Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial

Abstract

BackgroundImproved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide.ObjectiveThe objective of this study was to ascertain whether customized, automated, one-way text messaging (short message service, SMS) reminders delivered to caregivers via mobile phones when a child is due for an RI visit can improve vaccination uptake and timelines in Pakistan.MethodsThis was a randomized controlled trial, conducted in an urban squatter settlement area of Karachi, Pakistan. Infants less than 2 weeks of age with at least one family member who had a valid mobile phone connection and was comfortable receiving and reading SMS text messages were included. Participants were randomized to the intervention (standard care + one-way SMS reminder) or control (standard care) groups. The primary outcome was to compare the proportion of children immunized up to date at 18 weeks of age. Vaccine given at 6, 10, and 14 weeks schedule includes DPT-Hep-B-Hib vaccine (ie, diphtheria, pertussis, and tetanus; hepatitis B; and Haemophilus influenza type b) and oral poliovirus vaccine (OPV). Data were analyzed using chi-square tests of independence and tested for both per protocol (PP) and intention-to-treat (ITT) analyses.ResultsOut of those approached, 84.3% (300/356) of the participants were eligible for enrollment and 94.1% (318/338) of the participants had a working mobile phone. Only children in the PP analyses, who received an SMS reminder for vaccine uptake at 6 weeks visit, showed a statistically significant difference (96.0%, 86/90 vs 86.4%, 102/118; P=.03).The immunization coverage was consistently higher in the intervention group according to ITT analyses at the 6 weeks scheduled visit (76.0% vs 71.3%, P=.36). The 10 weeks scheduled visit (58.7% vs 52.7%, P=.30) and the 14 weeks scheduled visit (31.3% vs 26.0%, P=.31), however, were not statistically significant.ConclusionsAutomated simple one-way SMS reminders in local languages might be feasible for improving routine vaccination coverage. Whether one-way SMS reminders alone can have a strong impact on parental attitudes and behavior for improvement of RI coverage and timeliness needs to be further evaluated by better-powered studies and by comparing different types and content of text messages in low-and middle-income countries (LMICs).Trial RegistrationClinicalTrials.gov NCT01859546; https://clinicaltrials.gov/ct2/show/NCT01859546 (Archived by WebCite at http://www.webcitation.org/6xFr57AOc)

EPI immunization coverage, timeliness and dropout rate among children in a West Cameroon health district: a cross sectional study

“…The current study was not design to assess factors associated to low coverage but, other studies conducted in similar settings indexed parental ignorance, parental level of education, limitations due to geographical and cultural accessibility, outreach and door-to-door programs and poverty as key contributors to low immunization coverage [1][2][3]. Information and communication technology and incentives vaccination strategies for reminder has proven to be effective in improving childrens' access to EPI but have not been integrated in the routine EPI strategy [24][25][26][27][28][29]. On this note, the efficiency of these strategies should be assessed in the Cameroon context.…”

Effect of mobile phone text message reminders on improving completeness and timeliness of routine childhood vaccinations in North-West, Ethiopia: a study protocol for randomised controlled trial

“…Minimum detectable effect size (MDES): previous studies considered an effect size of 10%–20% as clinically significant and meaningful for public health decision makers 24 27 35. A priori, we selected a 15% difference among intervention and control groups as a meaningful outcome that would motivate policy makers to adapt and integrate the text message-based mHealth interventions in the existing EPI programme of Ethiopia.…”

Impacts of engaging communities through traditional and religious leaders on vaccination coverage in Cross River State, Nigeria

“…Similarly, a 2016 Cochrane review found that information, education and outreach efforts work, but that evidence for the impact of monetary incentives is limited (Oyo-Ita et al 2016). A similarly mixed picture emerges for the impact of text message reminders on immunisation outcomes, and leads to the conclusion that there is limited high-quality evidence especially from low-and middle-income countries (Oliver-Williams et al 2017) and a call for better-powered studies (Kazi et al 2018).…”