Background Anemia is a major public health concern among women of reproductive age leading to high maternal mortality in low-and middle-income countries. Of the prior studies conducted in Pakistan, most focused on large urban areas and did not explore the determinants of anemia among women of reproductive age (WRA) across socio-demographic, dietary, reproductive, and biological domains. Thus, we aimed to study the prevalence and determinants of anemia among WRA in rural Pakistan.
Background Balochistan is the largest province of Pakistan by area, and the least developed. It suffers from several political, tribal and border conflicts. The distances to health facilities for the catchment population are long with limited accessibility. Immunization is one of the most cost-effective interventions to prevent deaths from vaccine preventable diseases (VPDs), especially in children. While Pakistan has an overall routine immunization coverage of 66 per cent for fully immunized children (FIC), coverage in the province of Balochistan is much lower at 29 per cent. This study aimed to assess the feasibility of introducing mHealth intervention using an artificial intelligence (AI) platform based on SMS (short-message service) and Interactive Voice Response (IVRs) to remind and persuade parents to get their children vaccinated. Methods We employed a mixed study design using both quantitative and qualitative approaches. Baseline data were collected from 1,600 eligible mothers/parents within the catchment areas of 75 basic health units (BHUs) in Quetta (provincial capital of Balochistan province), and the automated platform was instituted with SMS and IVRs from EPI (Expanded Programme on Immunization) Quetta. Daily reminders and IVRs were sent to the cell numbers in the database/records. Responses were noted on the AI platform. After a period of about two months, an end line survey of 1,203 participants was undertaken with a loss of 397 (25%) participants due to seasonal migration to warmer cities in Sindh province. For the qualitative part, three key informant interviews (KII) were conducted; two KIIs with Lady Health Supervisors and one KII with the WHO staff responsible for routine immunization. There were also three focus group discussions (FGDs). Results We found that the intervention was feasible as well as acceptable both at the community and programme management levels. The baseline indicators of immunization coverage improved significantly on end line survey (95% confidence interval, CI = 0.208-0.269; P<0.001). Conclusions Our study demonstrates the potential for mHealth and AI to improve childhood immunization and addresses equity in the least developed areas of this country. The replication of the strategy in subnational immunization programmes could decrease morbidity and mortality due to VPDs.
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