Effectiveness of SMS Technology on Timely Community Health Worker Follow-Up for Childhood Malnutrition: A Retrospective Cohort Study in sub-Saharan Africa.

Shohinee Sarma,Heather Cole-Lewis,Seth Ohemeng-Dapaah,Nadi Kaonga,Patricia Namakula,Andrew S Kanter,Bennett Nemser,Joel Negin

doi:10.9745/ghsp-d-16-00290

Abstract

The Millennium Villages Project facilitated technology-based health interventions in rural under-resourced areas of sub-Saharan Africa. Our study examined whether data entry using SMS compared with paper forms by community health workers (CHWs) led to higher proportion of timely follow-up visits for malnutrition screening in under-5 children in Ghana, Rwanda, Senegal, and Uganda. Children under 5 years were screened for malnutrition every 90 days by CHWs using mid-upper arm circumference (MUAC) readings. CHWs used either SMS texts or paper forms to enter MUAC data. Reminder texts were sent at 15 days before follow-up was needed. Chi-square tests assessed proportion of timely follow-up visits within 90 days between SMS and paper groups. Logistic regression analysis was conducted in a step-wise multivariate model. Post-hoc power calculations were conducted to verify strength of associations. SMS data entry was associated with a higher proportion of timely malnutrition follow-up visits compared with paper forms across all sites. The association was strongest with consistent SMS use over consecutive visits. SMS use at the first of 2 consecutive visits was most effective, highlighting the importance of SMS reminder alerts. SMS technology with reminders increased timely CHW malnutrition screening visits for under-5 children in Ghana, Rwanda, Senegal, and Uganda, highlighting the importance of such technology for improving health worker behavior in low-resource settings.

Highlights

Global Health: Science and Practice 2018 | Volume 6 | Number 2Goals (MDGs) to combat extreme poverty by 2015
Child health remains a priority in the post-2015 agenda, as evidenced by the targets included in the Sustainable Development Goals (SDGs) 1, 2, and 3 to end poverty, prevent hunger, and improve health, respectively.[4]
The number of children with mid-upper arm circumference (MUAC) data entries ranged across the study sites from 1,970 in Ghana, to 10,256 in Uganda (Table 2)

Summary

Introduction

Global Health: Science and Practice 2018 | Volume 6 | Number 2Goals (MDGs) to combat extreme poverty by 2015. Global Health: Science and Practice 2018 | Volume 6 | Number 2. Goal No 1 targeted halving the proportion of people suffering from hunger globally[1] and Goal No 4 aimed to cut the global under-5 mortality rate by two-thirds.[2] In 2015, more than 99 million children under 5 years of age remained undernourished, with two-thirds of this number in Asia and one-third in Africa.[3] The pace of progress has not been consistent or equal across regions. Child health remains a priority in the post-2015 agenda, as evidenced by the targets included in the Sustainable Development Goals (SDGs) 1, 2, and 3 to end poverty, prevent hunger, and improve health, respectively.[4]. Our study examined whether data entry using SMS compared with paper forms by community health workers (CHWs) led to higher proportion of timely follow-up visits for malnutrition screening in under-5 children in Ghana, Rwanda, Senegal, and Uganda

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Results

Conclusion