisor
LHW: Lady Health Worker
mVRS: mobile Vital registration System
NADRA: National Database and Registration Authority
NIMDS: Neonatal Infant and Maternal Deaths E‐surveillance System
NIRA: National Identification and Registration Authority
RITA: Registration, Insolvency and Trusteeship agency
TBA: Traditional Birth Attendant
SMS: Short Message Service
UC: Union Council
USB: Universal Serial Bus
USSD: Unstructured Supplementary Service Data
VEO: Village Executive Officer
VHV: Village Health Volunteer
WHO: World Health Organization

2. Factors that influence the implementation of birth and death notification via mobile devices.

The 21 studies that addressed the secondary objectives described a variety of factors that could influence the implementation of birth and death notification using mobile phones. As described above, these findings are primarily based on the report authors’ own comments and observations and are not based on a formal data gathering or analysis process. Using the SURE framework as our starting point, we have grouped these findings as follows:

Factors related to health system constraints in the implementation of birth and death notification via mobile devices;
Factors related to characteristics of individuals providing birth and death notification via mobile devices;
Factors related to characteristics of families for whom birth and death is notified via mobile devices;
Factors related to characteristics of other stakeholders involved in birth and death notification via mobile devices;
Factors related to the mobile technologies used for birth and death notification – this component is not in the original SURE framework but was added for the purposes of this review.

The SURE Framework also includes factors tied to social and political constraints. However, only a few studies described factors influencing the implementation of birth and death notification strategies using mobile phones that could be categorised as such. The summary of findings on factors that influence the implementation of birth and death notification via mobile devices are presented in summary of findings Table 2.

A. Health system constraints in the implementation of birth and death notification via mobile devices

Finding A.1. Geographic barriers hamper timeliness of birth and death notification conducted via mobile devices, as well as post‐notification services or processes (e.g. certification of birth or death) (moderate‐confidence finding).

Digital devices could allow healthcare providers to more efficiently notify authorities about births and deaths. However, healthcare providers carrying mobile devices still need to reach families to ascertain that a birth has occurred and to gather information needed for the purposes of notification. Study authors described how geographical barriers hindered providers’ ability to reach families and gather the necessary information for notification and to deliver post‐notification services. In particular, two studies reported that accessibility challenges delay birth notification, which could then lead to delays in providing healthcare services that are due within 24 hours after birth (ANISA 2016; Xeuatvongsa 2016).

Primary challenges faced by providers in accessing families for birth or death notification by mobile phone or for the delivery of post‐notification services, were distance (ANISA 2016; Xeuatvongsa 2016), seasonal impassability of roads (Pascoe 2012), and lack of reliable and inexpensive transportation options (MOVE‐IT 2013; Pascoe 2012). In Tanzania, Pascoe and colleagues noted that during the rainy season, some roads were impassable by motor vehicles affecting the ability of health workers to travel there (Pascoe 2012).

Suggestions or efforts to improve accessibility to families for the purpose of timely notification via mobile devices or delivery of services centred on reducing the 'distance' between the health workers and the communities. In one study, staff were stationed at the project office to receive birth notification calls, and families and community health workers received prepaid phone cards to notify the project office of new births (ANISA 2016).

While health workers in some of the studies travelled to the family for the birth or death notification, families were usually expected to travel to facilities or the registrar’s office to access post‐notification services. Three studies described challenges faced by families in accessing post‐notification services such as certification of births or access to health services. For instance, transportation barriers impacted family members’ ability to access the registrar’s office to certify births and deaths and, in the case of births, to access health facilities to access post‐notification services (MBRT 2016; MOVE‐IT 2013; Ngabo 2012). For instance, in the MOVE‐IT project, transportation barriers and associated costs were cited as reasons for non‐certification of birth or death events by family members, following timely notification by health workers using mobile phones (MOVE‐IT 2013).

The studies made several suggestions on improving family members’ accessibility to registration services including increasing the number and proximity of ‘service points’ where registration can occur, and using digital systems for faster processing of registration information at these service points (ANISA 2016; MBRT 2016; mVRS 2017). Integration of birth registration with immunisation campaigns or other neonatal health services was suggested as one way to improve birth registration rates. Printing of birth certificates at the registration service points was also noted as a way of reducing the number of steps needed to complete registration, and for helping parents to avoid the ‘long expensive journey to a far‐away registration centre' (MBRT 2016).

Health workers using mobile devices for birth–death notification may also require supervision. But studies also reported challenges with in‐person supervision when access to communities was problematic. To resolve this issue, two studies reported using an online dashboard, which allowed officials/supervisors to remotely monitor birth notification data collected using mobile phones (MOVE‐IT 2013; Ngabo 2012).

Finding A.2. Birth and death data collected using mobile devices can help health and civil registration systems identify problems and introduce appropriate quality improvements (low‐confidence finding).

In several studies, authors described the benefits of collecting birth and death data via mobile phones as this could help identify problems, which again could lead to improvements in the organisation of healthcare services (MBRT 2016; Moshabela 2015; MVH 2017; NIMDS 2019; RapidSMS 2012). For instance, in the Millennium Villages Project in Senegal, study authors reported that verbal autopsy data collected via mobile phones during routine death surveillance enabled the early identification of increased maternal mortality rates in the region (Moshabela 2015). This, in turn, provided justification for implementing responsive quality improvement measures at the local hospital to reduce maternal deaths. A study in Pakistan described a maternal and neonatal death registration system with the purpose of identifying regions with high mortality rates and generating appropriate strategies to reduce mortality (NIMDS 2019). In studies in Tanzania and Nigeria, authors speculated that government accountability towards registration services may increase due to the real‐time availability of birth data notified from health facilities (MBRT 2016; RapidSMS 2012). In Nigeria, the availability of real‐time information was seen as a way of identifying poor‐performing (“lazy”) registrars (officials who validate, register and certify life events such as births and deaths) (RapidSMS 2012).

One study described how a WhatsApp‐based reporting tool was used in war zones to document violence against healthcare services and mortality among healthcare workers (MVH 2017). This data was used to document breaches of international humanitarian law protecting healthcare workers. These data were disseminated via monthly reports, infographics and advocacy. However, the authors noted that attacks on healthcare facilities and healthcare workers continued, despite the availability of real‐time data.

Finding A.3. Health workers who lack familiarity with, or prior experience in, using mobile technologies may need rigorous training as well as post‐training support (moderate‐confidence finding).

Most studies reported training health workers and community‐based notifiers prior to the implementation of birth and death notification via mobile devices (Andreatta 2011; Gisore 2012; MBRL 2011; MBRT 2016; MOVE‐IT 2013; mSIMU 2017; mTika 2016; Ngabo 2012; Van Dam 2015; Xeuatvongsa 2016; Yugi 2016). Studies reported that notifiers sometimes lacked familiarity with mobile devices or features prior to training; were unfamiliar with the digital communication protocols selected for delivering the notification (e.g. the format for SMS); or had gaps in clinical training, including aspects of health service delivery or disease aetiology; and health management. (Andreatta 2011; Gisore 2012; NIMDS 2019; Xeuatvongsa 2016; Yugi 2016). Some studies also reported that health workers faced technical challenges in learning to use phones for data collection, for instance making mistakes in composing the SMS notification string (mSIMU 2017; mTika 2016; NIMDS 2019).

Health workers’ knowledge gaps were mitigated by implementing rigorous training on the use of mobile technologies and the use of various communication formats for providing notification. Training sessions described in the included studies varied from day‐long workshops to multiple workshops lasting several days (Andreatta 2011; Gisore 2012; MBRL 2011; MOVE‐IT 2013; mSIMU 2017; Ngabo 2012; Xeuatvongsa 2016; Yugi 2016). Most studies reported using group training formats which typically involved interactive exercises and practice on using mobile phones to notify birth or death information (Andreatta 2011; Gisore 2012; MBRL 2011; mSIMU 2017; Ngabo 2012; Yugi 2016). For instance, in the M‐SIMU project in Kenya, village reporters were trained in groups of 30, followed by one‐on‐one training by field supervisors for those with persistent challenges in data entry (mSIMU 2017). Training materials included pictographic instructions and reference cards, and were typically translated into local languages (Andreatta 2011; mSIMU 2017; Ngabo 2012). In one study in Rwanda, national trainers collaborated on the development of training material development (Ngabo 2012).

Studies also described various strategies to address technical challenges in the use of mobile devices for notification. In Pakistan, authors reported simplifying the death notification SMS string by reducing its length and removing case‐sensitive text, leading to fewer errors in spelling, format, and string order (NIMDS 2019). In Kenya, health workers began data collection using phones in advance of the evaluation period so that initial technical issues with the use of phones for data collection could be rectified (mSIMU 2017). In other studies, health workers were given ad hoc post‐training support, mechanisms were established so that they could report problems and receive help, and continuous monitoring of data quality and timeliness was conducted (MBRT 2016; MOVE‐IT 2013; mTika 2016; Van Dam 2015; Yugi 2016). In one study in Zambia, the authors hypothesized that training needs for health workers may reduce in the future as the use of mobile devices becomes more pervasive (Van Dam 2015).

Finding A.4. Local capacity to train future cadres of notifiers may be strengthened through 'train the trainer' approaches (low‐confidence finding).

Two studies described approaches for local capacity building of trainers for training future cadres of health workers involved in birth and death notification using mobile devices (MBRL 2011; Ngabo 2012). One study reported a cascade training approach in Rwanda where, in the first stage, ten national trainers from the Ministry of Health were trained. The second stage involved training of district‐level supervisors and data managers by the national trainers and the final stage was training of over 400 community health workers by the district‐level supervisors (Ngabo 2012). A second study described including representatives from local IT companies in the pool of trainers to support the Liberian Ministry of Health and Social Welfare in future training sessions (MBRL 2011).

Finding A.5. Mechanisms for continuous monitoring and supportive supervision are important for ensuring the quality and timeliness of birth and death data collected via mobile devices (moderate‐confidence finding).

A number of studies noted that while rigorous training of health workers on how to conduct mobile device‐based data collection was critical for implementation, additional and continuous monitoring mechanisms were also crucial for ensuring data quality and timeliness (Andreatta 2011; MOVE‐IT 2013; mTika 2016; Ngabo 2012; Yugi 2016). A study in Ghana recommended cross‐verification of data for accuracy since favourable outcomes may be over‐reported while unfavourable ones are under‐reported by data collectors (Andreatta 2011). One study in Tanzania used simple feedback messages to acknowledge receipt of weekly disease surveillance reports or to remind health workers without timely submissions (Pascoe 2012). Uddin and colleagues were less specific, but cited the need for continuous monitoring of field activities and inclusion of project and technical staff input in order to mitigate implementation challenges for birth and death notification via mobile devices (mTika 2016).

One study described that quality assurance may be facilitated through the use of web‐based dashboards that track data (Ngabo 2012). In this study, authors reported that notifiers made fewer errors in data transmission over time (Ngabo 2012). In other studies, the authors suggested that supervision may be targeted to low‐performers, who could be identified rapidly through the availability of ‘real time’ digital performance data. For instance, the supervisory team from the MOVE‐IT project conducted spot checks on whether SMS messages were formatted correctly in addition to focussing on notifiers who had submitted data on no or few events prior to the supervision (MOVE‐IT 2013). One study described the use of compulsory reporting of reasons for failure to register newborns within 24 hours of birth as the basis for increased accountability and performance of study teams (ANISA 2016). Another study in South Sudan further highlighted the case for continuous monitoring – here the timeliness of reporting of disease surveillance data dropped in a county where the surveillance officer vacated his post (Yugi 2016). To mitigate such issues, the authors recommended identifying backup surveillance officers, in addition to quarterly review of performance with health workers (Yugi 2016).

Finding A.6. Inadequate attention is paid to legal frameworks governing civil registration. These may need to be modified to allow notification via mobile device and the inclusion of new cadres of notifiers (low‐confidence finding).

Three included studies discussed legal frameworks governing civil registration, and the limitations they may impose on the authority of the notifier to provide the full range of civil registration services (eCRVS‐Mozambique 2017; MBRP 2015; mVRS 2017). One study in Uganda reported that hospital administrators or community notifiers using the Mobile Vital Registration System (MVRS) were able to issue a lawful notification but did not have the authority to issue the birth certificate (mVRS 2017). Alternatives to legal reform (e.g. the use of a memorandum of understanding) were viewed as temporary fixes to allow the use of mobile devices in the notification process (MBRP 2015). Instead, authors recommended working with the government to incorporate modern methods of birth registration (including notification) in the law. In Mozambique (eCRVS‐Mozambique 2017), legal and policy reforms undertaken by the government to accommodate notification of births and deaths via mobile devices, included:

Identification of acceptable technologies needed for birth and death notification via mobile devices;
Acceptance of digital notifications over paper‐based notifications; and
Development of systems used to uniquely identify individuals in the digital civil registration database, and updates to reflect how these processes might change due to the use of mobile devices for notification.

Finding. A.7. The availability of adequate human resources to conduct birth and death notification via mobile devices may be facilitated by hiring new cadres of notifiers or recruiting existing cadres of health workers to undertake notification (moderate‐confidence finding).

Studies reported the need for adequate numbers of trained, local staff to conduct birth and death notification. A lack of staff was seen as a potential constraint to scaling up birth and death notification strategies using digital devices. (Andreatta 2011; ANISA 2016; eCRVS‐Mozambique 2017; Gisore 2012; MBRL 2011; MBRT 2016; mVRS 2017; Pascoe 2012). Several studies suggested recruiting existing cadres of health workers not previously involved in notification (Andreatta 2011; ANISA 2016; eCRVS‐Mozambique 2017; MBRT 2016). In other studies, health workers and community leaders already engaged in paper‐based notification of births and deaths were equipped with mobile phones (ANISA 2016; Gisore 2012; Xeuatvongsa 2016). For instance, in Kenya, village leaders already responsible for recording home births and deaths were equipped with mobile phones for notification of vital data and birth weights (Gisore 2012). Another study in Tanzania suggested that relieving health workers of administrative tasks may allow them to direct more effort into notification and other health services (Pascoe 2012). Several studies reported hiring additional staff in supervisory and project coordination roles to support and monitor individuals providing vital notification via mobile devices (ANISA 2016; MOVE‐IT 2013; Yugi 2016).

Finding A.8. Implementing birth and death notification via mobile devices may be influenced by underlying health and civil registration system infrastructure, resources, and processes (low‐confidence finding).

In addition to adequate numbers of notifiers, several studies pointed to the need for strong underlying health and civil registration systems when mobile phones are used for birth and death notification (ANISA 2016; Gisore 2012; MBRL 2011; Moshabela 2015; MOVE‐IT 2013; mVRS 2017; Ngabo 2012). In those studies, birth and death data were collected as part of routine study activities, prior to implementation of mobile devices for collection of this data (Gisore 2012; Moshabela 2015; Ngabo 2012). For instance, one study in Rwanda described “an already existing and well organised community based health programme, the PBF approach coupled with the scale‐up of community health insurance…and perfect delineation of administrative boundaries with clearly defined roles and responsibilities for CHWs…” as reasons for successful implementation of birth and death notification via mobile phones (Ngabo 2012). A study in Liberia described the need to establish necessary technical infrastructure and training of staff for the implementation of their mobile birth registration system (MBRL 2011). In rural areas in Syria, the lack of more than one partner health organisation made it challenging to verify accounts of death following an attack from independent sources (MVH 2017).

B. Factors related to individuals providing birth and death notification via mobile devices

Finding B.1. Costs incurred by health workers sending notifications using mobile personal phones may need to be reimbursed to facilitate sustained use of these technologies for notification (moderate‐confidence finding).

Some studies discussed the need to cover the costs incurred by notifiers when using their own phones to notify births and deaths (mSIMU 2017; Ngabo 2012; Pascoe 2012; Xeuatvongsa 2016; Yugi 2016). In a study in Lao PDR, health workers in the intervention and control arms used their mobile phones for notification. While health workers in the intervention arm were compensated for the use of mobile phone credit, those in the control arm were not. In the absence of compensation, the lack of phone credit was reported more frequently in the control arm as the reason for not being able to use the phone for notification (Xeuatvongsa 2016).

To address costs incurred by notifiers when using their own phones, most studies reported providing phone credit to the notifiers (mSIMU 2017; Pascoe 2012; Xeuatvongsa 2016; Yugi 2016). A study in Rwanda reported the use of a reverse billing system through which the Rwandan government covered the costs of phone use by the health workers (Ngabo 2012). Another study in Kenya reported that the Village Elders were asked to purchase the airtime for their phones themselves (Gisore 2012). Further studies are needed to describe the impact of costs incurred by the notifiers on the timeliness or coverage of notification.

Finding B.2. The use of mobile phones for notification is acceptable to health workers, and helps them to undertake their job responsibilities (moderate‐confidence finding).

Several studies reported high acceptability among health workers for using mobile devices to conduct notification (mSIMU 2017; Ngabo 2012; NIMDS 2019; Pascoe 2012; Van Dam 2015; Yugi 2016). These studies found that health workers using mobile phones for notification:

Displayed more self‐confidence or reported being more proactive in finding and reporting pregnancies due to reminders sent to their phones (Ngabo 2012; NIMDS 2019);
Spent less time than during the pilot study period in composing and sending notification (NIMDS 2019);
Reported spending more time delivering services rather than reporting data, especially when reports were submitted electronically rather than in‐person (Pascoe 2012);
Reported earning more trust and respect from families due to their ability to communicate with and coordinate emergency services with health facilities (Ngabo 2012);
Reported that the phone‐based notification system was easy to use (mSIMU 2017; NIMDS 2019; Van Dam 2015; Yugi 2016).

Strategies reported in the studies to improve intervention acceptability and adoption among health workers included:

Using an iterative, human‐centred process for the development of the mobile application or format for communication (NIMDS 2019);
Providing financial incentives based on performance (see Finding B.3.).

Finding B.3. Health workers’ adoption of mobile birth and death notification strategies may be affected by competing priorities and the availability of adequate incentives (moderate‐confidence finding).

Several studies reported challenges with the successful adoption of strategies for mobile birth and death notification by health workers, and this was seen to be due to competing priorities and a lack of adequate incentive structures (MOVE‐IT 2013; mSIMU 2017; mTika 2016; MVH 2017). The MOVE‐IT project in Tanzania reported that some Village Executive Officers did not follow up proactively to report new births, sometimes even waiting for the parents or relatives of the newborn to come to their offices to initiate the process (MOVE‐IT 2013). Reasons provided for this lack of engagement included the busy schedules of the Village Executive Officers; home visits not being part of routine job responsibilities; and a lack of incentives or commissions for reporting births. Similarly, a study in Kenya suggested that the small incentive payment provided may have been responsible for the sporadic use of mobile phones for notification by some notifiers, despite the high acceptability of the strategy in general (mSIMU 2017). One study in Bangladesh engaged mothers to provide notification of births, but found the rates of maternal notification to be low. The authors suggested that this might be connected to a lack of time among mothers, who were busy taking care of new babies (mTika 2016). Finally, a study in Syria noted that it was challenging to convince partners to continue reporting on attacks on and deaths among health workers, as the availability of these data did not appear to lead to any change (MVH 2017).

C. Factors related to families for whom birth and death is notified via mobile devices

Finding C.1. For some families, costs may be a barrier to completing birth and death registration post‐notification (low‐confidence finding).

Several studies described costs incurred by families when registering and certifying births and deaths that may be prohibitive for some families. While these costs are not specific to notification conducted via mobile devices, they included transportation costs to and from the registration centre (MOVE‐IT 2013), lost wages (MBRP 2015; MBRT 2016), and penalties associated with late certification (MOVE‐IT 2013). Transportation costs in these studies included the lack of inexpensive transport options, the time required for travel, and the need for multiple trips to distant registration centres (MBRP 2015; MBRT 2016; MOVE‐IT 2013). Some studies suggested that families living farther away from registration centres or that were poorer were less likely to complete birth or death registration and certification due to cost barriers (MBRP 2015; MOVE‐IT 2013). For example, in Pakistan, the costs of birth registration were estimated to be equivalent to the average daily wage in some communities (MBRP 2015). One study pointed out that the use of mobile devices to facilitate issuance of birth certification at the site of notification would remove the need for families to travel to registration centres (MBRT 2016).

Finding C.2. There may be a need for targeted demand generation activities in communities with low awareness of the need of birth and death registration, alongside the use of mobile phones for birth and death notification (low‐confidence finding).

Several studies reported the need for targeted advocacy campaigns, including campaigns delivered via mobile phones, to increase awareness of the importance of timely vital registration (MBRG 2014; MBRT 2016; MOVE‐IT 2013; mVRS 2017) (although low awareness is not specific to notification conducted via mobile devices). Two studies suggested that linking birth registration with school entry requirements may lead some families to delay the process until the child is ready to begin attending school (MBRG 2014; mVRS 2017). In Tanzania, some families provided no specific reason for the failure to complete registration, even though births and deaths in these families had already been notified by the health workers using mobile phones (MOVE‐IT 2013).

Finding C.3. Sociocultural norms may influence the timely identification of births and deaths, and should be taken into consideration when developing mobile phone interventions for notification (low‐confidence finding).

Studies reported that sociocultural norms could create challenges for identifying births and deaths (MBRG 2014; MBRP 2015; MOVE‐IT 2013). Examples of such sociocultural norms included moving out of a district after the death of family member (MOVE‐IT 2013); delays in, or failure to record still births, abortions, or maternal deaths (MBRG 2014); preference for giving birth outside of the study area (ANISA 2016); as well as shame and stigma associated with births to unmarried women (MBRP 2015). In the ANISA study, authors also reported the unwillingness of people living in rural areas in Pakistan to be outside after sunset, limiting identification of births that occurred in the evening or night until the next morning (ANISA 2016). Again, these issues are relevant for, but not specific to, notification of birth and deaths by mobile device.

Finding C.4. Birth and death notification may increase access to these services for some families. However, they may also increase inequities in access related to low availability of supportive infrastructure (network coverage, roads, human resources), human factors (age, gender, literacy, poverty), and selective funding priorities of donors (moderate‐confidence finding).

A number of studies suggested that the use of mobile devices improved the reach of birth and death notification interventions to marginalised populations. For instance, a study from Kenya suggested that using community‐based lay notifiers for conducting birth notification via mobile devices facilitated the timely identification and registration of 'hard‐to‐reach' populations of rural women (Gisore 2012). Similarly, a study from Bangladesh reported successfully registering urban street children (mTika 2016). However, studies also reported inequities in the implementation of birth and death notification via mobile devices related to the availability of supportive infrastructure, human factors and availability of funding.

In Tanzania and Pakistan, where birth notification via mobile devices was conducted in areas with low birth registration rates, study authors reported prioritising regions with adequate network coverage, good roads, and access to provincial capital cities for implementation (MBRP 2015; MBRT 2016). In the MOVE‐IT project in Tanzania, some villages could not participate in the implementation of birth notification via mobile devices due to lack of network coverage or absence of a village executive officer to send notifications (MOVE‐IT 2013). A study from South Sudan also reported challenges in achieving 100% reporting of disease surveillance activities due to lack of staff and network coverage (Yugi 2016). In Rwanda, it was reported that some community health workers had to travel long distances to access facilities where they could charge their mobile devices (Ngabo 2012).

In the M‐SIMU project in Kenya, gender and education status was associated with ability to notify events using mobile phones. For example, village reporters who were female, or had higher education levels, performed better and made fewer errors compared to their male and less educated counterparts (mSIMU 2017). A study in South Sudan reported challenges in composing SMS disease surveillance notifications among health workers with lower English proficiency (Yugi 2016). Another study in Ghana reported using bilingual proctors during training sessions with health workers to accommodate Twi and English speakers (Andreatta 2011). In the mTika study in Bangladesh, where mothers were expected to send SMS notification related to the birth of their child, the authors reported that most mothers shared phones but did not own them (mTika 2016). A study in Lao PDR reported the inability of health workers in the comparison arms to afford mobile phone credit as the reason for lower rates of timely birth notifications (Xeuatvongsa 2016).

Finally, one study in Uganda reported that districts which received the greatest funding from donors also showed the greatest improvements in birth registration rates (mVRS 2017).

D. Factors related to government involvement in birth and death notification via mobile devices

Finding D.1. Strong government commitment is a key factor in the successful implementation of birth and death notification via mobile devices (low‐confidence finding).

Studies reported successful implementation of birth and death notification initiatives via mobile devices in countries where there was strong political will and support from the national government (eCRVS‐Mozambique 2017; MBRL 2011; MBRT 2016; mVRS 2017; Ngabo 2012; Yugi 2016). For instance, in Tanzania, the government’s willingness to adopt a decentralised approach to civil registration was listed as a factor driving successful implementation of the mobile birth registration initiative (MBRT 2016). Authors reported that they included government as a formal partner from the start, and solicited their input throughout the project lifecycle (MBRT 2016).

E. Factors related to the technologies used for birth and death notification via mobile devices

Finding E.1. Cost is an important consideration in the purchase, set‐up, and scaling up of mobile technologies needed for birth and death notification (low‐confidence finding).

The studies noted taking costs into consideration during the purchase, set‐up, and scaling of mobile technologies for birth and death notification (Gisore 2012; mTika 2016; mVRS 2017; Ngabo 2012; Pascoe 2012; Van Dam 2015; Xeuatvongsa 2016; Yugi 2016) The cost categories mentioned included:

Initial costs of setting up the technology, including purchase of mobile devices for notifiers, servers, and other related technologies (MBRT 2016; mVRS 2017; Ngabo 2012; Pascoe 2012; Xeuatvongsa 2016);
Purchasing airtime for notifiers or paying for costs of information transmission (e.g. costs of SMS) (Ngabo 2012; Pascoe 2012; Xeuatvongsa 2016).

Some studies reported that the operating costs of using mobile phones reduced as the project progressed beyond the initial investment and technology set‐up phase, although reasons for this reduction were not given (Gisore 2012; MOVE‐IT 2013; mVRS 2017).

Some strategies to reduce technology costs discussed in the studies included:

Using notifiers’ own phones (mTika 2016; Xeuatvongsa 2016);
Public‐private partnerships with mobile network operators for cheaper rates on SMS or data‐related expenses (Ngabo 2012);
Planning for communication costs in monthly project or health worker budgets (Yugi 2016).

Finding E.2. Challenges when notifying births and deaths via mobile devices include poor access to electricity and incompatibility with existing systems (low‐confidence finding).

The studies reported several challenges related to using and maintaining mobile devices, which in turn impacted the ability of health workers to provide birth and death notifications. Challenges described included:

Access to electricity for charging devices (Ngabo 2012; Pascoe 2012);
Reliable electricity to maintain servers, in part due to frequent power cuts (MBRL 2011; MBRP 2015);
Insufficient phone memory for storing data (MBRT 2016; Pascoe 2012);
Accidentally erasing apps related to birth or death notification (Pascoe 2012);
Lost devices (Gisore 2012; Pascoe 2012);
New developments in technology and the need for newer technology (MBRT 2016; Pascoe 2012);
Incompatibility with existing systems (MBRT 2016).

Finding E.3. The availability of network connectivity is a key factor in the successful implementation and scale‐up of birth and death notification via mobile devices (moderate‐confidence finding).

Most studies reported the high coverage of mobile networks in the study areas as the key reason for implementing notification of vital events via mobile devices (ANISA 2016; MBRT 2016; mSIMU 2017; mVRS 2017; Ngabo 2012). However, other studies reported challenges in implementing or scaling mobile phone‐based notification of vital events in areas with poor network coverage (Pascoe 2012; Xeuatvongsa 2016; Yugi 2016). Two studies in Tanzania reported overcoming barriers related to poor or unreliable network coverage by using a system that was capable of offline data collection and storage. This allowed data to be transmitted when a network connection was available (MBRT 2016; Pascoe 2012). Upon implementing a system capable of offline data collection, Pascoe and colleagues reported that messages would queue for submission when offline, and health workers had to find locations with good mobile network coverage to upload the data (Pascoe 2012).

Finding E.4: Data security and encryption measures are needed to preserve the confidentiality of birth and death information notified via mobile devices (low‐confidence finding).

The included studies described a variety of data security measures including:

Use of dedicated usernames and passwords (MVH 2017; Ngabo 2012; Van Dam 2015);
Anonymous reporting of sensitive data (MVH 2017);
Data encryption and secure protocols for data transmission (MVH 2017; Van Dam 2015);
Limiting user permissions to view or edit data (MBRT 2016; MVH 2017; Ngabo 2012); and
Ability to lock and wipe phone remotely if phone is lost (MBRT 2016).

In addition, one study from Zambia described the ability to produce de‐identified reports from data, which could be subsequently used for research (Van Dam 2015).

Discussion

Summary of main results

We identified only one study, focusing on birth notification, which met the eligibility criteria for inclusion in relation to the review's primary objective. Based on this study, we are uncertain about the impacts of birth notification via mobile devices as the certainty of the evidence is very low. No studies evaluating the effectiveness of death notification via mobile devices were eligible for inclusion in the review.

In relation to the review's secondary objectives, we identified a number of studies that helped us summarise factors that could influence the implementation of birth and death notification via mobile devices. These studies showed that a wide range of factors appear to influence the implementation of this approach, including issues tied to the health system and the notification system, the person responsible for notifying, the community, and the families involved.

All 21 studies of birth or death notification via mobile phones were from low‐ or middle‐income countries. This can probably be explained by the use of more robust health information and civil registration and vital statistics systems in high‐income countries, making it unnecessary to use mobile phones for birth and death notification.

Description of interventions

We found significant heterogeneity in the implementation of birth and death notification via mobile devices. Most studies used lay health workers, community informants, healthcare organisations, or families/individuals as notifiers of birth and death. The emphasis, in many cases, was on the use of simple technologies (e.g. basic phones, SMS or voice‐based notification), although we found examples of smartphone app‐based data collection for birth and death notification.

Overall completeness and applicability of evidence

This review is a comprehensive assessment of the evidence published since 2000 on birth and death notification via mobile devices. The findings of this review suggest that there is a paucity of well conducted studies on the effectiveness of birth and death notification via mobile devices (primary review objective). We used a multi‐pronged search strategy including peer‐reviewed and grey literature, solicitation of relevant studies from the digital health community, and a review of trial registration databases to improve the chances of identifying published, unpublished and ongoing studies. We therefore anticipate that we identified all eligible studies of the effectiveness of birth and death notification via mobile devices. Because the evidence that we identified was limited in nature and of very low certainty, we cannot meaningfully discuss the applicability of this evidence. Outcome measures like coverage (e.g. proportion) of births or deaths notified via mobile devices may not be indicators of intervention impact if overall coverage of births or deaths notification does not increase. In future iterations of the review, authors may wish to consider additional outcome measures such as the vital statistics performance index.

Certainty of the evidence

Based on the GRADE approach, the certainty of evidence for the birth notification outcomes was very low, and this was related to the non‐randomised study design used and concerns regarding precision and directness. As noted above, we did not identify any eligible studies evaluating the effectiveness of death notification via mobile devices.

For the findings based on the studies included in the review of the secondary objectives, confidence in the evidence, based on the GRADE‐CERQual approach, was low to moderate. The main reasons for downgrading related to the methodological limitations of the studies and concerns regarding adequacy of the evidence.

Potential biases in the review process

For the primary objectives, we attempted to minimise potential biases in the review process by adhering to Cochrane (Higgins 2011) and EPOC guidance (EPOC 2017a). We conducted comprehensive searches without limiting the searches to a specific language, and two review authors independently assessed study eligibility, extracted data, and assessed the risk of bias for each included study.

For the secondary review objective, we followed Cochrane and EPOC guidance for qualitative evidence syntheses (Glenton 2019, Noyes 2018) and also undertook comprehensive searches and used two review authors to independently assess study eligibility, extract data, and assess the methodological limitations of each included source. However, as more of these studies may be available through the grey literature only, or may be unpublished, it is possible that some were missed in our search process. Also, we used a newly developed tool (the WEIRD tool) to assess the limitations of some of the sources, and it is not yet completely clear how best to apply this tool (Lewin 2019).

Agreements and disagreements with other studies or reviews

There is one previous review of birth and death notification (WHO 2013a). The main differences between this review and the earlier review are that our review:

Limited the intervention to those delivered via mobile devices only. The previous review included any e‐health intervention.
Expanded the definition of the intervention to use cases outside the realm of national civil registration and vital statistics systems. The previous review focussed on civil registration and vital statistics systems exclusively.
Used a more comprehensive search strategy inclusive of the grey literature.
Used the EPOC review group methods and approaches to reduce bias in development and implementation of the review protocol.

Despite these differences, our finding that there are very few rigorous studies of the effectiveness of birth and death notification via mobile devices agrees with that of the earlier review. In addition, a qualitative evidence synthesis of healthcare workers’ perceptions and experience of using mHealth technologies for delivering primary healthcare services has now been published (Odendaal 2020). The findings of this synthesis complement those of this review and contributed to the Implications for practice section.

Figure 1

Linkage between CRVS and health system
Adapted fromSetel 2007and World Bank and World Health Organization 2014 (World Bank 2014).

Figure 2

Study flow diagram.

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Summary of findings 1. Primary objective: Summary of findings

Coverage of birth notification
Birth notification via mobile device compared to standard practice
Patient or population: Health Care Workers (HCWs), Village Health Volunteers (VHVs), newborn children Setting: Lao People’s Democratic Republic Intervention: Provision of mobile phone and credit to HCWs and VHVs to facilitate birth notification Comparison: Standard practice, i.e. no provision of mobile phone or credit to HCWs and VHVs to facilitate birth notification
Outcomes	Birth notification via mobile phone versus standard practice	No of Participants (studies)	Certainty of the evidence (GRADE)	What happens?
Proportion of VHVs who reported notifying a HCW about deliveries or births using mobile phones (post‐intervention comparison)	12% more VHVs in the intervention group reported notifying a HCW using mobile phones compared to the comparison group	101 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4	We are uncertain of the effect of the intervention on coverage of birth notification because the certainty of the evidence is very low.
Proportion of HCWs who reported receiving a notification from VHV about deliveries or birth using mobile phones (post‐intervention comparison)	38% more HCWs in the intervention group reported receiving a notification using mobile phones compared to the comparison group	30 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4
Timeliness of birth notification
Proportion of VHVs who reported notifying HCWs either during labour or within 1 day of birth using mobile phones	18% moreVHVs in the intervention group reported notifying HCWs of imminent deliveries within 1 day of birth via mobile phones compared to the comparison group	101 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4	We are uncertain of the effect of the intervention on the timeliness of birth notification because the certainty of the evidence is very low.
Proportion of HCWs who reported receiving a notification from VHV about imminent deliveries or within 1 day of birth using mobile phones	15% moreHCWs in the intervention group reported being notified by VHVs of imminent deliveries within 1 day of birth via mobile phones compared to the comparison group	30 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4
Proportion and timeliness of legal birth registrations
No studies were identified that reported on this outcome.
Coverage of newborn or child health services
Proportion of births where HCW made postnatal care visit to home	There were 10% more postnatal care home visits by HCW in the intervention group compared to the comparison group.	1339 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4	We are uncertain of the effect of the intervention on coverage of newborn or child health services because the certainty of the evidence is very low
Proportion of births for which Hepatitis B birth dose vaccination was provided within 30 days	There were 23% more children who received the Hepatitis B birth dose vaccination within 30 days of birth in the intervention group compared to the comparison group	1525 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4
Timeliness of newborn or child health services
Proportion of births where Hepatitis B birth dose vaccination was administered within 0‐1 day	There was a 0% change in the number of newborns receiving Hepatitis B birth dose vaccination within the first day after birth in the intervention group compared to comparison group.	1525 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4	We are uncertain of the effect of the intervention on timeliness of newborn or child health services because the certainty of the evidence is very low
Proportion of births where Hepatitis B birth dose vaccination was administered within 2‐7 days	5% fewer children received Hepatitis B birth dose vaccination between days 2 and 7 in the intervention group compared to the comparison group.	1525 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4
Proportion of births where the HCW made a postnatal care home visit within 24 hours of notification	18% fewer children received a postnatal care visit at least 50% of the time by the HCW in the intervention group within 24 hours of birth compared to the comparison group.	30 (1 CBA)¹	⊕⊝⊝⊝ VERY LOW^2,3,4
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio; CBA: Controlled Before‐After study; VHV: Village Health Volunteer; HCW: Health Care Worker
GRADE Working Group grades of evidence High = This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different^† is low. Moderate = This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different^† is moderate. Low = This research provides some indication of the likely effect. However, the likelihood that it will be substantially different^† is high. Very low = This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different^† is very high. ^† Substantially different = a large enough difference that it might affect a decision
¹Xeuatvongsa 2016 Explanations for certainty rating: ² Initial rating of low certainty assigned due to non‐randomised study design, resulting in high or unclear risk of bias ³ The initial rating was downgraded one level to very low certainty for outcomes related to the coverage and timeliness of birth notification due to small sample sizes and small numbers of events. ⁴ The initial rating was downgraded one level to very low certainty for outcomes related to the coverage and timeliness of post‐notification health services due to concerns related to indirectness. It is unclear how many of the post‐notification service events were directly in response to the notification. Abbreviations: VHV, Village Heath Volunteer; HCW, Health Care Worker.

Summary of findings 1. Primary objective: Summary of findings

Summary of findings 2. Secondary objectives: Summary of qualitative findings

Summary of review finding		Studies contributing to the review finding	Overall GRADE‐CERQual assessment of confidence in the evidence	Explanation for assessment
A. Health system constraints in the implementation of birth and death notification via mobile devices
A.1	Geographic barriers hamper timeliness of birth and death notification conducted via mobile devices, as well as post‐notification services or processes (e.g. certification of birth or death).	Xeuatvongsa 2016; ANISA 2016; Pascoe 2012; MOVE‐IT 2013; Ngabo 2012; MBRT 2016, mVRS 2017	Moderate confidence	Serious concerns related to methodological limitations. Few or no concerns related to coherence, relevance and adequacy
A.2	Birth and death data collected using mobile devices can help health and civil registration systems identify problems and introduce appropriate quality improvements.	Moshabela 2015; MBRT 2016; RapidSMS 2012; MVH 2017; NIMDS 2019	Low confidence	Serious concerns related to methodological limitations and adequacy. Few or no concerns with coherence and relevance
A.3	Health workers who lack familiarity with, or prior experience in, using mobile technologies may need rigorous training as well as post‐training support.	Andreatta 2011; Gisore 2012; Ngabo 2012; mSIMU 2017; Yugi 2016 mTika 2016; Xeuatvongsa 2016; MBRT 2016; Van Dam 2015; MBRL 2011; MOVE‐IT 2013; NIMDS 2019	Moderate confidence	Moderate concerns related to methodological limitations. Few or no concerns related to coherence, relevance, and adequacy
A.4	Local capacity to train future cadres of notifiers may be strengthened though 'train the trainer' approaches.	Ngabo 2012; MBRL 2011	Low confidence	Serious concerns related to methodological limitations and adequacy. Few or no concerns with coherence and relevance
A.5	Mechanisms for continuous monitoring and supportive supervision are important for ensuring the quality and timeliness of birth and death data collected via mobile devices.	Andreatta 2011; mTika 2016; Ngabo 2012; MOVE‐IT 2013; Yugi 2016; Pascoe 2012	Moderate confidence	Moderate concerns related to methodological limitations and adequacy. Few or no concerns with coherence and relevance
A.6	Inadequate attention is paid to legal frameworks governing civil registration. These may need to be modified to allow notification via mobile device and the inclusion of new cadres of notifiers (low confidence finding).	eCRVS‐Mozambique 2017; mVRS 2017; MBRP 2015	Low confidence	Serious concerns related to methodological limitations and adequacy. Few or no concerns with coherence and relevance
A.7	The availability of adequate human resources to conduct birth and death notification via mobile devices may be facilitated by hiring new cadres of notifiers or recruiting existing cadres of health workers to undertake notification.	Andreatta 2011; MBRL 2011; Gisore 2012; Pascoe 2012; MOVE‐IT 2013; Xeuatvongsa 2016; Yugi 2016; ANISA 2016; mVRS 2017; eCRVS‐Mozambique 2017; MBRT 2016	Moderate confidence	Serious concerns related to methodological limitations. Few or no concerns with coherence, relevance, and adequacy
A.8	Implementing birth and death notification via mobile devices may be influenced by underlying health and civil registration system infrastructure, resources, and processes.	Ngabo 2012; MBRL 2011; MOVE‐IT 2013; Moshabela 2015; ANISA 2016; mVRS 2017; Gisore 2012;MVH 2017	Low confidence	Serious concerns related to methodological limitations. Minor concerns related to adequacy. Few or no concerns with coherence, and relevance
B. Factors related to individuals providing birth and death notification via mobile devices
B.1	Costs incurred by health workers sending notification using personal mobile phones may need to be reimbursed to facilitate sustained use of these technologies for notification.	Ngabo 2012; Pascoe 2012; mSIMU 2017; Yugi 2016; Xeuatvongsa 2016; Gisore 2012	Moderate confidence	Moderate concerns related to methodological limitations and adequacy. Few or no concerns related to coherence or relevance
B.2	The use of mobile phones for notification is acceptable to health workers, and helps them to undertake their job responsibilities.	Ngabo 2012; Pascoe 2012; mSIMU 2017, Van Dam 2015; Yugi 2016; NIMDS 2019	Moderate confidence	Moderate concerns related to methodological limitations and adequacy. Few or no concerns related to coherence and relevance
B.3	Health workers’ adoption of mobile birth and death notification strategies may be affected by competing priorities and the availability of adequate incentives.	MOVE‐IT 2013; mSIMU 2017; mTika 2016; MVH 2017	Moderate confidence	Minor concerns related to methodological limitations. Serious concerns related to adequacy. Few or no concerns related to coherence and relevance
C. Factors related to families for whom birth and death is notified via mobile devices
C.1	For some families, costs may be a barrier to completing birth and death registration post‐notification.	MOVE‐IT 2013, MBRP 2015, MBRT 2016	Low confidence	Serious concerns related to methodological limitations and adequacy. Few or no concerns related to coherence, relevance, and adequacy
C.2	There may be a need for targeted demand generation activities in communities with low awareness of the need of birth and death registration, alongside the use of mobile phones for birth and death notification.	MOVE‐IT 2013; MBRG 2014; mVRS 2017; MBRT 2016;	Low confidence	Serious concerns related to methodological limitations. Moderate concerns related to adequacy. Few or no concerns related to coherence and relevance
C.3.	Sociocultural norms may influence the timely identification of births and deaths, and should be taken into consideration when developing mobile phone interventions for notification.	MOVE‐IT 2013; MBRG 2014; MBRP 2015; ANISA 2016	Low confidence	Serious concerns related to methodological limitations and adequacy. Few or no concerns related to coherence and relevance
C.4	Birth and death notification may increase access to these services for some families. However, they may also increase inequities in access related to low availability of supportive infrastructure (network coverage, roads, human resources), human factors (age, gender, literacy, poverty), and selective funding priorities of donors.	Gisore 2012; MBRP 2015; MBRT 2016; Andreatta 2011; Ngabo 2012; MOVE‐IT 2013; mSIMU 2017; mTika 2016; Yugi 2016; Xeuatvongsa 2016; mVRS 2017	Moderate confidence	Serious concerns related to methodological limitations. Few or no concerns related to coherence, relevance, and adequacy
D. Factors related to government involvement in birth and death notification via mobile devices
D.1	Strong government commitment is a key factor in the successful implementation of birth and death notification via mobile devices.	MBRL 2011; Ngabo 2012; Yugi 2016; mVRS 2017; eCRVS‐Mozambique 2017; MBRT 2016; MBRP 2015	Low confidence	Serious concerns related to methodological limitations. Moderate concerns related to adequacy. Few or no concerns related to coherence or relevance
E. Factors related to technologies used for birth and death notification via mobile devices
E.1	Cost is an important consideration in the purchase, set‐up, and scaling up of mobile technologies needed for birth and death notification.	Ngabo 2012; Xeuatvongsa 2016; Gisore 2012; mTika 2016; Pascoe 2012; Van Dam 2015; Yugi 2016; mVRS 2017	Low confidence	Serious concerns related to methodological concerns. Moderate concerns related to adequacy. Few or no concerns related to coherence and relevance
E.2	Challenges when notifying births and deaths via mobile devices include poor access to electricity and incompatibility with existing systems.	Ngabo 2012; MBRL 2011; Pascoe 2012; Gisore 2012; MBRP 2015; MBRT 2016	Low confidence	Serious concerns related to methodological concerns. Moderate concerns related to adequacy. Few or no concerns related to coherence and relevance
E.3	The availability of network connectivity is a key factor in the successful implementation and scale‐up of birth and death notification via mobile devices.	Ngabo 2012; Pascoe 2012; Yugi 2016; ANISA 2016; mSIMU 2017; mVRS 2017; MBRT 2016,	Moderate confidence	Serious concerns related to methodological limitations. Few or no concerns with coherence, relevance, and adequacy
E.4	Data security and encryption measures are needed to preserve confidentiality of birth and death information notified via mobile devices.	Van Dam 2015; MBRT 2016; Ngabo 2012; MVH 2017	Low confidence	Serious concerns with methodological limitations and adequacy. Few or no concerns with coherence and relevance

Summary of findings 2. Secondary objectives: Summary of qualitative findings

Table 1. Risk of bias in the included study for the primary objective (Xeuatvongsa 2016)

Bias	Authors' judgement^a	Support for judgement
Random sequence generation (selection bias)	High risk	Not a randomised controlled trial
Allocation concealment (selection bias)	High risk	Not a randomised controlled trial
Differences in baseline characteristics (selection bias)	High risk	(pg 5779) Participants different at baseline between intervention and control groups with respect to religion, ethnicity, maternal education, and HepB‐birth dose receipt
Baseline outcome measurements similar (selection bias)	Low risk	Similar outcomes measured at baseline
Blinding of participants and personnel (performance bias)	High risk	Blinding not possible
Blinding of outcome assessment (detection bias)	Unclear risk	Not reported
Incomplete outcome data (attrition bias)	High risk	Certain villages excluded due to lack of cold chain, large proportion of villages not visited. No details on the number of births registered, timeliness, only survey results from small proportion of HCWs
Selective reporting (reporting bias)	Unclear risk	Study protocol not available
Protection against contamination	High risk	Health workers in intervention and control groups using mobile phones
Other bias	Low risk	No other bias
^aJudgement specifies whether there is a low, unclear, or high risk of bias.

Table 1. Risk of bias in the included study for the primary objective (Xeuatvongsa 2016)

Table 2. Methodological limitations of the included studies for the secondary objectives a

Study ID

Clearly stated aim, objective or purpose?

Clear description of the source of the information (transparency)?

Clear description of the programme,intervention, policy or reform?

Clear description of the context/s?

Is the information accurate?

Is the evidence representative?

Any limitations of the information and/or methods discussed?

Is evidence provided to support any findings or conclusions made?

Relevant rights and ethics considerations described (empirical studies only)

Interests declared and any potential conflicts of interest noted?

Overall assessment^b

Explanation of WEIRD assessment

Yes

Unclear ‐ limited details on context presented

Unclear ‐ some details of data analysis not presented

Unclear ‐ small sample size

Yes

Unclear ‐ limited evidence to support implementation outcomes

Yes

Yes ‐ authors have no conflicts to declare

Minor limitations

Concerns about details of the context, accuracy, representativeness of evidence, and evidence to support findings and conclusions made.

Yes

Unclear ‐ only some sub‐assessment criteria described

Unclear ‐ insufficient information to assess accuracy

Unclear ‐ insufficient information to assess representativeness

Unclear ‐ insufficient information to assess limitations

Unclear ‐ insufficient details on evidence to support findings.

Yes

Yes ‐ authors have no conflicts to declare

Minor limitations

Concerns about description of source information, context, accuracy of information, representativeness, limitations, and evidence to support conclusions.

Unclear ‐ stated aim does not include assessment of implementation factors

No ‐ No description of source of information

Yes

Unclear ‐ Source material does not describe efforts to ensure that the information is complete and accurate

Yes

No ‐ not a study

Not applicable

Significant/major limitations

Yes

Yes ‐ authors have no conflicts to declare

No or few limitations

Unclear ‐ Stated aim does not include assessment of implementation factors.

Unclear ‐ some sources are referenced but others potentially missed

Unclear ‐ only some sub‐assessment criteria described

Unclear ‐ Source material does not describe efforts to ensure that the information is complete and accurate

No ‐ not a study

No ‐ not described

No ‐ describes implementation but there is no associated evidence or empirical study

Not applicable

Significant/major limitations

Yes

Unclear ‐ Source material does not describe efforts to ensure that the information is complete and accurate

Yes

No ‐ not described

No‐not described

Significant/major limitations

Concerns about accuracy of evidence, ethical considerations, and reporting of conflicts of interest

Unclear ‐ Stated aim does not include the assessment of implementation factors

No ‐ not described

Yes

Unclear ‐ Source material does not describe efforts to ensure that the information is complete and accurate

No ‐ not an empirical study

Unclear ‐ some limitations described but others potentially missed.

No ‐ describes implementation but there is no associated evidence or empirical study

Not applicable

Significant/major limitations

Yes ‐ Purpose of the source material is not stated but can be derived as follows: To describe the implementation of a mobile birth registration programme in Tanzania

No ‐ Some quotes presented but no description of the source of information

Yes

Unclear ‐ Source material does not describe efforts to ensure that the information is complete and accurate

No ‐ not an empirical study

Unclear ‐ Lessons learned are presented but not phrased as limitations

No ‐ describes implementation but there is no associated evidence or empirical study

Not applicable

Significant/major limitations

Concerns about accuracy of evidence, its representativeness, and description of study limitations

Yes

Unclear ‐ small sample size

Yes

Not applicable

Yes ‐ authors have no conflicts to declare

Minor limitations

Concerns about representativeness of evidence

Yes

Unclear ‐ sources of lessons learned not described

Yes

Unclear ‐ sources of lessons learned not described

Not applicable

Unclear ‐ funding source described but no other conflicts declared.

Minor limitations

Concerns about description of source of information, representativeness of evidence, limitations, declarations of conflict of interest, and evidence related to findings

Yes

Unclear ‐ not described

Unclear ‐ funding source listed but no conflict of interest statement available

Minor limitations

Lack of information on ethical considerations and conflict of interest declaration

Yes

Unclear ‐ Details of the qualitative data analysis are sparse

Yes

Unclear ‐ Limitations of qualitative interviews not discussed

Unclear ‐ No quotes or underlying evidence presented for qualitative interviews

Yes

Yes ‐ authors have no conflict of interest to declare

Minor limitations

Concerns about accuracy of the evidence, evidence to support findings and description of study limitations.

Yes

Unclear ‐ not described

Yes ‐ authors have no conflicts to declare

No or few limitations

Yes

Unclear ‐ insufficient information to assess whether ethical approval was necessary in the study settings.

No or few limitations

Yes

Unclear ‐ only some sub‐assessment criteria described

Yes

Not applicable

Yes ‐ authors have no conflicts to declare

No or few limitations

Yes

No‐Not described

Yes ‐ authors have no conflicts to declare

No or few limitations

Yes

Unclear ‐ only some sub‐assessment criteria described

Unclear ‐ small sample size

Yes

No ‐ not described

Significant/major limitations

Concerns about accuracy of evidence, small sample size, lack of conflict of interest disclosure and ethical considerations

Yes ‐ Purpose of the source material is not stated but can be derived as follows: To describe the implementation of the RapidSMS programme for birth registration in Nigeria

No ‐ not described

Unclear ‐ Source material does not describe efforts to ensure that the information is complete and accurate

Unclear ‐ The description is not based on a sampling approach and there is no rationale or description of how generalizations to wider populations or settings were made.

No ‐ Not described

No ‐ not described

Not applicable

Significant/major limitations

Concerns about the descriptions of transparency, methods, accuracy of evidence, study limitations presented in the source materials

Yes

Unclear ‐ only some sub‐assessment criteria described

Yes

Unclear ‐ small sample size

Yes

Not applicable

Yes ‐ author affiliations which may be perceived as conflict of interest are disclosed

Minor limitations

Concerns about description of context, accuracy of information, and representativeness of evidence

Yes

Unclear ‐ small sample size

Yes

Yes ‐ authors have no conflicts to declare

Minor limitations

Concerns about representativeness of evidence

Yes

Unclear ‐ small sample size

Yes

Not applicable

Yes ‐ authors have no conflicts to declare

Minor limitations

Concerns about description of source of information, representativeness and evidence related to findings

^aDetails of the WEIRD tool assessment criteria and prompts are available in Appendix 3.

Table 2. Methodological limitations of the included studies for the secondary objectives a

Table 3. Strategies used to implement birth and death notification via mobile devices

Study + setting

Notifier

Description of strategy

Tanzania (Mbeya and Mwanza regions)

Health workers in government clinics

Birth notification:

Health workers enter birth information using a mobile phone, either via a smartphone app interface or via SMS prompts on a basic phone.
Data are transferred via an SMS protocol to a central database in the Registration, Insolvency and Trusteeship agency (RITA)
Once the server at RITA returns a confirmation that the birth information is received, a birth certificate for the child is issued on the spot.

Pakistan (Panjab and Sindh provinces)

Community 'gatekeepers' (marriage registrars, lady health workers, and Telenor (telecom) agents)

Birth notification:

Gatekeepers enter birth information using an android app, and capture images of any supporting documents using the phone’s camera.
Data are transferred via internet or mobile USB to the Union Council (UC) secretary, who is responsible for civil registration records for residents of the union.
The UC secretary checks details of information received on a tablet device and creates a unique birth record in the paper‐based UC register and the National Database and Registration Authority (NADRA) database.
A confirmation SMS is sent upon registration to the parents.
Birth certificate is issued after completion of formalities at the UC.

Ghana

Community volunteers

Birth and death notification:

Community volunteers use android app to collect child’s details (name, gender, date of birth, other family details), and send data to a central database managed by the Ghana Births and Deaths Registry.
Data are stored and an automated response is sent to the Births and Deaths Registry official in the field to issue a certificate for the child.

Kenya (Nyanza province)

Village reporters working with the Health and Demographic Surveillance System (HDSS) programme

Birth notification:

Village reporters send birth notification via SMS to Rapid‐SMS server.
Server notifies field‐based community workers to screen and enrol infants in m‐SIMU study.

Kenya (Western Province)

Village Elders; registry administrator

Birth and death notification:

Village elders use mobile phones to notify registry administrator of birth outcomes (including stillbirths and early neonatal deaths), and birth weight within 7 days post‐delivery.
Village elder and registry administrator determine modality of mobile phone communication.

Zambia (Lusaka)

Health workers

Death notification:

Health workers used the eRegister system created using CommCare and deployed on Samsung Galaxy 2 tablet devices to enter information related to date and cause of death for Rheumatic Heart Disease patients.

Pakistan (Matiari district) and India

Families of pregnant women, Lady Health Workers (LHWs), Traditional Birth attendants (TBAs), or residents of the village with mobile phone access

Birth notification:

Prepaid phone cards worth 100 Pakistani Rupees provided to families of pregnant women, LHWs, and TBAs for birth notification.
In areas with no LHWs/TBAs, residents of the village reimbursed for phone calls to study staff for notifying births.

Bangladesh

Mothers

Birth notification:

During pregnancy, mothers receive unique code and instructions on sending SMS with birth details to the mTika server.

Lao People’s Democratic Republic (Luang and Xayabuly provinces)

Village Health Workers (VHVs); Health Care Workers (HCWs)

Birth notification:

VHVs and HCWs in intervention areas provided with mobile phones and airtime.
VHVs notify HCWs of imminent deliveries and new births to trigger postnatal care home visits and HepB birth dose vaccination by HCWs.

Tanzania (Pwani region)

Health workers

Death notification:

Health workers use the District Health Information System2 (DHIS2) mobile app for weekly reporting of cases and deaths per the WHO Integrated Disease Surveillance and Response (ISDR) strategy.

South Sudan (Eastern Equatoria state)

Health facility staff, county Health Department staff

Death notification:

Health facility staff use personal phones to send SMS to a county health department Android phone for weekly reporting of cases and deaths as per the WHO Integrated Disease Surveillance and Response (ISDR) strategy.
Data from the Android phone are submitted to the national Data Health Information System (DHIS) via an interface that decodes the SMS data.

Ghana (Sene district)

Birth attendants

Death notification:

For each delivery attended, birth attendants use a predefined SMS protocol to send data on maternal demographics, post‐partum haemorrhage status, maternal death outcome, neonatal death outcome, and prenatal service delivery statistics.
The SMS is sent to a central study phone, and the data are later transferred to a database.

Rwanda (Northern province)

Community Health Workers

Birth and death notification:

CHWs use RapidSMS system to report pregnancy outcomes including maternal and child deaths.

Senegal (Northwest)

Community Health Workers

Birth and death notification:

CHWs use Childcare+ to report births and cases of deaths of children under five, and women ages 12‐49 years.

Tanzania (Rufiji district)

Village Executive Officers (VEOs)

Birth and death notification:

VEOs record birth or death information in facility registers and use mobile phones to send the information as a structured SMS to a central database linked to the district civil registry.
VEOs provide copy of notification form to household members.
Household members visit the District Civil Registrar’s office to complete birth or death registration, pay the fee, and collect the birth or death certificate.

Mozambique

Village chiefs

Birth and death notification:

Village chiefs use USSD via mobile phone to notify the national e‐civil registration and vital statistics system regarding births or child deaths in their village.
In response to the notification, the village chief receives a personal number (single citizen’s identification number) for the child.
Families receive SMS when the birth or death certificate is ready.

Liberia (Bomi county)

Health workers

Birth notification:

Health workers use the Nokia Data Gathering software to enter data related to births and send to a centralised server.

Uganda

Village chiefs

Birth notification:

Birth notification is issued by the hospital administration or community notifier via mobile phone (USSD) to the Mobile Vital Registration System (mVRS).
Upon online verification by the National Identification and Registration Authority (NIRA), the notifier is able to print, sign and issue the notification to parents or other family members.

Syria, Turkey

Staff at all Turkey health cluster organisations (internal partners)

Death notification:

An internal or external partner posts information to a 293‐member WhatsApp group.
Members with physically verified information (via site visit or presence during incident) complete anonymous and confidential online alert form.
Form includes location, attack type, facility type, extent of damage, who is affected, injuries and deaths.
Triangulated, key data (location, type of service, modality of attack, deaths, and casualties) from forms distributed within 24 hours to all partners and donors.

Nigeria

Registrars

Birth notification:

Registrars with unique identification numbers send birth information using SMS to the RapidSMS server.

Pakistan (Punjab district)

Lady Health Supervisors (LHSs)

Death notification:

Neonatal Infant and Maternal Deaths E‐surveillance System (NIMDS)
Lady Health Workers (LHWs) and community midwives (CMWs) report neonatal, infant, or maternal deaths that have occurred by informing the respective Lady Health Supervisors (LHSs).
LHS confirms death and sends a SMS with complete neonatal, infant, or maternal death string to the system from her registered mobile number.
If the SMS reporting format is correct, then the system sends an auto confirmation message with a unique Case Number of that death.
If the SMS reporting format is incorrect, the system generates an error message with an auto reply to the sender about the specific error string.

Table 3. Strategies used to implement birth and death notification via mobile devices