Text Message Reminders to Health Workers on Malaria, Pneumonia, and Diarrhea Case Management in Malawi
NCT ID: NCT02645513
Last Updated: 2017-12-12
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
182 participants
INTERVENTIONAL
2015-01-31
2016-02-29
Brief Summary
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Detailed Description
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Malaria is endemic throughout Malawi and poses a significant burden for the health system. Malawi changed its malaria case management guidelines in 2011 to require diagnostic confirmation with microscopy or a malaria rapid diagnostic test (RDT) prior to treatment. A health facility survey in 2011 prior to the rollout of RDTs found that only 67% of patients with malaria were correctly treated, primarily due to a missed diagnosis of malaria. Although more recent assessments are lacking, it is likely that Malawi faces similar problems documented in other sub-Saharan African countries: non-systematic diagnostic testing of febrile patients for malaria, poor adherence to negative test results, failure to administer the first dose of antimalarial therapy during the consultation, and gaps in patient counseling. Furthermore, additional assessments have pointed to deficiencies in quality of care for other common illnesses in Malawi, such as pneumonia and diarrhea, which are similar to some of the widespread quality problems found in other developing countries.
Study design and objectives
This study is a trial of text message reminders to health workers in Malawi to improve case management of malaria and other common illnesses. The study will employ a cluster-randomized, controlled trial design with pre- and post-intervention measures, with health facilities as the cluster and unit of randomization. In several districts of Malawi, health facilities will be randomized to one of three arms:
1. Text messages to health facility-based health workers on the correct management of malaria (patients of all ages)
2. Text messages to health facility-based health workers on the correct management of malaria (patients of all ages) and other common illnesses, per Integrated Management of Childhood Illness guidelines (patients \< 5 years)
3. Control health facilities where health workers receive no study intervention (only routine supervision and supports from supervisors and district health management team, which will occur in text message arms as well)
Justification
This study will add to the small but growing body of literature on the potential for cell phones and text messages to improve malaria case management in different settings. In addition to providing evidence from a rigorously designed study on the effectiveness of text message reminders to health workers to improve malaria case management, this proposed study expands on the promising initial evidence base in the following ways:
* Assesses the effectiveness of text message reminders in a setting with malaria diagnostic testing
* Expands the intervention to include patients of all ages, not just children \< 5 years
* Includes messages on common non-malarial illnesses, including pneumonia and diarrhea
Methodology All health workers providing clinical care or working in the pharmacy dispensing drugs at facilities randomized to arms 1 or 2 will receive text messages. Before the intervention, data collection via a cross-sectional health facility survey will occur in the three study arms and will include patient exit interviews with a focused history, physical examination, and blood smear; health worker interviews; and a brief facility assessment. Results from this survey will be used to measure the baseline levels of case-management quality for malaria and other diseases and to pinpoint performance deficiencies to target with the text message intervention. Once preliminary baseline results are available, a workshop will be held with key stakeholders, including National Malaria Control Programme staff, researchers, technology specialists, health education specialists, and health workers, to discuss the results and design an appropriate intervention strategy, including message content and timing.
Text message reminders on case management of malaria (arm 1) and of malaria and other common illnesses (arm 2) will be sent to health workers twice a day in the intervention groups for six months. At the end of the six-month text message intervention, approximately one year after the baseline survey, follow-up data will be collected with another cross-sectional health facility survey. At this time, in-depth interviews will also be conducted with selected health workers in intervention facilities to better understand their reactions to the text messages and to help determine mechanisms of action of the text message reminders. A second follow-up health facility survey will be conducted six months after the end of the intervention to assess the extent that changes in performance are maintained over time. Cost data on the intervention will also be collected for a cost-effectiveness analysis.
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
HEALTH_SERVICES_RESEARCH
SINGLE
Study Groups
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Malaria-only text messages
Health workers at facilities in this arm receive twice-daily text message reminders for six months on key reminders related to malaria diagnosis and treatment.
Malaria text message reminders to health workers
Text message reminders contain key details from national case management guidelines on diagnosis and treatment of malaria
Malaria, pneumonia, and diarrhea messages
Health workers at facilities in this arm receive twice-daily text message reminders for six months on key reminders related to diagnosis and treatment of malaria, pneumonia, and diarrhea
Malaria, pneumonia, and diarrhea text message reminders to health workers
Text message reminders contain key details from national case management guidelines on diagnosis and treatment of malaria, pneumonia, and diarrhea
Control
No text message reminders to health workers, just the usual health system supports.
Control
No text message reminders
Interventions
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Malaria text message reminders to health workers
Text message reminders contain key details from national case management guidelines on diagnosis and treatment of malaria
Malaria, pneumonia, and diarrhea text message reminders to health workers
Text message reminders contain key details from national case management guidelines on diagnosis and treatment of malaria, pneumonia, and diarrhea
Control
No text message reminders
Eligibility Criteria
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Inclusion Criteria
* For health workers to be interviewed during baseline, endline, and follow-up surveys: working in the outpatient department sampled by the team during their visit.
* For patients to be interviewed during baseline, endline, and follow-up surveys: visiting facility to see a clinician for the first time for current illness
ALL
Yes
Sponsors
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Malaria Alert Centre
UNKNOWN
Centers for Disease Control and Prevention
FED
Responsible Party
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Laura Steinhardt, MPH, PhD
Epidemiologist
Principal Investigators
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Don Mathanga, MD, PhD
Role: PRINCIPAL_INVESTIGATOR
Malaria Alert Centre
References
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Zurovac D, Sudoi RK, Akhwale WS, Ndiritu M, Hamer DH, Rowe AK, Snow RW. The effect of mobile phone text-message reminders on Kenyan health workers' adherence to malaria treatment guidelines: a cluster randomised trial. Lancet. 2011 Aug 27;378(9793):795-803. doi: 10.1016/S0140-6736(11)60783-6. Epub 2011 Aug 3.
Steinhardt LC, Mathanga DP, Mwandama D, Nsona H, Moyo D, Gumbo A, Kobayashi M, Namuyinga R, Shah MP, Bauleni A, Troell P, Zurovac D, Rowe AK. The Effect of Text Message Reminders to Health Workers on Quality of Care for Malaria, Pneumonia, and Diarrhea in Malawi: A Cluster-Randomized, Controlled Trial. Am J Trop Med Hyg. 2019 Feb;100(2):460-469. doi: 10.4269/ajtmh.18-0529.
Other Identifiers
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6550
Identifier Type: -
Identifier Source: org_study_id