Use of mobile phones for improving vaccination coverage among children living in rural hard-to-reach areas and urban streets of Bangladesh

Abstract

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.

Immunization, urbanization and slums – a systematic review of factors and interventions

“…Frequency of attendance at GMP+ services significantly associated with higher coverage (OR 1.27, P  < 0.001)Sasaki, 2011 [90]“““Before and after cross-sectional surveysChildren in one slum area of 48.798 people (one of the 4 areas included in the above study).280 sampled households.DPT3 increased 75.7% (bf) to 87.3% (aft) and measles from 66.8% (bf) to 76.1% (aft).Closer distances to imms service points significantly associated with higher coverage, and impact of this reduced with GMP+ outreach services.Ansari, 2010 [78]India(Aligarh City)OutreachImmunisation outreach campsCross-sectionalChildren <5 in slum areas of Aligarh City253113,989 vaccines administered to the 2531 children attending services.Population coverage not reported. Significantly lower imms coverage observed in female children attending.Prabhakaran, 2014 [80]India(New Delhi)OutreachMobile health clinicEconomic EvaluationChildren <5 years living in Dakshinpuri extension resettlement colony.1583 children attending the clinic in 1 year.1583 children received 8488 vaccinations through the service at a cost of 66.14 Rupees per vaccine (US$0.10)Imms services provided alongside a range of other health services.Uddin, 2016 [89]Bangladesh(Dhaka)Reminder/ recallSMS (text) message reminders managed using mTika software system.Before and afterBoth children aged 0–11 months in hard-to-reach rural areas and urban street children in slums.2823 urban street children (intervention 518 bf and 520 aft, with 1785 controls)Urban intervention: 40.7% (bf) to 57.1% (aft) compared to controls 44.5% (bf) to 33.9% (aft).Adjusted OR = 3.0 (95% CI 1.4–6.4). Decline in control population imms coverage also noted in rural population (not shown here).Kazi, 2014 [83]Pakistan(Karachi)Reminder/ recallSMS (text) message monitoring of immunisation activities.Cross-sectional20 clusters of 200–250 households in 3 high polio risk areas.28 households with children under 5 in each cluster.Coverage in population who replied to messages was 74.5% (95% CI 71.6–77.4) which was very similar to result found using WHO lot quality assurance sampling.Text messages sent to parents to confirm if immunization staff had visited and vaccinated child.…”

Educating parents about the vaccination status of their children: A user-centered mobile application

“…The visual clues of the App help parents to see where they are in the process, to keep appointments and to prevent unnecessary delays in immunizations (Hofstetter et al, 2015, Jordan et al, 2015, Uddin et al, 2016, Schlumberger et al, 2015). At the same time parents generate important information to be stored on their smartphones, which may be helpful at any time when the vaccination record may not be at hand.…”

Effectiveness of a smartphone app to increase parents' knowledge and empowerment in the MMR vaccination decision: A randomized controlled trial

“…1,4,5 Their range of application is extremely wide and, more recently, they have made an appearance for vaccination-related purposes as well. Immunization apps include features: they can provide information on different vaccinations and on disease activity in a given area, [6][7][8] calculate one's risk of catching a disease, 9 offer a reminder about vaccines, 7,[10][11][12][13] and track, record and update immunization information. 14 The Immunization Action Coalition (IAC) lists 19 free immunization apps directed either to healthcare/immunization providers or to patients/parents and offered by recognized institutions, 15 but a search with the keyword "vaccin à " on Google Play generates as many as 249 results.…”