It may sound too good to be true, but text messages are an effective tool in the global anti-malaria effort. The parasite, spread among people by mosquitoes, kills more than 600,000 people each year. Insecticide-treated bednets are well documented as one way to prevent malaria, but it is not enough.
Particularly worrying is evidence of resistance to artemisinin-based combination therapy (ACT), one of the best ways to treat malaria.
“When patients don’t complete their full medication regimen, diseases can develop resistance to treatment. And with infectious diseases like malaria, drug-resistant diseases can spread to others,” explained Julia Raifman, a Ph.D. candidate in the Harvard School of Public Health. “Even in the United States, studies show that about half of people don’t adhere to their medications—it’s easy to forget, or to think you’ve beaten the disease because you feel better.
Research published today by Raifman and her colleagues shows cell phones help with treatment. Short text messages sent to malaria patients increased adherence to the treatment regimen by five percentage points, according to researchers with Harvard University and Innovations for Poverty Action. They see text messages as a promising way to prevent parasite resistance to artemisinin.
It is crucial to protect the most effective way to treat malaria. Evidence of artemisinin resistance emerged from the border between Thailand and Myanmar in 2012. It followed evidence of resistance reported in Cambodia in 2009. While the cases do not show artemisinin to be entirely ineffective, the slower progress of the drug-defeating malaria concerns health officials because it could get worse and spread beyond the region. If that were to happen, it is very likely malaria deaths to suddenly rise.
One way to prevent artemisinin resistance is to make sure people are diagnosed properly and they take all of the pills prescribed at the right time. Enter the text message. The Harvard team worked with medical facilities in Tamale, Ghana that distribute ACTs to place flyers encouraging people to enroll in a free health information program, using their phones. Those who joined were randomly placed into groups where some got messages reminding them to take the drugs and others who did not. Follow-up surveys showed that the reminders helped ensure people stuck to the schedule of taking the ACT every 12 hours.
“The results of this study suggest that a simple text message reminder can increase adherence to antimalarial treatment and that additional information included in messages does not have a significant impact on completion of ACT treatment,” concluded the researchers.
The biggest result might be the most subtle. More than 60 percent of people eligible enrolled in the text message reminders on their own. A simple poster was all it took to get them to join. That means taking the program nationwide in Ghana and to other countries will be relatively cheap. Doing work to test the posters and improve the messaging could presumably increase enrollment even further. This potential has wider implications when considering how mobile reminders are being used to support pregnant mothers and child health.
“SMS reminders are a ‘nudge,’ not a ‘shove’ ” said Aaron Dibner-Dunlap, an Innovations for Poverty Action researcher who studies text message reminders. “They can help people follow through on something they originally intended to do, but human nature is tricky and the science is still young. We’re optimistic because the technology has become so widespread and inexpensive to administer, that for programs like this one that work, there’s huge potential for helping people at very low cost.”
