4 august 2011

Text messages can improve treatment of malaria in Africa

Source: Wellcome Trust


SMS messaging in Africa can boost malaria treatment
Texts sent to health worker’s mobiles could boost malaria treatment in Africa.

Text message reminders sent to healthcare workers in rural Africa lead to more patients receiving accurate antimalarial treatment, a study led by Oxford University researchers has found.

The approach could improve the implementation of national guidelines for treating malaria, they report in the Lancet medical journal.

Health workers in Africa are vital in making sure that patients stick to and correctly complete malaria treatment doses. So researchers based in Nairobi, Kenya at the KEMRI-Wellcome Trust Research Programme carried out a randomised controlled trial looking at the impact of sending text messages to health workers’ personal mobile phones to encourage them to stick to treatment guidelines.

Their study showed a 25% improvement in health workers’ practices in providing correct care to patients with malaria.

For five working days, two text messages (one at 09:00 and one at 14:00) were sent daily to every health worker’s mobile phone. The same process was repeated every week for six months.

This trial has shown that a simple intervention like SMS can improve health workers' adherence to malaria treatment guidelines by 25%.

Dr Dejan Zurovac

Most randomised controlled trials from high-income countries have focused on reminders to improve patients’ adherence to treatment, and all studies assessed only short-term effects of the intervention. This is believed to be the first study to assess the use of text messaging to target health workers.

Dr Dejan Zurovac of the Centre for Tropical Medicine at Oxford University and lead author of the study says: ‘This trial, the first one using text-messaging to target health workers' behaviour in developing countries, has shown that a simple intervention like SMS can improve health workers' adherence to malaria treatment guidelines by 25%.

‘Text-messaging should complement traditional approaches to support clinical management such as in-service training of health workers, supportive supervision, or dissemination of job-aids.’

Dr Zurovac and colleagues believe the scheme may have been successful because text messages address health workers’ forgetfulness; emphasise the clinical importance of doing tasks described in the messages; and increase the priority of doing the tasks because the text messages represent the voice of authority of the health workers’ employer (the Ministry of Health).

The simplicity and low cost of texts means that widespread implementation of an intervention that uses this technology can be done quickly and successfully.

Professor Bob Snow of Oxford University, who heads the research group in Nairobi, says: ‘The role of the mobile phone in improving health providers' performance, health service management and patient adherence to new medicines across much of Africa has a huge potential to engage and promote health to many people, who despite being poor and often inaccessible nevertheless have access to cell phone communication.’

Co-author and head of the Kenyan Department of Disease Prevention and Control, Ministry of Public Health and Sanitation, Dr Willis Akhwale added: ‘This is an excellent example of high quality research responding to immediate needs of policy implementers who are continuously searching for simple and low cost solutions to strengthen weak health systems and provide better care for Kenyans. We need to explore ways of scaling up such intervention to all health workers in the country.’