Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
Lancet. 2011 Aug 27;378(9793):795-803. doi: 10.1016/S0140-6736(11)60783-6. Epub 2011 Aug 3.
Health workers' malaria case-management practices often differ from national guidelines. We assessed whether text-message reminders sent to health workers' mobile phones could improve and maintain their adherence to treatment guidelines for outpatient paediatric malaria in Kenya.
From March 6, 2009, to May 31, 2010, we did a cluster-randomised controlled trial at 107 rural health facilities in 11 districts in coastal and western Kenya. With a computer-generated sequence, health facilities were randomly allocated to either the intervention group, in which all health workers received text messages on their personal mobile phones on malaria case-management for 6 months, or the control group, in which health workers did not receive any text messages. Health workers were not masked to the intervention, although patients were unaware of whether they were in an intervention or control facility. The primary outcome was correct management with artemether-lumefantrine, defined as a dichotomous composite indicator of treatment, dispensing, and counselling tasks concordant with Kenyan national guidelines. The primary analysis was by intention to treat. The trial is registered with Current Controlled Trials, ISRCTN72328636.
119 health workers received the intervention. Case-management practices were assessed for 2269 children who needed treatment (1157 in the intervention group and 1112 in the control group). Intention-to-treat analysis showed that correct artemether-lumefantrine management improved by 23·7 percentage-points (95% CI 7·6-40·0; p=0·004) immediately after intervention and by 24·5 percentage-points (8·1-41·0; p=0·003) 6 months later.
In resource-limited settings, malaria control programmes should consider use of text messaging to improve health workers' case-management practices.
The Wellcome Trust.
卫生工作者的疟疾病例管理实践常常与国家指南不符。我们评估了向卫生工作者的移动电话发送短信提醒是否可以改善和维持他们对肯尼亚门诊儿科疟疾的治疗指南的遵守情况。
2009 年 3 月 6 日至 2010 年 5 月 31 日，我们在肯尼亚沿海和西部的 11 个区的 107 个农村卫生机构进行了一项基于群组的随机对照试验。通过计算机生成的序列，卫生机构被随机分配到干预组或对照组。在干预组中，所有卫生工作者在 6 个月内通过个人手机收到疟疾病例管理的短信提醒，而在对照组中，卫生工作者则不接收任何短信提醒。卫生工作者未对干预措施进行屏蔽，尽管患者并不知道他们所在的卫生机构是否为干预或对照组。主要结局是采用青蒿琥酯-咯萘啶进行正确的治疗管理，定义为符合肯尼亚国家指南的治疗、配药和咨询任务的二项式综合指标。主要分析采用意向治疗。该试验在当前对照试验中注册，ISRCTN72328636。
119 名卫生工作者接受了干预。对需要治疗的 2269 名儿童（干预组 1157 名，对照组 1112 名）进行了病例管理情况评估。意向治疗分析显示，干预后立即，正确的青蒿琥酯-咯萘啶治疗管理改善了 23.7 个百分点（95%CI 7.6-40.0；p=0.004），6 个月后改善了 24.5 个百分点（8.1-41.0；p=0.003）。
在资源有限的环境中，疟疾控制规划应考虑使用短信提醒来改善卫生工作者的病例管理实践。
惠康信托基金会。
