Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark.
PLoS One. 2019 Jun 6;14(6):e0217485. doi: 10.1371/journal.pone.0217485. eCollection 2019.
The impact of one-way SMS on health outcomes in Africa is unclear. We aimed to conduct a systematic review of one-way SMS randomised trials in Africa and a meta-analysis of their effect on healthcare appointments attendance and medicine adherence.
PubMed, Embase, CENTRAL, The Global Health Library, ClinicalTrials.gov, ICTRP, and PACTR were searched for published and unpublished trials in Africa without language restriction (up to April 2018). Trials reporting effect estimates on healthcare appointment attendance and medicine adherence were assessed for risk of bias and included in meta-analyses using random-effects models. Other outcomes were reported descriptively. The protocol is registered in PROSPERO, ID:CRD42018081062.
We included 38 one-way SMS trials conducted in Africa within a broad range of clinical conditions. Eighteen trials were included in the meta-analyses, and four were assessed as overall low risk of bias. One-way SMS improved appointment attendance, OR:2·03; 95% CI:1·40-2·95 (12 trials, 6448 participants), but not medicine adherence, RR:1·10; 95% CI:0·98-1·23 (nine trials, 4213 participants). Subgroup analyses showed that one-way SMS had the highest impact on childhood immunization attendance, OR:3·69; 95% CI:1·67-8·13 (three trials, 1943 participants). There was no clear evidence of one-way SMS improving facility delivery, knowledge level (reproductive/antenatal health, hypertension), diabetes- and hypertension management.
In an African setting, the clinical effect of one-way SMS is uncertain except for appointment attendance where the effect seems to vary depending on which clinical condition it is used in.
单向短信对非洲健康结果的影响尚不清楚。我们旨在对非洲的单向短信随机试验进行系统评价，并对其对医疗预约就诊和药物依从性的影响进行荟萃分析。
在非洲，我们对发表和未发表的试验进行了无语言限制的检索（截至 2018 年 4 月），包括 PubMed、Embase、CENTRAL、全球卫生图书馆、ClinicalTrials.gov、ICTRP 和 PACTR。报告了对医疗预约就诊和药物依从性的影响估计的试验被评估了偏倚风险，并使用随机效应模型纳入荟萃分析。其他结果则进行了描述性报告。该方案在 PROSPERO 中进行了注册，编号为 CRD42018081062。
我们纳入了在广泛临床条件下在非洲进行的 38 项单向短信试验。有 18 项试验纳入了荟萃分析，其中 4 项被评估为总体低偏倚风险。单向短信提高了预约就诊的比例，OR：2.03；95%CI：1.40-2.95（12 项试验，6448 名参与者），但对药物依从性没有影响，RR：1.10；95%CI：0.98-1.23（9 项试验，4213 名参与者）。亚组分析显示，单向短信对儿童免疫接种就诊的影响最大，OR：3.69；95%CI：1.67-8.13（3 项试验，1943 名参与者）。没有明确的证据表明单向短信能提高医疗设施的分娩率，也没有提高知识水平（生殖/产前保健、高血压）、糖尿病和高血压的管理水平。
在非洲环境中，单向短信的临床效果尚不确定，除了预约就诊，其效果似乎因所使用的临床条件而异。
