News Release

Text messaging improves management of malaria treatment by health workers

Peer-Reviewed Publication

The Lancet_DELETED

Sending daily text-message reminders to health workers can improve the number of children with malaria being correctly treated by nearly 25% over a six-month period, according to the first study to examine the use of text messaging on health workers' behaviour. The findings of the trial in Kenya, published Online First in The Lancet, also indicate that this intervention is cheap and would be easy to scale-up nationally.

In Africa, the prescription of antimalarial treatment by health workers according to national guidelines is vital to ensure patient adherence to medication and treatment success. However, research has shown that compliance with treatment guidelines remains low despite the introduction of many interventions to change clinical practice.

Text messaging is increasingly being used to promote health and to prevent disease. Like much of the developing world, mobile phone use in Kenya is widespread with 22 million mobile phone subscribers, and 86% of the population with access to mobile network coverage.

Dejan Zurovac from the Kenya Medical Research Institute–Wellcome Trust Research Programme, Nairobi, Kenya and colleagues assessed whether receiving daily text-message reminders to adhere to national malaria treatment guidelines could improve health-worker performance.

Between March 2009 and May 2010, 119 health workers were enrolled from 107 rural health facilities across Kenya and randomly assigned to receive text-message reminders or not. The text messages consisted of two components, recommendations about paediatric malaria-case management from Kenyan national guidelines and training manuals, and a motivational quote. The case-management practices of 2269 children who received malaria artemisinin combination therapies (ACTs) were assessed (1157 in the intervention group and 1112 in the control group).

Text-message reminders improved correct ACT management by 23.7% immediately after the intervention and by 24.5% 6 months later.

Importantly, text messaging had a substantial effect on the proportion of patients who received their first dose of ACT at a health facility and on those counselled on how to take the rest of their course, which was likely to have resulted in more patients following their treatment regimen.

The authors say: "Our intervention provided large and sustained improvements in the quality of care given to children with malaria, but resulted in only about half the children being correctly managed. Therefore, we recommend that text-message reminders should be used to complement existing interventions."

Bob Snow, who heads the group in Nairobi, concludes: "The simplicity and low cost of text messaging means that widespread implementation of an intervention that uses this technology can be done quickly and successfully…The cost of a text message in Kenya is about US$0.01, resulting in the cost of full exposure to our intervention of $2.6 per health worker, or $39 000 if scaled up to an estimated 15 000 health workers in all rural facilities nationwide."

In a Comment, Bruno Moonen and Justin Cohen from the Clinton Health Access Initiative, Nairobi, Kenya point out: "A combination of interventions will most likely be needed to improve adherence to national guidelines to acceptable levels. Zurovac and colleagues provide strong evidence that text-message reminders can be an effective, low-cost component of such a package; rigorous assessment of how additional interventions—both traditional and innovative—can be combined with these efforts will be needed to achieve maximum effect and ensure that donors are aware of the value of continued investment in such strategies."

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Professor Bob Snow, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya. T) +254 722 523 323 E) rsnow@nairobi.kemri-wellcome.org

Dr Bruno Moonen, Clinton Health Access Initiative, Nairobi, Kenya. T) + 254 733 331119 E) bmoonen@clintonhealthaccess.org


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