Mobile Phone Short Message Service to Improve Malaria Pharmacoadherence in Zambia.

Abstract

The current malaria treatment in Zambia is more than 97% effective when the regimen is strictly adhered to. However, the mean adherence rate in sub-Saharan Africa is only 38% to 48%. Poor pharmacoadherence remains a significant barrier to malaria control and elimination. The purpose of this study was to determine if adherence rates to a six-dose artemesinin-based combination therapy (ACT) treatment differ between patients who received short message service (SMS) reminders and those who did not. This is the first study of its kind using SMS directly to the patient for ACT adherence in sub-Saharan Africa. An experimental, randomized controlled trial was conducted through a sample of 96 adult malaria patients at Fisenge Clinic in Zambia in 2014. The intervention group received SMS messages to remind them to take their medication according to the prescribed regimen. An electronic pillbox was used to measure pharmacoadherence for both groups, and patients were classified as probably adherent or probably nonadherent. Data were analyzed using chi-square for association between the SMS intervention and pharmacoadherence, and logistic regression was used for predictors of adherence. No significant association was found between SMS reminders and pharmacoadherence (χ(2) = 0.19, df = 1, p = .67). Binary logistic regression indicated that there were no variables associated with adherence (p > .05). SMS reminder messages did not appear to improve pharmacoadherence in malaria medication. The study indicates few implications to nursing practice due to the lack of association between SMS and adherence, but adds to current knowledge.