EFFECTS OF MOBILE PHONE TEXT-MESSAGE REMINDERS ON UTILIZATION OF MALARIA PREVENTION STRATEGIES AMONG PREGNANT WOMEN IN BUSIA COUNTY, KENYA

Abstract

More than 600,000 deaths from malaria were recorded in 2020, making it a serious public health concern in sub-Saharan Africa, especially for pregnant women. In Kenya, 75% of the population is at risk, with Busia County having the highest prevalence at 27%. Despite the availability of effective prevention strategies like Insecticide-Treated Nets (ITNs) and Intermittent Preventive Treatment in Pregnancy (IPTp), utilization remains sub-optimal. This study evaluated malaria prevention strategies among pregnant women in Busia County, focusing on ITN and IPTp utilization, socio-economic and demographic determinants, the impact of SMS reminders on utilization, self-reported malaria incidence, and knowledge, attitudes, and practices (KAP). A parallel-group randomized trial was conducted, assigning 156 pregnant women to an intervention group receiving SMS reminders or a control group without messages. Data were collected at baseline (September–October 2023) and follow-up (January–February 2024) using intervieweradministered structured questionnaires. At baseline, ITN use was 95% overall (99% in control, 91% in intervention), rising to 97% post-intervention (p = 0.938). IPTp uptake increased from 10% at baseline to 76% post-intervention (82% control vs. 71% intervention, p = 0.179). Sociodemographic factors did not significantly affect ITN use. However, participants who received malaria prevention messages in the past six months were 2.7 times more likely to use IPTp (RR = 2.72, 95% CI: 1.65–4.49), and increased ANC visits were associated with higher IPTp utilization (RR = 1.47, 95% CI: 1.36–1.59). The estimated DiD effects suggest a modest additional benefit of SMS reminders: a 1.4%-point increase in IPTp use and a 7.6%-point increase in ITN use. Selfreported malaria incidence did not differ significantly between groups at baseline (p=0.463) or post-intervention (p=0.523). However, the intervention group was 18% less likely to report malaria (RR=0.82), and ITN use significantly reduced malaria incidence (RR=0.47, 95% CI: 0.25–0.93). Knowledge and attitudes toward malaria prevention remained high, with healthcare providers and CHWs as the primary information sources. Positive attitudes toward ITNs and IPTp were maintained in the intervention group (91%), while the control group experienced a significant decline from 75% to 58% (p = 0.019). Additionally, 94% overall recognized the value of these interventions. In conclusion, ITN utilization was higher than expected at both baseline and followup, while IPTp uptake increased significantly in both groups, driven by malaria messaging and ANC visits. Although the DiD effects were not statistically significant, the positive trends suggest SMS reminders may reinforce malaria prevention efforts by reinforcing knowledge, attitudes, and behavior. Integrating SMS reminders into national programs and strengthening ANC and CHW strategies is recommended.