Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia

Abstract

Background Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message–based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. Objective This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. Methods A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. Results A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants. Conclusions Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. Trial Registration Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839

Parental Reminder Strategies and the Cost Implication for Improved Immunisation Outcomes: A Systematic Review and Meta-Analysis

“…A total of 54,224 parents were recruited as participants in all the studies and numbers ranged from 42 in the study of Niederhauser et al [ 26 ] to 13,000 in the study of Busso et al [ 27 ]. In almost all the studies, participants were reportedly mothers or caregivers of the children [ 7 , 9 , 12 , 13 , 15 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 43 , 44 ]. Two studies reportedly mentioned males as participants, Hofstetter et al [ 39 ] reported a nearly even distribution of participants, male (1051) and females (1003) and Niederhauser et al [ 26 ] reported only one male participant in their study.…”

“…Twenty-four studies were included in the review to evaluated parental reminder or recall strategies for improved immunisation. Out of the 24 studies, 19 [ 9 , 13 , 15 , 26 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] provided sufficient information and were therefore included for meta-analysis. The 19 studies assess five different parental reminder/recall strategies on two major immunisation outcomes: coverage and timeliness of immunisation among children.…”

“…Measles, for example, accounted for over 140,000 childhood deaths in 2018 alone, and within three years, immunisation against measles prevented over 23 million childhood deaths [ 8 ]. Accordingly, childhood vaccinations effectively prevent about 22% of death from all causes of infectious diseases in children [ 9 ].…”

“…Active parental involvement in immunisation services is one of the most significant challenges to adequate immunisation coverage [ 11 ]. Several factors impede the active involvement of parents in immunisation services, they are negligence, acceptance, attitudes and forgetfulness [ 9 , 11 ]. Of these factors, evidence suggests that forgetfulness of scheduled vaccination appointments is the most prevalent of the impeding factors [ 12 , 13 ].…”

A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study

“…Health information technology tools, including health care mobile apps for use on a personal smartphone or desktop computer, have been demonstrated to be a sustainable strategy for facilitating patient provider communication, disseminating high-quality evidence-based information to end users on a global scale, increasing adherence to medical regimens and tracking when medical interventions are due, and improving outcomes in chronic illnesses [8][9][10][11][12]. mHealth (mobile health) apps have been successfully created and implemented to facilitate immunization delivery [13][14][15][16][17][18][19][20]. However, mHealth apps have never been utilized to improve immunization rates in high-risk populations (such as children awaiting transplant) who require a tailored vaccine schedule (such as the accelerated vaccine schedule) and comanagement by multiple providers (including the primary care physician and transplant team) who in turn may operate on different electronic medical records (EMRs).…”