Researchers tested a mobile health program called PICHA7 in the Democratic Republic of Congo to see if it could reduce diarrhea and help children grow better. The program sent weekly text and voice messages about clean water, sanitation, and hygiene to families, plus quarterly home visits. After following over 2,300 people for a year, they found the program cut diarrhea cases by 61%, reduced hospital visits for diarrhea by 56%, and helped prevent stunted growth in children under 5. The study shows that combining mobile technology with basic health education can make a big difference in preventing waterborne diseases in developing countries.

The Quick Take

  • What they studied: Whether sending weekly health messages by phone plus home visits could reduce diarrhea and improve child growth in Congo families
  • Who participated: 2,334 people from households in Bukavu, Congo where someone had recently had diarrhea, followed for 12 months
  • Key finding: The mobile health program reduced diarrhea cases by 61% and cut stunted growth in young children from 63% to 52%
  • What it means for you: Mobile health programs combining text messages with personal visits may be powerful tools for preventing waterborne diseases, especially in areas with limited healthcare access

The Research Details

This was a cluster-randomized controlled trial, which means researchers randomly divided households into two groups to compare different approaches. One group got the standard government message about treating diarrhea with oral rehydration solution and basic hygiene tips through a single visit. The other group got this same standard care plus the PICHA7 program, which included weekly voice and text messages about water safety, sanitation, and hygiene, along with someone visiting their home every three months to reinforce these messages.

This type of study design is considered the gold standard for testing whether health programs actually work because it eliminates bias by randomly assigning people to different groups. The researchers could directly compare outcomes between families who got the mobile health program versus those who didn’t.

This study was well-designed with a large sample size of over 2,300 people followed for a full year. The researchers measured multiple outcomes including diarrhea episodes, hospital visits, blood tests for cholera exposure, and child growth measurements. The study was also registered in advance, which means the researchers committed to their methods before starting.

What the Results Show

The mobile health program showed impressive results across multiple measures. Families receiving the PICHA7 program had 61% fewer cases of diarrhea compared to those getting standard care only. Hospital visits for diarrhea dropped by 56%, and cases of severe diarrhea with rice-water stools (a sign of cholera) fell by 52%. Blood tests showed lower levels of antibodies against cholera bacteria, suggesting less exposure to the disease. Most importantly for long-term health, children under 5 in the program group were significantly less likely to be stunted (too short for their age), with rates dropping from 63% to 52%.

The program showed high adherence rates, meaning families actually followed the water, sanitation, and hygiene recommendations they received through the mobile messages and home visits. This suggests that the combination of regular reminders via phone plus personal contact was effective at changing behavior over time.

This study adds to growing evidence that mobile health programs can be effective in low-resource settings. However, it’s one of the first to combine mobile messaging with regular home visits and measure such comprehensive outcomes including child growth over a full year.

The study was conducted in one urban area of Congo, so results may not apply to rural areas or other countries. Families knew they were in a study, which might have influenced their behavior. The researchers also couldn’t completely separate the effects of the mobile messages from the home visits.

The Bottom Line

Mobile health programs that combine regular text/voice messages with periodic personal contact appear highly effective for preventing diarrheal diseases and improving child nutrition. However, this approach requires infrastructure for mobile communications and trained health workers for home visits.

Public health officials, aid organizations, and governments working in areas with high rates of waterborne diseases should consider this model. Families in areas with poor sanitation may benefit from similar programs if available.

The benefits appeared within the first month and continued throughout the 12-month study period, suggesting both immediate and sustained effects from consistent health messaging and support.

Want to Apply This Research?

  • Track daily water treatment practices, handwashing frequency, and any diarrheal episodes in household members
  • Set up daily reminders for water purification, handwashing before meals and after bathroom use, and proper food storage practices
  • Monitor weekly adherence to WASH practices and monthly health outcomes, with particular attention to children’s growth measurements and any gastrointestinal symptoms

This research was conducted in a specific setting in the Democratic Republic of Congo and may not apply to all populations or locations. Always consult healthcare providers for medical advice and follow local public health guidelines for water safety and sanitation practices.