Efficacy of text-message reminders on paediatric malaria treatment adherence and their post-treatment return to health facilities in Kenya: a randomized controlled trial

Ambrose O Talisuna,Amos Oburu,Sophie Githinji,Robert W Snow,Beatrice Amboko,Dejan Zurovac,Philip Bejon,Josephine Malinga,Caroline Jones

doi:10.1186/s12936-017-1702-6

Ambrose O Talisuna, Amos Oburu + Show 7 more

Open Access

https://doi.org/10.1186/s12936-017-1702-6

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Abstract

BackgroundShort Message Service (SMS) reminders have been suggested as a potential intervention for improving adherence to medications and health facility attendance.MethodsAn open-label, randomized, controlled trial to test the efficacy of automated SMS reminders in improving adherence to artemether–lumefantrine (AL) and post-treatment attendance in comparison with standard care was conducted at four health facilities in western Kenya. Children below five years of age with uncomplicated malaria were randomized to intervention (SMS reminders) or control groups. Within each study group they were further randomized to three categories, which determined the timing of home visits to measure adherence to complete AL course and to individual AL doses. A sub-set of caregivers was advised to return to the facility on day 3 and all were advised to return after 28 days. The primary outcomes were adherence to medication and return on day 3. The primary analysis was by intention-to-treat.ResultsBetween 9 June, 2014 and 26 February, 2016, 1677 children were enrolled. Of 562 children visited at home on day 3, all AL doses were completed for 97.6% (282/289) of children in the control and 97.8% (267/273) in the intervention group (OR = 1.10; 95% CI = 0.37–3.33; p = 0.860). When correct timing in taking each dose was considered a criteria for adherence, 72.3% (209/289) were adherent in the control and 69.2% (189/273) in the intervention group (OR = 0.82; 95% CI = 0.56–1.19; p = 0.302). Sending SMS reminders significantly increased odds of children returning to the facility on day 3 (81.4 vs 74.0%; OR = 1.55; 95% CI = 1.15–2.08; p = 0.004) and on day 28 (63.4 vs 52.5%; OR = 1.58; 95% CI = 1.30–1.92; p < 0.001).ConclusionsIn this efficacy trial, SMS reminders increased post-treatment return to the health facility, but had no effect on AL adherence which was high in both control and intervention groups. Further effectiveness studies under the real world conditions are needed to determine the optimum role of SMS reminders.Trial registration ISRCTN39512726

Highlights

Short Message Service (SMS) reminders have been suggested as a potential intervention for improving adherence to medications and health facility attendance
Analyses of the post-treatment return included all of the 1677 enrolled children, and for adherence measurements excluded 118 (7.0%) patients who were not found at home during the scheduled visits and 54 patients (3.7%) where visits were made but data on adherence were missing
The ITT analysis showed that 97.7% of patients completed all AL doses: 97.6% (282/289) in the control and 97.8% (267/273) in the intervention group (OR = 1.10; 95% CI = 0.37–3.33; p = 0.860)

Summary

Introduction

Short Message Service (SMS) reminders have been suggested as a potential intervention for improving adherence to medications and health facility attendance. In other trials, SMS reminders were not effective in improving adherence to antiretroviral therapy or voluntary male circumcision [14, 15]. SMS reminders sent to either health workers or malaria patients and their caregivers have been suggested as a potential intervention [16,17,18] to improve sub-optimal caregivers’ adherence to artemisinin-based combination therapy (ACT) [19, 20] and poor outpatient attendance rates for follow-up [21]. Two trials, showing discrepant results, tested effects of SMS reminders on patients’ adherence to ACT [22, 23]

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