Skip to main content

Table 2 Malaria only and pneumonia, diarrhoea messages and proverbs posted on alternate weeks to Arm 2 health workers

From: The effect of mobile phone text message reminders on health workers’ adherence to case management guidelines for malaria and other diseases in Malawi: lessons from qualitative data from a cluster-randomized trial

sn Timing Arm I: Malaria only Arm 2: Malaria, pneumonia, and diarrhea
Mon a.m. “Check ALL patients with fever or history of fever for signs of severe malaria! If any severe sign TREAT & REFER urgently!” Better be safe than sorry “Check ALL sick children for any DANGER sign-if unable to drink OR lethargic OR vomit everything OR convulsions TREAT & REFER!” Well begun is half done
Mon p.m. “Ask ALL patients about fever, take temperature and check other malaria signs and symptoms.” Where there is smoke there is fire “Check ALL sick children for danger signs! Check ALL for fever, cough, difficult breathing, diarrhea, pallor, ear and other problems!” The seeker is the finder
Tues a.m. “Test for malaria ALL children < 5 and preg women with fever. Also test ALL patients ≥ 5 with fever + 1 symptom.” Look before you leap “For ALL children with cough or difficult breathing COUNT BREATHS in 1 min & look for chest in-drawing and stridor!” Actions speak louder than
Tues p.m. “For febrile patients without severe signs TREAT for malaria ONLY if test is positive—do NOT treat negatives for malaria!” A word to the wise is sufficient “Child has PNEUMONIA IF breath count is FAST: over 60 if less than 2 months, over 50 if 2–12 mos. or over 40 if 12–59 mos.” Never too old to learn
Wed a.m. “When malaria test is NEGATIVE check for other causes; if none found give antipyretic and ask patient to return if fever persists!” Persistent work triumphs “Child with cough or difficult breathing has SEVERE PNEUMONIA if any danger sign, chest in-drawing or stridor present-TREAT & REFER!” Knowledge is power
Wed p.m. “For uncomplicated malaria 1st line Rx is LA; 2nd line is ASAQ. For children < 5 kg and in 1st preg trimester give quinine + clindamycin” Do the right thing “Child does NOT have pneumonia if breath count is NOT fast and NO danger/severe sign—treat for cold; do NOT give antibiotic!” Things don’t change; we change
Thurs a.m. “New pre-referral Rx for severe malaria is IM artesunate; if not available use IM quinine; if quinine 0/S use rectal artesunate.” Never too old to learn “For pneumonia 1st line Rx is amoxicillin and 2nd line is erythromycin. For SEVERE pneumonia treat with IM X-pen & REFER!” It works if you work it
Thurs p.m. “Prescribe LA based on WEIGHT: 1 × 6 for 5–14 kg; 2 × 6 for 15–24 kg; 3 × 6 for 25–34 kg; 4 × 6 for ≥ 35 kg.” A goal without a plan is just a wish “Give ALL children FIRST antibiotic dose at facility, explain dosing at home and advise to finish all doses even if feel better!” A little late is too late
Fri a.m. “Give FIRST LA DOSE to ALL patients with uncomplicated malaria at FACILITY even if on an empty stomach!” To be willing is to be able “Give ALL children with diarrhea ORS, zinc and advice on extra fluids; give antibiotics ONLY if blood in stool!” First things first
Fri p.m. “Advise ALL patients to take 2nd LA dose after 8 h, then every 12 h to complete all 6 doses even if they feel better!” Say little but say it well “Assess dehydration in child with diarrhea; if some dehydration give ORS + 1st dose zinc at FACILITY; if severe give IV fluid or REFER!” Willingness is the key