Vey Trinity, Kinnicutt Eleonora, Day Andrew G, West Nicola, Sleeth Jessica, Nchimbi Kenneth Bernard, Yeates Karen
Department of Medicine, Queen's University, Kingston, ON, Canada.
Management Sciences for Health, Arlington, VA, United States.
J Med Internet Res. 2025 Mar 19;27:e51524. doi: 10.2196/51524.
Malaria remains a significant cause of maternal and neonate morbidity and mortality in sub-Saharan Africa. Long-lasting insecticidal nets (LLINs) represent an important component of malaria prevention and can decrease the adverse health outcomes associated with malaria infection during pregnancy. Voucher programs have been successfully implemented for a variety of initiatives across sub-Saharan Africa, including the distribution of subsidized LLINs in Tanzania. However, mobile messaging for behavior change communication (BCC), in combination with an e-voucher program, has not been explored for malaria prevention.
This study aimed to assess the efficacy of mobile messaging in increasing the redemption of e-vouchers for LLINs for pregnant women and adolescents in Tanzania.
This study was a blinded, 2-arm, cluster randomized controlled trial implemented in 100 antenatal health facilities in Tanzania (both urban and rural settings), with 50 clusters in both intervention and control groups. Clusters were antenatal clinics with e-voucher capabilities, with randomization stratified such that 25 urban and 25 rural clinics were randomized to each arm. Participants were pregnant females aged 13 years or older. Participants in both intervention and control groups were issued e-vouchers on their mobile phones that could be redeemed for LLINs at registered retailers within a 14-day redemption period. Participants in the intervention group received targeted BCC messages about the importance of malaria prevention and LLIN use during pregnancy, while participants in the control group did not receive BCC messages. Analyses were by intention to treat. The primary outcome was the redemption rate of e-vouchers for LLINs from retailers. Outcome measures pertain to clinic sites and individual participant-level data.
The study enrolled 5449 participants; the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm (49 clusters in each group analyzed). There was no significant difference in the raw redemption rate of e-vouchers between pregnant participants in the intervention group (70%) and the control group (67%). Younger participants were less likely to redeem e-vouchers.
The use of a BCC mobile messaging intervention did not result in a significant increase in LLIN uptake for pregnant individuals. However, the study shows that e-voucher distribution through nurses in antenatal clinics in partnership with local retailers is feasible on a large scale. Consideration of women and adolescents who are low-income and live in rural areas is needed for future interventions leveraging e-vouchers or mHealth technology in low-resource settings.
ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624.
在撒哈拉以南非洲，疟疾仍然是孕产妇和新生儿发病及死亡的重要原因。长效驱虫蚊帐（LLINs）是疟疾预防的重要组成部分，可减少孕期疟疾感染相关的不良健康后果。代金券计划已在撒哈拉以南非洲成功实施了各种举措，包括在坦桑尼亚分发补贴的长效驱虫蚊帐。然而，尚未探索将用于行为改变沟通（BCC）的移动信息与电子代金券计划相结合用于疟疾预防。
本研究旨在评估移动信息在提高坦桑尼亚孕妇和青少年兑换长效驱虫蚊帐电子代金券方面的效果。
本研究是一项在坦桑尼亚100个产前保健机构（包括城市和农村地区）实施的双盲、双臂、整群随机对照试验，干预组和对照组各有50个整群。整群为具备电子代金券功能的产前诊所，随机分组分层，使25个城市诊所和25个农村诊所随机分配到每组。参与者为年龄13岁及以上的怀孕女性。干预组和对照组的参与者都在其手机上收到可在14天兑换期内在注册零售商处兑换长效驱虫蚊帐的电子代金券。干预组的参与者收到关于孕期疟疾预防和使用长效驱虫蚊帐重要性的定向行为改变沟通信息，而对照组的参与者未收到行为改变沟通信息。分析采用意向性分析。主要结局是零售商处长效驱虫蚊帐电子代金券的兑换率。结局指标涉及诊所层面和个体参与者层面的数据。
该研究招募了5449名参与者；分析包括干预组的2708名参与者和对照组的2740名参与者（每组分析49个整群）。干预组孕妇（70%）和对照组孕妇（67%）电子代金券的原始兑换率没有显著差异。年轻参与者兑换电子代金券的可能性较小。
使用行为改变沟通移动信息干预并未使孕妇对长效驱虫蚊帐的使用显著增加。然而，该研究表明，通过产前诊所的护士与当地零售商合作分发电子代金券在大规模实施上是可行的。在未来利用电子代金券或移动健康技术在资源匮乏地区开展干预时，需要考虑低收入且生活在农村地区的妇女和青少年。
ClinicalTrials.gov NCT02561624；https://clinicaltrials.gov/ct2/show/NCT02561624 。
