In Bangladesh, full vaccination rates among children living in rural
hard-to-reach areas and urban streets are low. We conducted a quasi-experimental
pre-post study of a 12-month mobile phone intervention to improve vaccination
among 0–11 months old children in rural hard-to-reach and urban street
dweller areas. Software named “mTika” was employed within the
existing public health system to electronically register each child’s
birth and remind mothers about upcoming vaccination dates with text messages.
Android smart phones with mTika were provided to all health
assistants/vaccinators and supervisors in intervention areas, while mothers used
plain cell phones already owned by themselves or their families. Pre and
post-intervention vaccination coverage was surveyed in intervention and control
areas. Among children over 298 days old, full vaccination coverage actually
decreased in control areas – rural baseline 65.9% to endline 55.2% and
urban baseline 44.5% to endline 33.9% – while increasing in intervention
areas from rural baseline 58.9% to endline 76*8%, difference +18.8% (95% CI
5.7–31.9) and urban baseline 40.7% to endline 57.1%, difference +16.5%
(95% CI 3.9–29.0). Difference-in-difference (DID) estimates were +29.5%
for rural intervention versus control areas and +27.1% for urban areas for full
vaccination in children over 298 days old, and logistic regression adjusting for
maternal education, mobile phone ownership, and sex of child showed intervention
effect odds ratio (OR) of 3.8 (95% CI 1.5–9.2) in rural areas and 3.0
(95% CI 1.4–6.4) in urban areas. Among all age groups, intervention
effects on age-appropriate vaccination coverage were positive: DIDs
+13.1–30.5% and ORs 2.5–4.6 (p < 0.001 in
all comparisons). Qualitative data showed the intervention was well-accepted.
Our study demonstrated that a mobile phone intervention can improve vaccination
coverage in rural hard-to-reach and urban street dweller communities in
Bangladesh. This small-scale successful demonstration should serve as an example
to other low-income countries with high mobile phone usage.
BackgroundMobile health (mHealth) approaches for non-communicable disease (NCD) care seem particularly applicable to sub-Saharan Africa given the penetration of mobile phones in the region. The evidence to support its implementation has not been critically reviewed.MethodsWe systematically searched PubMed, Embase, Web of Science, Cochrane Central Register of Clinical Trials, a number of other databases, and grey literature for studies reported between 1992 and 2012 published in English or with an English abstract available. We extracted data using a standard form in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsOur search yielded 475 citations of which eleven were reviewed in full after applying exclusion criteria. Five of those studies met the inclusion criteria of using a mobile phone for non-communicable disease care in sub-Saharan Africa. Most studies lacked comparator arms, clinical endpoints, or were of short duration. mHealth for NCDs in sub-Saharan Africa appears feasible for follow-up and retention of patients, can support peer support networks, and uses a variety of mHealth modalities. Whether mHealth is associated with any adverse effect has not been systematically studied. Only a small number of mHealth strategies for NCDs have been studied in sub-Saharan Africa.ConclusionsThere is insufficient evidence to support the effectiveness of mHealth for NCD care in sub-Saharan Africa. We present a framework for cataloging evidence on mHealth strategies that incorporates health system challenges and stages of NCD care. This framework can guide approaches to fill evidence gaps in this area. Systematic review registration: PROSPERO CRD42014007527.
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