Table 4 Text message content for Intervention and Control groups

1

SMART quiz:How many ovaries does a woman have? Reply SMT1 for 1 ovary or SMT2 for 2 ovaries. Reply to this number for free. Reply until you receive confirmation

SMT2

SMART:Right! A woman has 2 ovaries. This is where eggs are stored. She has a womb (uterus) where a fertilized egg implants and a pregnancy grows.Two fallopian tubes connect ovaries to the womb.The cervix connects the womb to the vagina. The vagina is a tube of muscle connecting cervix to outside of body

SMART fact: In 2012, malaria killed over 483,000 children under 5 years, or about 1 child every minute. Malaria kills over 45,000 adolescents per year in Africa.

2

SMART quiz:When is the most likely time that a girl can get pregnant? Reply SMT1 for days 1–7 of her menses, reply SMT2 for days 8–19, or SMT3 for days 20–28.

SMT2

SMART answer: Correct! The menstrual cycle is usually 28 days. If day 1 is the first day of your menses, then days 8–19 are the most likely time that you can get pregnant. The egg is released from the ovaries between days 8–19. If sperms are present, then the egg may be fertilized, causing pregnancy.

SMART fact:Malaria is caused by Plasmodium falciparum parasites.The only way the parasites are spread to people are thru bites of infected Anopheles mosquitoes.

3

SMART quiz: True or False: Standing up during sex can prevent a girl from getting pregnant. Reply SMT1 for true or SMT2 for false.

SMT2

SMART answer: Correct! Standing up during sex does NOT prevent pregnancy. When a man ejaculates (releases sperm), the sperms are deposited deep into the vagina immediately after ejaculation, allowing fertilization to take place. Bathing/washing will NOT prevent pregnancy either.

SMART fact:Getting malaria while pregnant is very serious. About 9% of pregnant women in Ghana die of malaria. It can also result in low birth weight babies.

Tip 1: End of week 3

SMART tip: If you have any questions about your health, you can call 0302208585 or 080028585 (Toll free- Voda only) to speak to a nurse. It is confidential.

4

SMART:Can you be a carrier of a Sexually Transmitted Infection (STI) and NOT be aware that you have it? Reply SMT1 for yes or SMT2 for no.

SMT1

SMART:Right!You can have STI without having any symptoms or knowing you are a carrier.It can take months to see symptoms like sores, itches and problems urinating.A partner may have a STI and it may be impossible for him or you to know that he has it.Condoms or abstinence are effective ways to prevent STI

SMART fact:The first symptoms of malaria are fever, headache, and chills. These occur 2–3 days after the mosquito bite.Other symptoms are body pain and nausea.

5

SMART quiz: True or False: A woman with an untreated gonorrhea may have severe lower abdominal pains. Reply SMT1 for true or SMT2 for false.

SMT1

SMART:Right! Untreated gonorrhea may lead to severe pains in lower abdomen called pelvic inflammatory disease. It can cause infertility. It also makes it easier to get HIV. It may take months to see signs of gonorrhea in females. In males it takes days. Its important to seek treatment from a health center.

SMART:Malaria symptoms resemble diseases like pneumonia or typhoid.At health centers you can get rapid diagnostic test (just a few min) to identify the disease.

Tip 2: End of week 5

SMART Tip: Talking about reproductive health with friends, family, and a boyfriend/future boyfriend is smart. It can help you to be healthier and make good choices that are right for you. Be sure to talk to your friends about the SMART messages, and encourage them to participate! Win together!

6

SMART quiz: True or false: A woman can wear the female condom for up to 8 h before she has sex. Reply SMT1 for true or SMT2 for false.

SMT1

SMART:Right! The female condom is made of a thin transparent and soft plastic that looks like a tube that is closed at one end.It is designed to fit into a woman’s vagina. It can be worn up to 8 h before a woman has sex.It protects against both STIs and pregnancy.It is 95% effective if worn correctly.

SMART fact: You can cure malaria with drugs called ACTs like Artesunate-Amodiaquine. ACTs combine two drugs together into each pill. They are 97% effective.

Tip 3: End of week 6

SMART Tip: Great job! Remember, if you don’t want to have sex, it’s ok to say no. Call 0302208585 or 080028585 (Toll free- Vodafone only) to speak to a nurse about strategies for saying no. It is completely confidential. You could also call this number if you have any questions bothering you.

7

SMART:When putting on a condom, should a man unroll it all the way first before putting it on the penis? Reply SMT1 for yes or SMT2 for no.

SMT2

SMART: Right! When putting on a condom, do NOT unroll the entire condom first. Open the package, hold the tip of the condom with one hand and roll it down the penis with the other hand. Leave space at the tip to collect semen. If there is no space at the tip the condom will burst open during ejaculation.

SMART fact: The malaria parasite has developed resistance to previous drugs like chloroquine. This means the drug no longer works to cure malaria. Only ACTs cure.

8

SMART:When using a condom, when should a man pull out of the vagina after ejaculation? Reply SMT1 for while penis is still stiff or SMT2 for when penis is soft.

SMT1

SMART answer: Right! When using a condom, it is important for the man to pull his penis out right after ejaculation, while it is still stiff. If the penis gets soft then the condom could fall off inside the woman’s vagina. If this happens then it is possible that the woman will get pregnant.

SMART fact: If you take an ACT and don’t finish all the pills, the malaria parasite will survive. This builds resistance to the medicine. Always finish ACTs.

Tip 4: End of Week 8

SMART Tip: Contraception means a method to prevent pregnancy. Birth control pills and condoms are types of contraception.Condoms are only effective if you use them correctly and use them every time you have sex. Then they are 98% effective against STDs and pregnancy.Condoms do NOT cause infertility in men.

9

SMART quiz:How often is the Pill taken (the birth control Pill)? Reply SMT1 for only after a woman has sex or reply SMT2 for once a day, everyday.

SMT2

SMART answer: Right! The Pill is taken once a day whether or not a woman has sex.If you choose to use the Pill as your contraceptive method then you must take it everyday or it is NOT effective. You can’t just take it whenever you please! It contains low and safe doses of hormones and prevents pregnancy.

SMART fact: There are no vaccines against malaria. You can prevent malaria with treated mosquito nets.Traditional medicines are not effective in curing malaria.

10

SMART quiz: True or False: Birth control pills are effective even if a woman misses taking them for 2–3 days in a row. Reply SMT1 for true or SMT2 for false.

SMT2

SMART answer: Right! The Pill is NOT effective if a woman misses it for 2 or 3 days in a row. The Pill must be taken everyday and if a woman stops taking it then she may get pregnant after 2–3 days. It does NOT take 6 months to become pregnant after stopping birth control.

SMART fact:Children who survive episodes of severe malaria may develop learning problems, brain damage, or anemia (low iron in body which affects their growth).

11

SMART:True or False:A woman should take a rest from the Pill every year because the pills build up in the body over time. Reply SMT1 for true or SMT2 for false.

SMT2

SMART answer: Right! The Pill does NOT build up in the body so women do NOT need to take a rest from the Pill. If a woman has side effects like nausea, switching to another type or brand might help. The Pill protects against pregnancy but not STIs. The Pill does not cause infertility later in life.

SMART fact: Common myths about how malaria is spread are that you can get infected from working too much in the sun or eating hot foods. These are NOT true.

12

SMART quiz: True or False. Emergency contraception must be taken within 1 h of unprotected sex. Reply SMT1 for true, and SMT2 for false.

SMT2

SMART: Right! Emergency contraception (like Postinor-2) is a method to reduce chance of pregnancy after unprotected sex or when a condom breaks. The 2 pills must be taken within 5 DAYS of unprotected sex (that’s 120 h). It should only be used for emergencies, not as a regular method of contraception.

SMART fact:Increased prevention of malaria with nets and treatment with ACTs have led to more than 3million lives saved since 2010, mostly children under 5 yrs.