Background

Low rates of adherence to artemisinin-based combination therapy (ACT) regimens increase the risk of treatment failure and may lead to drug resistance, threatening the sustainability of current anti-malarial efforts. We assessed the impact of text message reminders on adherence to ACT regimens.

Methods

Health workers at hospitals, clinics, pharmacies, and other stationary ACT distributors in Tamale, Ghana provided flyers advertising free mobile health information to individuals receiving malaria treatment. The messaging system automatically randomized self-enrolled individuals to the control group or the treatment group with equal probability; those in the treatment group were further randomly assigned to receive a simple text message reminder or the simple reminder plus an additional statement about adherence in 12-hour intervals. The main outcome was self-reported adherence based on follow-up interviews occurring three days after treatment initiation. We estimated the impact of the messages on treatment completion using logistic regression.

Results

1140 individuals enrolled in both the study and the text reminder system. Among individuals in the control group, 61.5% took the full course of treatment. The simple text message reminders increased the odds of adherence (adjusted OR 1.45, 95% CI [1.03 to 2.04], p-value 0.028). Receiving an additional message did not result in a significant change in adherence (adjusted OR 0.77, 95% CI [0.50 to 1.20], p-value 0.252).

Conclusion

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. Further research is needed to develop the most effective text message content and frequency.

Trial Registration

ClinicalTrials.gov NCT01722734

Over the last few decades, total fertility rates, child morbidity and mortality rates have declined
in most parts of sub-Saharan Africa. One of the most striking trends observed is the rapid rate of
urbanization, and the often remarkably large gaps in fertility between rural and urban areas.
While a large literature has highlighted the importance of migration and urbanization within
countries’ demographic transitions, relatively little is known regarding the impact of migration
on migrants’ reproductive health outcomes in general, and abortion in particular. In this paper,
we use detailed pregnancy and migration histories collected as part of the Household and
Welfare Study of Accra (HAWS) to examine the association between migration and pregnancy
outcomes among women residing in the urban slums of Accra, Ghana. We find that the
completed fertility patterns of lifetime Accra residents are remarkably similar to those of
residents who migrated. Our results suggest that recent migrants have an increased risk of
pregnancy, but not an increased risk of live birth in the first years post-move as compared to
those who had never moved. This gap seems to be largely explained by an increased risk of
miscarriage or abortion among recent migrants. The increased risk of pregnancy loss may be due
to a lack of social network, increased stress, and increased access to and knowledge on abortive
measures. Increasing access to contraceptives for recent migrants has the potential to reduce the
incidence of unwanted pregnancies, lower the prevalence of abortion and contribute to improved
maternal health outcomes.