The use of mobile phones as a behaviour change communication and surveillance tool for the prevention of malaria and other febrile illnesses among children under-five at the Asante Akyim North District of Ghana

ABSTRACT BACKGROUND: Worldwide, millions of children under-five continue to die before their fifth birthday due to preventable infectious diseases including malaria, pneumonia and diarrhoea; sub-Saharan Africa alone accounts for almost half of these deaths. The situation is not different in Ghana, where the under-five mortality rate in 2014 was reported to be 60 per 1,000 live births. Existing evidence suggests that the practice of healthy behaviours by families and communities, coupled with early diagnosis and treatment of childhood febrile illnesses could greatly accelerate reductions in under-five mortality. Mobile technology has been suggested to improve health outcomes by supporting the delivery of health services, even in the most remote and resource poor settings in developing countries. Despite its demonstrated applicability to the health sector, empirical evidence to support its usefulness as a Behaviour Change Communication (BCC) and surveillance tool is fraught with continuous scepticism. OBJECTIVE: This study aimed to assess the effect of delivering BCC intervention via mobile phones on malaria prevalence in children under-five at the Asante Akyim North District. Additionally, the feasibility of use of mobile technology for monitoring common childhood disease symptoms was assessed. METHODS: A Quasi-experimental nonequivalent study design was employed using a random sample of 334 caregivers with children under-five from two sub-districts of the Asante Akyim North district and assigned to either an intervention or control group. Caregivers in the intervention group received bi-weekly voice SMS on malaria for twelve months. They were also given a toll-free health line to call and report disease symptoms of their sick children during the period of the intervention. The effect of the intervention on prevalence of malaria in the children, knowledge on malaria and health behaviours of caregivers were assessed using logistic regression and nearest neighbour propensity score matching analysis to estimate the treatment effect (ATETnn) using Stata 13. Spatial distribution of childhood malaria cases were also geo-statistically assessed using ArcGIS 10.2. The feasibility of the mobile technology for monitoring disease symptoms and providing valid data was assessed using Cohen Kappa statistics and predictive values. RESULTS: Among children under-five whose caregivers received the intervention, malaria prevalence significantly decreased from 73.9% at baseline to 43.5% at endline vii (p<0.001) compared with children in the control group, where a reduction of 76.1% to 58.9% (p<0.001) was observed. Children whose caregivers received the intervention were significantly less likely (odds ratio [AOR] = 0.53, p-value ≤0.01, 95% CI = 0.34, 0.83) to experience malaria compared with children in the control group. The spatial distribution of malaria revealed significantly high-cluster areas in the control site and low-cluster areas in the intervention site at post-intervention. The post intervention treatment effect showed a statistically significant reduction in malaria prevalence (ATETnn = -0.170, tnn = -3.07, 95% CI = -0.28, -0.03) compared to the baseline estimate (ATETnn = -0.02, tnn = -0.26, 95% CI = -0.14, 0.09). Receiving the intervention significantly improved the knowledge (odds ratio [AOR] = 1.81, 95% CI = 1.09, 2.99) and health behaviours: attitude (odds ratio [AOR] = 2.58, p-value ≤0.001, 95% CI =1.61, 4.15) and behaviour (odds ratio [AOR] = 2.03, p-value ≤0.01, 95% CI =1.29, 3.19) of caregivers in the intervention group compared with caregivers in the control group. Additionally, with the aid of the mobile phone technology, based on phone calls from caregivers, a total of 52 potential childhood cases were identified. Common symptoms reported included fever (46.0%, n=24), cough (52.1%, n=25), diarrhoea (40.0%, n=18) and vomiting (39.2%, n=20). An assessment of the validity of the symptom reports between the mobile technology and that of clinician’s revealed the highest agreement for fever (percentage agreement, 84.9%, kappa=0.70, p<0.001, sensitivity=86.7%, NPV=88.2%), good agreement for diarrhoea (percentage agreement, 74.2%, kappa=0.44, p<0.007, sensitivity=70.0%, NPV=84.2%) and vomiting (percentage agreement, 73.7%, kappa=0.46, p<0.002, sensitivity=68.8%, NPV=77.3%), with cough showing a fair agreement (percentage agreement, 67.7%, kappa=0.37, p<0.0129, sensitivity=80.0%, NPV=78.6%). CONCLUSION: The findings of the study provide support for using mobile phone technology as a BCC tool for disseminating health messages to caregivers in a bid to reduce malaria incidence and mortality in children under-five, and monitoring symptoms of childhood illnesses. Further research could assess the cost-benefit of implementing this intervention on a larger scale.

Source: KNUST