Text message reminders sent to health care workers’
personal mobile phones significantly improved adherence to malaria case
management guidelines, according to new findings published in The Lancet.
“In resource limited settings, malaria control
programs should consider use of text-messaging to improve clinical
practices,” Dejan Zurovac, PhD, of the Kenya Medical Research
Institute-Wellcome Trust Research Programme in Africa, told Infectious
Malaria case-management practices of health care workers
(HCWs) are often different from recommended guidelines, according to background
information in the study. For the cluster-randomized controlled trial, Zurovac
and colleagues used text messaging to remind HCWs to adhere to national
treatment guidelines, and evaluated whether this could improve and maintain
their adherence to guidelines for outpatient cases in children.
Dejan Zurovac, PhD
Between March 2009 and May 2010, 107 health facilities
across coastal and western Kenya were randomly assigned to either the text
message intervention for 6 months or to a control group (no text messages). The
researchers then assessed case management practices among 1,157 children in the
intervention group and 1,112 in the control group.
After the intervention was implemented, text message
reminders improved artemether-lumefantrine management practices by 23.7%
(95%CI, 7.6-40), and by 24.5% (95%CI, 8.1- 41) 6 months after the intervention
Further, the researchers observed an increase in the
proportion of children who received their first dose of artemisinin combo
therapies from a health facility; and an increase in children who were told how
to administer the rest of the treatment course.
In an accompanying editorial, Bruno Moonen, MD
and Justin M. Cohen, PhD, both from the Clinton Health
Access Initiative in Nairobi, Kenya, said that 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.” – by Ashley
For more information:
- Moonen B. Lancet. 2011;doi:10.1016/s0140-6736(11)61089-1.
- Zurovac D. Lancet. 2011;doi:10.1016/S0140-6736(11)60783-6.
Disclosure: This research was funded by The Wellcome Trust.