Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 2, 2023
Date Accepted: Oct 2, 2024
A cluster randomized controlled trial of targeted behaviour change communication using a mobile health platform to increase uptake of long-lasting insecticidal nets among pregnant women in Tanzania: The Hati Salama “Secure Voucher” (HASA) study
ABSTRACT
Background:
Malaria remains a significant cause of maternal and neonate morbidity and mortality in sub-Saharan Africa. Long-lasting insecticidal nets (LLINs) represent an important component of malaria prevention and can decrease the adverse health outcomes associated with malaria infection during pregnancy. Voucher programs have been successfully implemented for a variety of initiatives across sub-Saharan Africa, including the distribution of subsidized LLINs in Tanzania. However, mobile messaging for behaviour change communication (BCC), in combination with an e-voucher program, has not been explored for malaria prevention.
Objective:
This study assessed the efficacy of mobile messaging to increase the redemption of e-vouchers for LLINs in pregnant women in Tanzania.
Methods:
This study was a cluster-randomized controlled blinded two-arm trial implemented in 100 antenatal health facilities in Tanzania (both urban and rural settings), with 50 clusters in both intervention and control groups. Participants were pregnant women aged 13+. Participants in both intervention and control groups were issued e-vouchers on their mobile phones that could be redeemed for LLINs at registered retailers within a 14-day redemption period. Participants in the intervention group received targeted BCC messages about the importance of malaria prevention and LLIN use during pregnancy, while participants in the control group did not receive BCC messages. Analyses were by intention to treat. The primary outcome was the redemption rate of e-vouchers for LLINs from retailers.
Results:
The study enrolled 5449 participants, the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm. There was no significant difference in the raw redemption rate of e-vouchers between pregnant women in the intervention group (70%) and the control group (67%). Younger participants were less likely to redeem e-vouchers.
Conclusions:
The use of a BCC mobile messaging intervention did not result in a significant increase in LLIN uptake for pregnant women. However, the study shows that e-voucher distribution via nurses in antenatal clinics in partnership with local retailers is feasible on a large scale. Consideration of women who are low-income and live in rural areas is needed for future interventions leveraging e-voucher or mHealth technology in low-resource settings. Clinical Trial: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624
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