SMS a day keeps malaria at bay

Sending daily SMS reminders to health workers can mean nearly 25% more children are properly treated for malaria, according to the results of a six month trial conducted in Kenya.

Researchers reporting their findings in the Lancet said the technique — where messages are sent urging health workers to check their patients and reminding them how to do it — would be cheap and easy to extend to a national scale with the potential to save many lives and reduce the risk of drug resistance.

Africa accounts for about 90% of the roughly 800 000 malaria deaths every year, mainly among children under five. There are about 240-million cases of the mosquito-borne disease worldwide each year, according to the World Health Organisation, and in Africa malaria kills a child every 45 seconds.

Adherence by health workers to malaria treatment guidelines is vital in making sure patients stick to and complete malaria treatment courses.

If patients fail to do this it can affect their recovery and also increase the likelihood of the malaria parasites developing resistance to the drugs.

But despite the relatively simple guidelines, malaria experts say failure by the health workers to adhere to the guidelines has been widely reported across Africa.

Researchers enrolled 119 health workers from 107 rural health facilities across Kenya and randomly assigned them to receive SMS reminders or not.

The trial ran between March 2009 and May 2010 and SMSes consisted of two components — a reminder about how to assess or manage a potential malaria case based on Kenyan national health guidelines, and a motivational quote.

‘Persistent work triumphs’
One SMS said: “Check ALL sick children <5yrs for any severe signs! Also check for fever, cough, diarrhoea, pallor & any other problem. 'Persistent work triumphs',".

Another example said: “Child has FEVER when complained by mother or child is hot or Temp is >=37·5 – Pls ask mother, touch child & take Temp! ‘Actions speak louder than words’.”

The study showed a 25% improvement in health workers practices in providing the right care to patients with malaria. The SMSes also resulted in a substantial increase in the number of patients who got prompt anti-malarial treatment at the health facility and were correctly advised about how and when to take remaining tablets when they were at home, the researchers said.

“This trial … has shown that a simple intervention like SMS can improve health workers adherence to malaria treatment guidelines by 25%,” said Dejan Zurovac of the Kenya Medical Research Institute-Wellcome Trust Research Programme in Nairobi, who led the study.

SMSing is increasingly being used in healthcare to promote health and help prevent disease. Like much of the developing world, cellphone use in Kenya is widespread with 22-million subscribers, and 86% of the population with access to network coverage.

The research team said the simplicity and low cost of SMSing means it could be scaled up quickly and successfully.

The cost of an SMS in Kenya is about one US cent, they said, which would translate into programme costs of $2.60 per health worker, or $39 000 if used for the estimated 15 000 health workers in all rural facilities across Kenya. – Reuters

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