Mailman School of Public Health, Columbia University, New York, NY, USA. Now with McMaster University, Hamilton, Canada.
Millennium Villages Project, Earth Institute, Columbia University. Now with UNICEF, New York, NY, USA. Now with University of the Western Cape, Cape Town, South Africa.
Glob Health Sci Pract. 2018 Jun 29;6(2):345-355. doi: 10.9745/GHSP-D-16-00290. Print 2018 Jun 27.
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.
千年村项目在撒哈拉以南非洲资源匮乏的农村地区促进了基于技术的卫生干预措施。我们的研究考察了使用短信输入数据与社区卫生工作者（CHW）使用纸质表格相比，是否会导致加纳、卢旺达、塞内加尔和乌干达五岁以下儿童营养不良筛查的及时随访比例更高。
CHW 每 90 天使用上臂中部周长（MUAC）读数对五岁以下儿童进行营养不良筛查。CHW 使用短信或纸质表格输入 MUAC 数据。在需要随访前 15 天发送提醒短信。卡方检验评估了短信和纸质组之间 90 天内及时随访的比例。采用逐步多元模型进行逻辑回归分析。事后进行了功效计算，以验证关联的强度。
与使用纸质表格相比，所有地点的短信数据输入与更高比例的及时营养不良随访之间存在关联。在连续就诊中持续使用短信的关联最强。在连续两次就诊中的第一次就诊时使用短信最有效，突出了短信提醒警报的重要性。
带提醒功能的短信技术提高了加纳、卢旺达、塞内加尔和乌干达五岁以下儿童 CHW 营养不良筛查的及时性，突出了这种技术在改善资源匮乏环境中卫生工作者行为方面的重要性。
