Use of mobile phones to improve post-hospitalisation follow-up of children in rural Kenya

Abstract

Background: Re-admission is considered a high priority quality measure in the health care setting. Most of the studies using text messaging, however, have slanted towards adults, in the form of reminders or instructions of some sort. Paediatric patients are often re-hospitalised after discharge. Recurrent hospitalisations are responsible for considerable health care spending, and some studies suggest that a substantial proportion of re-admissions are preventable through effective discharge planning and close patient follow up.

Objective: To examine the effect of use of mobile phone to improve post-hospitalisation follow-up of children in rural Kenyan health facilities.

Design: A cross sectional study.

Setting: Siaya County Health facilities, in Nyanza province, Kenya.

Subjects: Children under five years of age, discharged following hospitalisation.

Main outcome measures: These included, total number of discharges, readmissions, gender, socio-economics, prospective results, educational level and distance from hospital, home location, nearest health facility, acceptability, suitability, and utilisation of the message, and immunisation status of the child.

Results: The respondents’ minimum age was 18 years, with a maximum and mean age of 49 and 29.3 respectively. Most of the respondents were in monogamous marriages (69%), Protestants (57%), highest maternal education level was between primary five to eight (42%) and 40% were self employed. Re-admission rate in the Intervention group was 5% compared to Control group 1 and 2 of 28% and 21% respectively. In testing H0:1,significant relationships of p-Value 0.00, at 95% confidence interval, when the alpha is 0.05, proves that SMS messaging led to reduced re-admission rates. In testing H1:2, according to the responses relating to SMS satisfaction, majority (98.7%) expressed satisfaction with text messaging, compared to the 1.3% who expressed otherwise. There was no relationship between rate of re-admission and age, socio-economic status, distance from health facility or home location in relation to the admitting facility.

Conclusion: The study found that there was a relationship between post-discharge SMS communication and rate of re-admission. It was also established that there was a relationship between post-discharge SMS communication and improved knowledge, efficacy in childcare as well as relationship with staff. Text messaging therefore was found to improve post discharge follow-up care and eventual reduction in re-admission rate. The researcher recommended that a similar study be done on adults to see if it could have the same effect.