Mobile phone-delivered reminders and incentives to improve childhood immunisation coverage and timeliness in Kenya (M-SIMU): a cluster randomised controlled trial

Abstract

SummaryBackgroundAs mobile phone access continues to expand globally, opportunities exist to leverage these technologies to support demand for immunisation services and improve vaccine coverage. We aimed to assess whether short message service (SMS) reminders and monetary incentives can improve immunisation uptake in Kenya.MethodsIn this cluster-randomised controlled trial, villages were randomly and evenly allocated to four groups: control, SMS only, SMS plus a 75 Kenya Shilling (KES) incentive, and SMS plus 200 KES (85 KES = USD$1). Caregivers were eligible if they had a child younger than 5 weeks who had not yet received a first dose of pentavalent vaccine. Participants in the intervention groups received SMS reminders before scheduled pentavalent and measles immunisation visits. Participants in incentive groups, additionally, received money if their child was timely immunised (immunisation within 2 weeks of the due date). Caregivers and interviewers were not masked. The proportion of fully immunised children (receiving BCG, three doses of polio vaccine, three doses of pentavalent vaccine, and measles vaccine) by 12 months of age constituted the primary outcome and was analysed with log-binomial regression and General Estimating Equations to account for correlation within clusters. This trial is registered with ClinicalTrials.gov, number NCT01878435.FindingsBetween Oct 14, 2013, and Oct 17, 2014, we enrolled 2018 caregivers and their infants from 152 villages into the following four groups: control (n=489), SMS only (n=476), SMS plus 75 KES (n=562), and SMS plus 200 KES (n=491). Overall, 1375 (86%) of 1600 children who were successfully followed up achieved the primary outcome, full immunisation by 12 months of age (296 [82%] of 360 control participants, 332 [86%] of 388 SMS only participants, 383 [86%] of 446 SMS plus 75 KES participants, and 364 [90%] of 406 SMS plus 200 KES participants). Children in the SMS plus 200 KES group were significantly more likely to achieve full immunisation at 12 months of age (relative risk 1·09, 95% CI 1·02–1·16, p=0·014) than children in the control group.InterpretationIn a setting with high baseline immunisation coverage levels, SMS reminders coupled with incentives significantly improved immunisation coverage and timeliness. Given that global immunisation coverage levels have stagnated around 85%, the use of incentives might be one option to reach the remaining 15%.FundingBill & Melinda Gates Foundation.

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.…”

Mobile phone interventions for tuberculosis should ensure access to mobile phones to enhance equity – a prospective, observational cohort study in Peruvian shantytowns

“…However, the findings of recent reviews on the potential for mobile phone interventions, including daily text message reminders, to influence patient treatment outcomes were inconclusive and the authors repeatedly highlighted the lack of high‐quality data available for analysis . Outside of TB care, a recent study in Kenya evaluating text message reminders for increasing vaccination coverage showed no increase in overall vaccination rates in the group only allocated to receive reminders . These ‘nudge’ interventions have historically been popular with policy makers partly because they are perceived to be wide‐reaching and low‐cost.…”

Mobile Phone Incentives for Childhood Immunizations in Rural India

“…In addition to providing automated mobile phone reminders and compliance-linked incentives, the platform also served as a standardized, cloud-based immunization record system that linked to positive identification (biometrics) of individual children. Unlike previous studies in which researchers restricted recruitment to young infants (≤6 weeks old), 10,11 we recruited all eligible children 24 months and younger to measure improvement in primary immunizations in young infants recruited early in their lives as well as partially immunized toddlers. This study was performed in a rural, low-income area with low literacy rates; 83.6% of mothers had no schooling.…”

“…In several studies, researchers have assessed the role of mobile messaging and/ or compliance-linked incentives to improve health indices 8 and immunizations in young children. 9 -12 Gibson et al 11 recently reported that mobile phone reminders coupled with mobile phone-delivered monetary incentives significantly improved immunization coverage and timeliness in rural western Kenya, a community with high baseline (86%) immunization coverage.…”

“…Although immunization coverage increased significantly in the intervention groups, a nonsignificant increase was also observed in the control group, consistent with observations made in similar studies. 11 The institution of electronic records reduces errors and reveals improvements in immunization coverage. 24 A recent study in a resource-limited setting also revealed that in comparison with records from written health logbooks, the direct capture of data from the source documents by using mobile devices led to higher reported immunization coverage among children.…”