title: Efficacy of text-message reminders on paediatric malaria treatment adherence and their post-treatment return to health facilities in Kenya: a randomized controlled trial.
abstract: Short Message Service (SMS) reminders have been suggested as a potential intervention for improving adherence to medications and health facility attendance.
  
  
  
  An open-label, randomized, controlled trial to test the efficacy of automated SMS reminders in improving adherence to artemether-lumefantrine (AL) and post-treatment attendance in comparison with standard care was conducted at four health facilities in western Kenya. Children below five years of age with uncomplicated malaria were randomized to intervention (SMS reminders) or control groups. Within each study group they were further randomized to three categories, which determined the timing of home visits to measure adherence to complete AL course and to individual AL doses. A sub-set of caregivers was advised to return to the facility on day 3 and all were advised to return after 28 days. The primary outcomes were adherence to medication and return on day 3. The primary analysis was by intention-to-treat.
  
  
  
  Between 9 June, 2014 and 26 February, 2016, 1677 children were enrolled. Of 562 children visited at home on day 3, all AL doses were completed for 97.6% (282/289) of children in the control and 97.8% (267/273) in the intervention group (OR = 1.10; 95% CI = 0.37-3.33; p = 0.860). When correct timing in taking each dose was considered a criteria for adherence, 72.3% (209/289) were adherent in the control and 69.2% (189/273) in the intervention group (OR = 0.82; 95% CI = 0.56-1.19; p = 0.302). Sending SMS reminders significantly increased odds of children returning to the facility on day 3 (81.4 vs 74.0%; OR = 1.55; 95% CI = 1.15-2.08; p = 0.004) and on day 28 (63.4 vs 52.5%; OR = 1.58; 95% CI = 1.30-1.92; p < 0.001).
  
  
  
  In this efficacy trial, SMS reminders increased post-treatment return to the health facility, but had no effect on AL adherence which was high in both control and intervention groups. Further effectiveness studies under the real world conditions are needed to determine the optimum role of SMS reminders. Trial registration ISRCTN39512726.
authors.affiliation: KEMRI-Welcome Trust Research Programme, Nairobi, Kenya.|Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
authors.forename: Ambrose O
authors.initials: AO
authors.lastname: Talisuna
authors.affiliation: KEMRI-Welcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Amos
authors.initials: A
authors.lastname: Oburu
authors.affiliation: KEMRI-Welcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Sophie
authors.initials: S
authors.lastname: Githinji
authors.affiliation: KEMRI-Welcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Josephine
authors.initials: J
authors.lastname: Malinga
authors.affiliation: KEMRI-Welcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Amboko
authors.affiliation: KEMRI-Welcome Trust Research Programme, Nairobi, Kenya.|Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Bejon
authors.affiliation: KEMRI-Welcome Trust Research Programme, Nairobi, Kenya.|Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Jones
authors.affiliation: KEMRI-Welcome Trust Research Programme, Nairobi, Kenya.|Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
authors.affiliation: KEMRI-Welcome Trust Research Programme, Nairobi, Kenya. dzurovac@kemri-wellcome.org.|Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK. dzurovac@kemri-wellcome.org.
authors.forename: Dejan
authors.identifier: 0000-0001-8267-9026
authors.initials: D
authors.lastname: Zurovac
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000008:administration & dosage*; D017028:Caregivers / Q000706:statistics & numerical data; D002675:Child, Preschool; D004338:Drug Combinations; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage*; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007630:Kenya; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D017010:Reminder Systems / Q000706:statistics & numerical data*; D060145:Text Messaging / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes
keywords: Adherence; Artemether–lumefantrine; Follow-up; SMS