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      One-way SMS and healthcare outcomes in Africa: Systematic review of randomised trials with meta-analysis

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          Abstract

          Background

          The impact of one-way SMS on health outcomes in Africa is unclear. We aimed to conduct a systematic review of one-way SMS randomised trials in Africa and a meta-analysis of their effect on healthcare appointments attendance and medicine adherence.

          Methods

          PubMed, Embase, CENTRAL, The Global Health Library, ClinicalTrials.gov, ICTRP, and PACTR were searched for published and unpublished trials in Africa without language restriction (up to April 2018). Trials reporting effect estimates on healthcare appointment attendance and medicine adherence were assessed for risk of bias and included in meta-analyses using random-effects models. Other outcomes were reported descriptively. The protocol is registered in PROSPERO, ID:CRD42018081062.

          Results

          We included 38 one-way SMS trials conducted in Africa within a broad range of clinical conditions. Eighteen trials were included in the meta-analyses, and four were assessed as overall low risk of bias. One-way SMS improved appointment attendance, OR:2·03; 95% CI:1·40–2·95 (12 trials, 6448 participants), but not medicine adherence, RR:1·10; 95% CI:0·98–1·23 (nine trials, 4213 participants). Subgroup analyses showed that one-way SMS had the highest impact on childhood immunization attendance, OR:3·69; 95% CI:1·67–8·13 (three trials, 1943 participants). There was no clear evidence of one-way SMS improving facility delivery, knowledge level (reproductive/antenatal health, hypertension), diabetes- and hypertension management.

          Conclusion

          In an African setting, the clinical effect of one-way SMS is uncertain except for appointment attendance where the effect seems to vary depending on which clinical condition it is used in.

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          Most cited references38

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          Effectiveness of mHealth interventions for maternal, newborn and child health in low– and middle–income countries: Systematic review and meta–analysis

          Objective To assess the effectiveness of mHealth interventions for maternal, newborn and child health (MNCH) in low– and middle–income countries (LMIC). Methods 16 online international databases were searched to identify studies evaluating the impact of mHealth interventions on MNCH outcomes in LMIC, between January 1990 and May 2014. Comparable studies were included in a random–effects meta–analysis. Findings Of 8593 unique references screened after de–duplication, 15 research articles and two conference abstracts met inclusion criteria, including 12 intervention and three observational studies. Only two studies were graded at low risk of bias. Only one study demonstrated an improvement in morbidity or mortality, specifically decreased risk of perinatal death in children of mothers who received SMS support during pregnancy, compared with routine prenatal care. Meta–analysis of three studies on infant feeding showed that prenatal interventions using SMS/cell phone (vs routine care) improved rates of breastfeeding (BF) within one hour after birth (odds ratio (OR) 2.01, 95% confidence interval (CI) 1.27–2.75, I2 = 80.9%) and exclusive BF for three/four months (OR 1.88, 95% CI 1.26–2.50, I2 = 52.8%) and for six months (OR 2.57, 95% CI 1.46–3.68, I2 = 0.0%). Included studies encompassed interventions designed for health information delivery (n = 6); reminders (n = 3); communication (n = 2); data collection (n = 2); test result turnaround (n = 2); peer group support (n = 2) and psychological intervention (n = 1). Conclusions Most studies of mHealth for MNCH in LMIC are of poor methodological quality and few have evaluated impacts on patient outcomes. Improvements in intermediate outcomes have nevertheless been reported in many studies and there is modest evidence that interventions delivered via SMS messaging can improve infant feeding. Ambiguous descriptions of interventions and their mechanisms of impact present difficulties for interpretation and replication. Rigorous studies with potential to offer clearer evidence are underway.
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            The impact of mobile health interventions on chronic disease outcomes in developing countries: a systematic review.

            Rates of chronic diseases will continue to rise in developing countries unless effective and cost-effective interventions are implemented. This review aims to discuss the impact of mobile health (m-health) on chronic disease outcomes in low- and middle-income countries (LMIC). Systematic literature searches were performed using CENTRAL, MEDLINE, EMBASE, and LILACS databases and gray literature. Scientific literature was searched to identify controlled studies evaluating cell phone voice and text message interventions to address chronic diseases in adults in low- or middle-income countries. Outcomes measured included morbidity, mortality, hospitalization rates, behavioral or lifestyle changes, process of care improvements, clinical outcomes, costs, patient-provider satisfaction, compliance, and health-related quality of life (HRQoL). From the 1,709 abstracts retrieved, 163 articles were selected for full text review, including 9 randomized controlled trials with 4,604 participants. Most of the studies addressed more than one outcome. Of the articles selected, six studied clinical outcomes, six studied processes of care, three examined healthcare costs, and two examined HRQoL. M-health positively impacted on chronic disease outcomes, improving attendance rates, clinical outcomes, and HRQoL, and was cost-effective. M-health is emerging as a promising tool to address access, coverage, and equity gaps in developing countries and low-resource settings. The results for m-health interventions showed a positive impact on chronic diseases in LMIC. However, a limiting factor of this review was the relatively small number of studies and patients enrolled, highlighting the need for more rigorous research in this area in developing countries.
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              Mobile phone text messaging to improve medication adherence in secondary prevention of cardiovascular disease

              Worldwide at least 100 million people are thought to have prevalent cardiovascular disease (CVD). This population has a five times greater chance of suffering a recurrent cardiovascular event than people without known CVD. Secondary CVD prevention is defined as action aimed to reduce the probability of recurrence of such events. Drug interventions have been shown to be cost-effective in reducing this risk and are recommended in international guidelines. However, adherence to recommended treatments remains sub-optimal. In order to influence non-adherence, there is a need to develop scalable and cost-effective behaviour-change interventions.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                6 June 2019
                2019
                : 14
                : 6
                : e0217485
                Affiliations
                [1 ] Department of Clinical Research, University of Southern Denmark, Odense, Denmark
                [2 ] Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
                [3 ] Odense Patient Data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
                [4 ] Danish Centre for Health Economics (DaCHE), Department of Public Health, University of Southern Denmark, Odense, Denmark
                [5 ] Department for Cancer Prevention Services, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
                [6 ] Centre for Evidence-Based Medicine (CEBMO), Odense University Hospital, Odense, Denmark
                [7 ] Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
                [8 ] Department of Medical Endocrinology, Odense University Hospital, Odense, Denmark
                University of the Witwatersrand, SOUTH AFRICA
                Author notes

                Competing Interests: DSL, VR, MSA are currently conducting a trial in Tanzania assessing the effect of one-way SMS on attendance to cervical cancer screening follow-up appointment attendance. This does not alter our adherence to PLOS ONE policies on data sharing and materials. AL, MK and JK have no conflicts of interest.

                Author information
                http://orcid.org/0000-0002-0851-6760
                http://orcid.org/0000-0002-4982-8680
                http://orcid.org/0000-0002-4603-9504
                Article
                PONE-D-18-35958
                10.1371/journal.pone.0217485
                6553734
                31170176
                3e67feb2-020e-40cc-bc1b-e11ff9cd6826
                © 2019 Linde et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 December 2018
                : 12 May 2019
                Page count
                Figures: 5, Tables: 1, Pages: 18
                Funding
                Funded by: Danish International Development Agency (Danida)
                Award ID: 14-P+2-TAN / A26775
                Funded by: University of Southern Denmark
                Funding was provided by The University of Southern Denmark and by Denmark’s International Development (Danida) grant no. 14-P+2-TAN/A26775. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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