Abstract
BackgroundTrials evaluating the impact of mobile phone text-messaging to support management of acute diseases, such as malaria, are urgently needed in Africa. There has been however a concern about the feasibility of interventions that rely on access to mobile phones among caregivers in rural areas. To assess the feasibility and inform development of an intervention to improve adherence to malaria medications and post-treatment review, mobile phone network, access, ownership and use among caregivers in western Kenya was assessed.MethodsA cross-sectional survey based on outpatient exit interviews was undertaken among caregivers of children with malaria at four trial facilities. The main outcomes were proportions of caregivers that have mobile signal at home; have access to mobile phones; are able to read; and use text-messaging. Willingness to receive text-message reminders was also explored. Descriptive analyses were performed.ResultsOf 400 interviewed caregivers, the majority were female (93.5%), mothers of the sick children (87.8%) and able to read (97.3%). Only 1.7% of caregivers were without any education. Nearly all (99.8%) reported access to a mobile signal at home. 93.0% (site range: 89-98%) had access to a mobile phone within their household while 73.8% (site range: 66-78%) possessed a personal phone. Among caregivers with mobile phone access, 93.6% (site range: 85-99%) used the phone to receive text-messages. Despite only 19% having electricity at home nearly all (99.7%) caregivers reported that they would be able to have permanent phone access to receive text-messages in the next 28 days. Willingness to receive text-message reminders was nearly universal (99.7%) with 41.7% of caregivers preferring texts in English, 32.3% in Kiswahili and 26.1% in Dholuo.ConclusionsDespite concerns that the feasibility of text-messaging interventions targeting caregivers may be compromised in rural high malaria risk areas in Kenya, very favourable conditions were found with respect to mobile network, access and ownership of phones, use of text-messaging and minimum literacy levels required for successful intervention delivery. Moreover, there was a high willingness of caregivers to receive text-message reminders. Impact evaluations of carefully tailored text-messaging interventions targeting caregivers of children with malaria are timely and justified.
Highlights
Trials evaluating the impact of mobile phone text-messaging to support management of acute diseases, such as malaria, are urgently needed in Africa
The expansion of mobile network coverage, the rapid growth in mobile phone penetration and decreasing costs of phone services has been seen as an opportunity to overcome communication, infrastructure and human resource weaknesses of health systems in Africa [1,2]
The feasibility, patterns of use and acceptability of using mobile phone text-messaging to improve malaria treatment adherence and post-treatment review was investigated in an area of high malaria risk in Kenya
Summary
Trials evaluating the impact of mobile phone text-messaging to support management of acute diseases, such as malaria, are urgently needed in Africa. Despite growing trends in network and mobile phone coverage across Africa, it has been found that even in the countries with high penetration such as Kenya, the basic technology interventions using low-end mobile phones and text-messaging may be subject to access disparities with respect to geographical area, gender, age, education, literacy, urbanization and poverty [18,19] Such disparities are of concern for malaria control where populations at highest risk of poor outcomes are rural communities with coincidental lower levels of literacy and socioeconomic status
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