The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial
Open accessAbstract
Background Health workers' malaria case-management practices often differ from national guidelines. We assessed whether text-message reminders sent to health workers' mobile phones could improve and maintain their adherence to treatment guidelines for outpatient paediatric malaria in Kenya.Methods From March 6, 2009, to May 31, 2010, we did a cluster-randomised controlled trial at 107 rural health facilities in 11 districts in coastal and western Kenya. With a computer-generated sequence, health facilities were randomly allocated to either the intervention group, in which all health workers received text messages on their personal mobile phones on malaria case-management for 6 months, or the control group, in which health workers did not receive any text messages. Health workers were not masked to the intervention, although patients were unaware of whether they were in an intervention or control facility. The primary outcome was correct management with artemether-lumefantrine, defined as a dichotomous composite indicator of treatment, dispensing, and counselling tasks concordant with Kenyan national guidelines. The primary analysis was by intention to treat. The trial is registered with Current Controlled Trials, ISRCTN72328636.Findings 119 health workers received the intervention. Case-management practices were assessed for 2269 children who needed treatment (1157 in the intervention group and 1112 in the control group). Intention-to-treat analysis showed that correct artemether-lumefantrine management improved by 23·7 percentage-points (95% CI 7·6-40·0; p=0·004) immediately after intervention and by 24·5 percentage-points (8·1-41·0; p=0·003) 6 months later.Interpretation In resource-limited settings, malaria control programmes should consider use of text messaging to improve health workers' case-management practices.Funding The Wellcome Trust.
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In a proof-of-concept randomized controlled Kenyan trial, both immediate and 6-month analyses showed improved malaria case management after SMS with drug delivery instructions and a motivational message to rural health facility workers.
“A proof-of-concept randomized controlled Kenyan trial on adherence to malaria treatment guidelines used 10 carefully designed SMSs with drug delivery instructions and an unrelated motivational message to aid rural health facility workers [33]. Both immediate and 6-month analyses showed improved malaria case management.”
In a randomised controlled trial in Kenya, short-term treatment adherence improved by 31.7% (95% CI 15.6-47.8) and long-term treatment adherence improved by 28.6% (95% CI 12.7-44.6).
“Results suggested that, in the short term, treatment adherence improved by 31.7% (95% CI 15.6–47.8) and, in the long term, treatment adherence improved by 28.6% (95% CI 12.7–44.6).”
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Seven randomized controlled trials testing effects of SMS communication on various health outcomes reported positive effects.
“For the seven randomised controlled trials testing effects of SMS communication on various health outcomes had reported positive effects [16, 20, 32, 33, 44–49], while the remaining trial showed no effect of mobile alarm devices on treatment adherence for HIV patients [15].”
From Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya (2017) · cites this paper as [48]
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- Authors
- Zurovac, D., Sudoi, R. K., Akhwale, W. S., Ndiritu, M., Hamer, D. H., Rowe, A. K., & Snow, R. W.
- Affiliations
- Boston University (US)
- Kenya Medical Research Institute (KE)
- Ministry of Health (KE)
- Centers for Disease Control and Prevention (US)
- John Radcliffe Hospital (GB)
- Corresponding author
- Zurovac, Dejan
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2011-08
- Volume
- 378
- Issue
- 9793
- Pages
- 795-803
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC3163847
- OpenAlex
- W2160800204
- Cited by
- 403
- References
- 25
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 30 · 2023: 11 · 2022: 17 · 2021: 30 · 2020: 26 · 2019: 29 · 2018: 25 · 2017: 32 · 2016: 38 · 2015: 30 · 2014: 52 · 2013: 40 · 2012: 23
- FWCI
- 71.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- The Lancet (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- the Wellcome Trust, UK through a project grant to RWS ((grant number 084253))
- the Wellcome Trust as Principal Research Fellow ((grant number 079080))
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
- Keywords
- SMS reminders, mobile phone intervention, malaria treatment guidelines, pediatric malaria, artemether-lumefantrine, malaria case management, health worker education, rural health facilities, Kenya
- MeSH terms
- Artemether, Lumefantrine Drug Combination, Antimalarials, Child, Child, Preschool, Drug Combinations, Ethanolamines, Fluorenes, Health Personnel, Humans, Infant, Kenya, Malaria, Quality Assurance, Health Care, Cluster Analysis, Reminder Systems, Rural Health Services, Guideline Adherence, Artemisinins, Cell Phone
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