手机电话提醒以提高儿童急性腹泻口服补液盐和锌的依从性：一项单中心、随机对照试验。

Mobile phone call reminders to improve oral rehydration salt and zinc adherence for acute diarrhea in children: a single-center, randomized controlled trial.

机构信息

Department of Paediatrics, Nyanya General Hospital, Abuja, Nigeria.

Department of Paediatrics and Child Health, University of Ilorin & University of Ilorin Teaching Hospital, Ilorin, Nigeria.

出版信息

BMC Health Serv Res. 2024 Sep 6;24(1):1036. doi: 10.1186/s12913-024-11507-w.

DOI:10.1186/s12913-024-11507-w

PMID:39242528

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11380190/

Abstract

BACKGROUND

Low-osmolarity oral rehydration salt (ORS) and zinc therapy effectively manage diarrhea in children under five years of age, offering both short- and long-term benefits. Despite this, caregivers' adherence to ORS and zinc is often unsatisfactory due to factors such as forgetfulness, resolution of symptoms, and underestimation of the disease's severity. This study assessed the effect of mobile call reminders on ORS and zinc tablet adherence among children with acute diarrhea in a secondary-level health facility in Kwara State, Nigeria.

METHODS

Using an open-label, randomized controlled trial design, this study compared caregiver-child pairs with acute diarrhea aged 6-59 months who received standard instructions (SI) alone (control group) and an intervention group (IG) who received SI plus phone call reminders on days three and seven of zinc sulfate therapy. All participants used a pictorial diary to track loose/watery stools and ORS and zinc tablet treatments for ten days. The primary outcome measures were independent and combined adherence to ORS and zinc therapy. The secondary outcomes were independent and combined adherence scores, defined as the percentage of times the ORS was given post-diarrhea and the percentage of prescribed zinc tablets administered out of ten.

RESULTS

A total of 364/400 mother-child pairs completed the study. The percentage of mothers with full adherence in the intervention group was 82.5% for ORS, 72.1% for zinc, and 58.5% for combined use, compared to 78.8%, 60.8%, and 43.6%, respectively, in the control group. The odds of full adherence to ORS and zinc were 1.6 and 1.7 times higher among intervention mothers [ORS: OR = 1.561, 95% CI = 0.939-2.598, P = 0.085; zinc: OR = 1.671, 95% CI = 1.076-2.593, P = 0.022], and 1.8 times higher for combined use according to WHO guidelines [OR = 1.818, 95% CI = 1.200-2.754, P = 0.005]. The mean adherence scores for the intervention group were higher than those for the control group by 4.1% (95% CI = 0.60-7.60) for ORS, 7.3% (95% CI = 3.74-10.86) for zinc, and 5.7% (95% CI = 3.23-8.17) for the combined treatment.

CONCLUSION

Phone reminders can effectively improve consistency of home treatment administered by caregivers for children under five years old.

TRIAL REGISTRATION

The study was registered retrospectively (17/3/2023) with the Pan African Clinical Trial Registry (PACTR202301560735856).

摘要

背景

低渗口服补液盐（ORS）和锌治疗可有效治疗五岁以下儿童腹泻，具有短期和长期益处。尽管如此，由于健忘、症状缓解和低估疾病严重程度等因素，护理人员对 ORS 和锌的依从性往往不尽人意。本研究评估了在尼日利亚夸拉州二级医疗机构中，手机提醒对急性腹泻儿童ORS 和锌片服用依从性的影响。

方法

本研究采用开放标签、随机对照试验设计，比较了接受标准指导（SI）的急性腹泻 6-59 月龄儿童（对照组）和接受 SI 加硫酸锌治疗第 3 天和第 7 天电话提醒的干预组（IG）。所有参与者均使用图片日记记录稀便/水样便和 ORS 和锌片治疗 10 天的情况。主要结局指标为 ORS 和锌治疗的独立和联合依从性。次要结局指标为独立和联合依从性评分，定义为腹泻后ORS 给予次数的百分比和十次规定锌片给药次数的百分比。

结果

共有 400 对母子中的 364 对完成了研究。干预组中完全依从ORS 的母亲比例为 82.5%，锌为 72.1%，联合使用为 58.5%，而对照组分别为 78.8%、60.8%和 43.6%。干预组母亲ORS 和锌完全依从的可能性分别高出 1.6 和 1.7 倍[ORS：OR=1.561，95%CI=0.939-2.598，P=0.085；锌：OR=1.671，95%CI=1.076-2.593，P=0.022]，根据世卫组织指南，联合使用的可能性高出 1.8 倍[OR=1.818，95%CI=1.200-2.754，P=0.005]。干预组的平均依从评分高于对照组，ORS 为 4.1%（95%CI=0.60-7.60），锌为 7.3%（95%CI=3.74-10.86），联合治疗为 5.7%（95%CI=3.23-8.17）。