According to the first ever study to examine the impact of using text messaging on health workers behavior, results have shown over a six-month period, that sending daily text-message reminders to health workers can improve the number of children with malaria being correctly treated by nearly 25%.

First published online in The Lancet, the results of the trial in Kenya proved that implementation is cheap and would be easy to expand nationally.

According to national guidelines, the prescription of antimalarial treatment by health workers in Africa is crucial to ensure patient adherence to medication and treating them successfully. Unfortunately the research revealed, that compliance with treatment guidelines remains low irrespective of introducing numerous interventions to change clinical practice. The use of text messaging is more and more used for health promotion and prevention of disease.

As many countries in the developing world, the usage of mobile phones is expanding with 86% of Kenya’s population having access to mobile network coverage and 22 million mobile phone subscribers.

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

The study involved enrolling 119 health workers from 107 rural health facilities across Kenya between March 2009 and May 2010 to randomly receive text-message reminders or not. The text messages consisted of two parts. One was a recommendation about pediatric malaria-case management from Kenyan national guidelines and training manuals, the other a motivational quote.

The assessment included the case-management practices of 2,269 children receiving malaria artemisinin combination therapies (ACTs) (1157 in the intervention group and 1112 in the control group).

Immediately after the implementation of text messaging, reminders improved correct ACT management by 23.7% and increased to 24.5% 6 months later. Consequently, text messaging had a substantial effect on the proportion of patients receiving their first dose of ACT at a health facility, and on those counseled on how to take the rest of their course, which was likely to have increased the number of patients following their treatment plan.

The authors commented:

“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, head of the Nairobi group concluded:

“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.”

Bruno Moonen and Justin Cohen from the Clinton Health Access Initiative, Nairobi, Kenya highlighted in a comment:

“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.”

Written by Grace Rattue