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Gilano G, Sako S, Molla B, Dekker A, Fijten R. The effect of mHealth on childhood vaccination in Africa: A systematic review and meta-analysis. PLoS One 2024; 19:e0294442. [PMID: 38381753 PMCID: PMC10880990 DOI: 10.1371/journal.pone.0294442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/31/2023] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Vaccine-preventable diseases are the public health problems in Africa, although vaccination is an available, safe, simple, and effective method prevention. Technologies such as mHealth may provide maternal access to health information and support decisions on childhood vaccination. Many studies on the role of mHealth in vaccination decisions have been conducted in Africa, but the evidence needs to provide conclusive information to support mHealth introduction. This study provides essential information to assist planning and policy decisions regarding the use of mHealth for childhood vaccination. METHODS We conducted a systematic review and meta-analysis for studies applying mHealth in Africa for vaccination decisions following the Preferred Reporting Items for Systematic and Meta-Analysis [PRISMA] guideline. Databases such as CINAHL, EMBASE, PubMed, PsycINFO, Scopus, Web of Science, Google Scholar, Global Health, HINARI, and Cochrane Library were included. We screened studies in Endnote X20 and performed the analysis using Revman 5.4.1. RESULTS The database search yielded 1,365 articles [14 RCTs and 4 quasi-experiments] with 21,070 participants satisfied all eligibility criteria. The meta-analysis showed that mHealth has an OR of 2.15 [95% CI: 1.70-2.72; P<0.001; I2 = 90%] on vaccination rates. The subgroup analysis showed that regional differences cause heterogeneity. Funnel plots and Harbord tests showed the absence of publication bias, while the GRADE scale showed a moderate-quality body of evidence. CONCLUSION Although heterogeneous, this systematic review and meta-analysis showed that the application of mHealth could potentially improve childhood vaccination in Africa. It increased childhood vaccination by more than double [2.15 times] among children whose mothers are motivated by mHealth services. MHealth is more effective in less developed regions and when an additional incentive party with the messaging system. However, it can be provided at a comparably low cost based on the development level of regions and can be established as a routine service in Africa. REGISTRATION PROSPERO: CRD42023415956.
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Affiliation(s)
- Girma Gilano
- Department of Public Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Sewunet Sako
- Department of Public Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Berihun Molla
- Department of Public Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Andre Dekker
- Department of Radiation Oncology [Maastro], GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rianne Fijten
- Department of Radiation Oncology [Maastro], GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Oyo-Ita A, Oduwole O, Arikpo D, Effa EE, Esu EB, Balakrishna Y, Chibuzor MT, Oringanje CM, Nwachukwu CE, Wiysonge CS, Meremikwu MM. Interventions for improving coverage of childhood immunisation in low- and middle-income countries. Cochrane Database Syst Rev 2023; 12:CD008145. [PMID: 38054505 PMCID: PMC10698843 DOI: 10.1002/14651858.cd008145.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Immunisation plays a major role in reducing childhood morbidity and mortality. Getting children immunised against potentially fatal and debilitating vaccine-preventable diseases remains a challenge despite the availability of efficacious vaccines, particularly in low- and middle-income countries. With the introduction of new vaccines, this becomes increasingly difficult. There is therefore a current need to synthesise the available evidence on the strategies used to bridge this gap. This is a second update of the Cochrane Review first published in 2011 and updated in 2016, and it focuses on interventions for improving childhood immunisation coverage in low- and middle-income countries. OBJECTIVES To evaluate the effectiveness of intervention strategies to boost demand and supply of childhood vaccines, and sustain high childhood immunisation coverage in low- and middle-income countries. SEARCH METHODS We searched CENTRAL, MEDLINE, CINAHL, and Global Index Medicus (11 July 2022). We searched Embase, LILACS, and Sociological Abstracts (2 September 2014). We searched WHO ICTRP and ClinicalTrials.gov (11 July 2022). In addition, we screened reference lists of relevant systematic reviews for potentially eligible studies, and carried out a citation search for 14 of the included studies (19 February 2020). SELECTION CRITERIA Eligible studies were randomised controlled trials (RCTs), non-randomised RCTs (nRCTs), controlled before-after studies, and interrupted time series conducted in low- and middle-income countries involving children that were under five years of age, caregivers, and healthcare providers. DATA COLLECTION AND ANALYSIS We independently screened the search output, reviewed full texts of potentially eligible articles, assessed the risk of bias, and extracted data in duplicate, resolving discrepancies by consensus. We conducted random-effects meta-analyses and used GRADE to assess the certainty of the evidence. MAIN RESULTS Forty-one studies involving 100,747 participants are included in the review. Twenty studies were cluster-randomised and 15 studies were individually randomised controlled trials. Six studies were quasi-randomised. The studies were conducted in four upper-middle-income countries (China, Georgia, Mexico, Guatemala), 11 lower-middle-income countries (Côte d'Ivoire, Ghana, Honduras, India, Indonesia, Kenya, Nigeria, Nepal, Nicaragua, Pakistan, Zimbabwe), and three lower-income countries (Afghanistan, Mali, Rwanda). The interventions evaluated in the studies were health education (seven studies), patient reminders (13 studies), digital register (two studies), household incentives (three studies), regular immunisation outreach sessions (two studies), home visits (one study), supportive supervision (two studies), integration of immunisation services with intermittent preventive treatment of malaria (one study), payment for performance (two studies), engagement of community leaders (one study), training on interpersonal communication skills (one study), and logistic support to health facilities (one study). We judged nine of the included studies to have low risk of bias; the risk of bias in eight studies was unclear and 24 studies had high risk of bias. We found low-certainty evidence that health education (risk ratio (RR) 1.36, 95% confidence interval (CI) 1.15 to 1.62; 6 studies, 4375 participants) and home-based records (RR 1.36, 95% CI 1.06 to 1.75; 3 studies, 4019 participants) may improve coverage with DTP3/Penta 3 vaccine. Phone calls/short messages may have little or no effect on DTP3/Penta 3 vaccine uptake (RR 1.12, 95% CI 1.00 to 1.25; 6 studies, 3869 participants; low-certainty evidence); wearable reminders probably have little or no effect on DTP3/Penta 3 uptake (RR 1.02, 95% CI 0.97 to 1.07; 2 studies, 1567 participants; moderate-certainty evidence). Use of community leaders in combination with provider intervention probably increases the uptake of DTP3/Penta 3 vaccine (RR 1.37, 95% CI 1.11 to 1.69; 1 study, 2020 participants; moderate-certainty evidence). We are uncertain about the effect of immunisation outreach on DTP3/Penta 3 vaccine uptake in children under two years of age (RR 1.32, 95% CI 1.11 to 1.56; 1 study, 541 participants; very low-certainty evidence). We are also uncertain about the following interventions improving full vaccination of children under two years of age: training of health providers on interpersonal communication skills (RR 5.65, 95% CI 3.62 to 8.83; 1 study, 420 participants; very low-certainty evidence), and home visits (RR 1.29, 95% CI 1.15 to 1.45; 1 study, 419 participants; very low-certainty evidence). The same applies to the effect of training of health providers on interpersonal communication skills on the uptake of DTP3/Penta 3 by one year of age (very low-certainty evidence). The integration of immunisation with other services may, however, improve full vaccination (RR 1.29, 95% CI 1.16 to 1.44; 1 study, 1700 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Health education, home-based records, a combination of involvement of community leaders with health provider intervention, and integration of immunisation services may improve vaccine uptake. The certainty of the evidence for the included interventions ranged from moderate to very low. Low certainty of the evidence implies that the true effect of the interventions might be markedly different from the estimated effect. Further, more rigorous RCTs are, therefore, required to generate high-certainty evidence to inform policy and practice.
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Affiliation(s)
- Angela Oyo-Ita
- Department of Community Health, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Olabisi Oduwole
- Department of Medical Laboratory Science, Achievers University, Owo, Nigeria
| | - Dachi Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Emmanuel E Effa
- Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Ekpereonne B Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Yusentha Balakrishna
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Moriam T Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Chioma M Oringanje
- GIDP Entomology and Insect Science, University of Tucson, Tucson, Arizona, USA
| | | | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Cité du Djoué, Brazzaville, Congo
| | - Martin M Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
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Sánchez-Páez DA, Masquelier B, Menashe-Oren A, Baruwa OJ, Reniers G. Measuring under-5 mortality and fertility through mobile phone surveys: an assessment of selection bias in 34 low-income and middle-income countries. BMJ Open 2023; 13:e071791. [PMID: 37977863 PMCID: PMC10693685 DOI: 10.1136/bmjopen-2023-071791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aims to assess sample selection bias in mobile phone survey estimates of fertility and under-5 mortality. DESIGN With data from the Demographic and Health Surveys, we use logistic regressions to identify sociodemographic correlates of mobile phone ownership and access, and Poisson regressions to estimate the association between mobile phone ownership (or access) and fertility and under-5 mortality estimates. We evaluate the potential reasons why estimates by mobile phone ownership differ using a set of behavioural characteristics. SETTING 34 low-income and middle-income countries, mostly in sub-Saharan Africa. PARTICIPANTS 534 536 women between the ages of 15 and 49. OUTCOME MEASURES Under-5 mortality rate (U5MR) and total fertility rate (TFR). RESULTS Mobile phone ownership ranges from 23.6% in Burundi to 96.7% in Armenia. The median TFR ratio and U5MR ratio between the non-owners and the owners of a mobile phone are 1.48 and 1.29, respectively. Fertility and mortality rates would be biased downwards if estimates are only based on women who own or have access to mobile phones. Estimates of U5MR can be adjusted through poststratification using age, educational level, area of residence, wealth and marital status as weights. However, estimates of TFR remain biased even after adjusting for these covariates. This difference is associated with behavioural factors (eg, contraceptive use) that are not captured by the poststratification variables, but for which there are also differences between mobile phone owners and non-owners. CONCLUSIONS Mobile phone surveys need to collect data on sociodemographic background characteristics to be able to weight and adjust mortality estimates ex post facto. Fertility estimates from mobile phone surveys will be biased unless further research uncovers the mechanisms driving the bias.
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Affiliation(s)
- David A Sánchez-Páez
- Department of Economics, Universidad de Valladolid, Valladolid, Spain
- Centre for Demographic Research, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Bruno Masquelier
- Centre for Demographic Research, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Ashira Menashe-Oren
- Centre for Demographic Research, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Ololade Julius Baruwa
- Centre for Demographic Research, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Georges Reniers
- Population Studies Group, London School of Hygiene and Tropical Medicine, London, UK
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Shaikh M, Ota E, Van Gestel R. Childhood Immunization and Competing Mortality Risks in Kenya: A Longitudinal Analysis for Multiparous Mothers. J Pediatr 2023; 262:113590. [PMID: 37419239 DOI: 10.1016/j.jpeds.2023.113590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE To assess the relationship between childhood immunization and mortality risks for nonvaccine-preventable diseases (competing mortality risks, or CMR) in Kenya. STUDY DESIGN A combination of the Global Burden of Disease and Demographic Health Survey data was used to measure basic vaccination status, CMR, and control variables for each child in the Demographic Health Survey data. A longitudinal analysis was performed. This uses within-mother variation between children to compare the vaccine decisions for different children, who are exposed to different mortality risks. The analysis also distinguishes between overall and disease-specific risks. RESULTS The study included 15 881 children born between 2009 and 2013, who were at least 12 months old at the time of interview and not part of a twin birth. Mean basic vaccination rates ranged from 27.1% to 90.2% and mean CMR from 13.00 to 738.32 deaths per 100 000 across different counties. A one-unit increase in mortality risk from diarrhea, the most prevalent disease among children in Kenya, is associated with a 1.1 percentage point decline in basic vaccination status. In contrast, mortality risks for other diseases and HIV increase the likelihood of vaccination. The effect of CMR was found to be stronger for children with higher birth orders. CONCLUSIONS A significant negative correlation between severe CMR and vaccination status was found, which has important implications for immunization policies, particularly in Kenya. Interventions aimed at reducing the most severe CMR, such as diarrhea, and targeted toward multiparous mothers may improve childhood immunization coverage.
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Affiliation(s)
| | - Elsa Ota
- Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| | - Raf Van Gestel
- Erasmus School of Health Policy and Management, Erasmus School of Economics, Rotterdam, The Netherlands.
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Karkonasasi K, Cheah YN, Vadiveloo M, Mousavi SA. Acceptance of a Text Messaging Vaccination Reminder and Recall System in Malaysia's Healthcare Sector: Extending the Technology Acceptance Model. Vaccines (Basel) 2023; 11:1331. [PMID: 37631899 PMCID: PMC10458098 DOI: 10.3390/vaccines11081331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Malaysian healthcare institutions still use ineffective paper-based vaccination systems to manage childhood immunization schedules. This may lead to missed appointments, incomplete vaccinations, and outbreaks of preventable diseases among infants. To address this issue, a text messaging vaccination reminder and recall system named Virtual Health Connect (VHC) was studied. VHC simplifies and accelerates immunization administration for nurses, which may result in improving the completion and timeliness of immunizations among infants. Considering the limited research on the acceptance of these systems in the healthcare sector, we examined the factors influencing nurses' attitudes and intentions to use VHC using the extended technology acceptance model (TAM). The novelty of the conceptual model is the incorporation of new predictors of attitude, namely, perceived compatibility and perceived privacy and security issues. We conducted a survey among 121 nurses in Malaysian government hospitals and clinics to test the model. We analyzed the collected data using partial least squares structural equation modeling (PLS-SEM) to examine the significant factors influencing nurses' attitudes and intentions to use VHC. Moreover, we applied an artificial neural network (ANN) to determine the most significant factors of acceptance with higher accuracy. Therefore, we could offer more accurate insights to decision-makers in the healthcare sector for the advancement of health services. Our results highlighted that the compatibility of VHC with the current work setting of nurses developed their positive perspectives on the system. Moreover, the nurses felt optimistic about the system when they considered it useful and easy to use in the workplace. Finally, their attitude toward using VHC played a pivotal role in increasing their intention to use it. Based on the ANN models, we also found that perceived compatibility was the most significant factor influencing nurses' attitudes towards using VHC, followed by perceived ease of use and perceived usefulness.
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Affiliation(s)
- Kamal Karkonasasi
- School of Computer Sciences, Universiti Sains Malaysia, USM Penang 11800, Malaysia;
| | - Yu-N Cheah
- School of Computer Sciences, Universiti Sains Malaysia, USM Penang 11800, Malaysia;
| | - Mogana Vadiveloo
- Faculty of Information and Communication Technology, Universiti Tunku Abdul Rahman, Kampar 31900, Malaysia;
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Yau IB, Zubair Mustapha M, Nwaze E, Nobila O, Maigoro A, Abdullah A, Gamawa A, Meissner P, Albrecht J, Müller O. Improving the timeliness and completeness of childhood vaccination through color-coded bracelets: a pilot study among Fulani tribe populations in Nigeria. J Public Health Afr 2023; 14:2079. [PMID: 37441119 PMCID: PMC10334432 DOI: 10.4081/jphia.2023.2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 07/03/2022] [Indexed: 07/15/2023] Open
Abstract
Background Childhood immunization remains one of the most cost-effective public health interventions. Globally, millions of children are not being reached with safe and effective vaccines and Nigeria has the highest number of unprotected children. Objective The effects of locally adapted interventions on vaccination timeliness and completeness were studied amongst Fulani populations across 6 health facilities in 2 districts of Bauchi State, Nigeria. Methods The intervention group consisted of newborns who received 5-color-coded bracelets representing different immunization contacts, while the control group had no bracelets. Vaccination rates across contacts were followed for 11 months. In addition, mothers of children in the intervention group were voluntarily recruited as peer-to-peer mobilizers (PPM). Results In this study, 435 children were studied. Vaccination completeness was higher in the intervention group compared to the control group at all contacts during follow-up. The difference was most noticeable at the fifth contact, with 158/256 (62%) children in the intervention group completing, compared to 73/179 (41%) in the control group (P<0.0001). Vaccination timeliness was better in the intervention group compared to the control one, which reached statistical significance at the second and third vaccination contacts (P<0.05). 68% of women volunteered as PPM and recruited 82 additional children for vaccination. Conclusion This study demonstrated the feasibility of a composite intervention (bracelets and PPM) to increase the completeness and timeliness of childhood immunization and provided preliminary evidence for its efficacy among Fulani populations in Nigeria. Findings from this pilot study should be confirmed through a larger cluster randomized controlled trial.
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Affiliation(s)
- Inuwa Barau Yau
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | - Eric Nwaze
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | | | - Adamu Abdullah
- Bauchi State Primary Health Care Development Agency, Bauchi, Nigeria
| | - Adamu Gamawa
- Bauchi State Primary Health Care Development Agency, Bauchi, Nigeria
| | - Peter Meissner
- Department of Pediatrics and Adolescent Medicine, Ulm University, Germany
| | - Jahn Albrecht
- Institute of Global Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
| | - Olaf Müller
- Institute of Global Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
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Ostermann J, Hair NL, Moses S, Ngadaya E, Godfrey Mfinanga S, Brown DS, Noel Baumgartner J, Vasudevan L. Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania. Vaccine X 2023; 13:100266. [PMID: 36814594 PMCID: PMC9939728 DOI: 10.1016/j.jvacx.2023.100266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/03/2022] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Background Globally, approximately 19.7 million children remain under-vaccinated; many more receive delayed vaccinations. Sustained progress towards global vaccination targets requires overcoming, or compensating for, incrementally greater barriers to vaccinating hard-to-reach and hard-to-vaccinate children. We prospectively assessed pregnant women's valuations of routine childhood vaccinations and preferences for alternative incentives to inform interventions aiming to increase vaccination coverage and timeliness in southern Tanzania. Methods Between August and December 2017, 406 women in their last trimester of pregnancy were enrolled from health facilities and communities in the Mtwara region of Tanzania and asked contingent valuation questions about their willingness to vaccinate their child if they were (a) given an incentive, or (b) facing a cost for each vaccination. Interval censored regressions assessed correlates of women's willingness to pay (WTP) for timely vaccinations. Participants were asked to rank monetary and non-monetary incentive options for the timely vaccination of their children. Findings All women expected to get their children vaccinated according to the recommended schedule, even without incentives. Nearly all women (393; 96.8 %) were willing to pay for vaccinations. The average WTP was Tanzania Shilling (Tsh) 3,066 (95 % confidence interval Tsh 2,523-3,610; 1 USD ∼ Tsh 2,200) for each vaccination. Women's valuations of timely vaccinations varied significantly with vaccine-related knowledge and attitudes, economic status, and rural vs urban residence. Women tended to prefer non-monetary over monetary incentives for the timely vaccination of their children. Interpretation Women placed a high value on timely childhood vaccinations, suggesting that unexpected system-level barriers rather than individual-level demand factors are likely to be the primary drivers of missed vaccinations. Systematic variation in the value of vaccinations across women reflects variation in perceived benefits and opportunity costs. In this setting, nonmonetary incentives and other interventions to increase demand and compensate for system-level barriers hold significant potential for improving vaccination coverage and timeliness. ClinicalTrialsgov Protocol NCT03252288.
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Affiliation(s)
- Jan Ostermann
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Corresponding author at: Arnold School of Public Health, 915 Greene St. #351, Columbia, SC 29208, USA.
| | - Nicole L. Hair
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sara Moses
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
| | - Sayoki Godfrey Mfinanga
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, United Republic of Tanzania
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, United Republic of Tanzania
- School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, United Republic of Tanzania
| | - Derek S. Brown
- Brown School of Social Work, Washington University in Saint Louis, St. Louis, MO, USA
| | - Joy Noel Baumgartner
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lavanya Vasudevan
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Obi-Jeff C, Garcia C, Adewumi F, Bamiduro T, David W, Labrique A, Wonodi C. Implementing SMS reminders for routine immunization in Northern Nigeria: a qualitative evaluation using the RE-AIM framework. BMC Public Health 2022; 22:2370. [PMID: 36528596 PMCID: PMC9758467 DOI: 10.1186/s12889-022-14822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Short Message Service (SMS) reminders have improved vaccine uptake in low- and middle-income countries (LMICs). However, the limited use of SMS reminders in LMICs requires evaluating the intervention's internal and external validity to improve adoption and sustainability. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we qualitatively assessed the impact of a SMS reminder intervention implemented in Kebbi State, Northwest Nigeria between May 20, 2019 and May 31, 2020. This will guide and inform future SMS reminder interventions to improve childhood immunization uptake in LMICs. METHODS In June 2020, we conducted 14 focus group discussions, 13 in-depth interviews, and 20 key informant interviews among 144 purposively selected participants from five local government areas of Kebbi State. For analysis, we used a deductive approach to develop preliminary codes based on the RE-AIM framework and the inductive approach to generate themes that emerged from the interviews. RESULTS The perceived importance and impact of the SMS reminder in improving demand and uptake for vaccinations were the consistent contributing factors that encouraged participants' participation. Other facilitators included the involvement of health workers in supporting SMS reminder registration and community gatekeepers using existing structures to convey messages on scheduled immunization services. Policymakers adopted the intervention because it aligns with the state's priority to improve immunization coverage. Similarly, the SMS reminder appealed to health workers and program managers because it reduced their workload and served as a performance monitoring tool to track immunization and intervention defaulters. Despite these, low mobile phone ownership and the inability to read text messages due to the low literacy level were the main barriers during implementation. Finally, data availability on cost-effectiveness and the intervention's impact on improving coverage was critical for scalability. CONCLUSIONS Our study demonstrated that SMS reminders in local languages could improve vaccination demand and uptake in resource-constrained settings due to their perceived importance and impact. Addressing the cited implementation barriers and promoting the facilitators is critical to its adoption and sustainability. Costing and impact data are needed to collaborate findings on the effectiveness of the SMS reminder to improve childhood vaccination uptake.
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Affiliation(s)
- Chisom Obi-Jeff
- Department of Research, Direct Consulting and Logistics Limited, Federal Capital Territory, Abuja, Nigeria
| | - Cristina Garcia
- grid.21107.350000 0001 2171 9311Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health Baltimore, Baltimore, MD USA
| | - Funmi Adewumi
- Department of Research, Direct Consulting and Logistics Limited, Federal Capital Territory, Abuja, Nigeria
| | - Tobi Bamiduro
- Department of Research, Direct Consulting and Logistics Limited, Federal Capital Territory, Abuja, Nigeria
| | - Winnie David
- Department of Research, Direct Consulting and Logistics Limited, Federal Capital Territory, Abuja, Nigeria
| | - Alain Labrique
- grid.21107.350000 0001 2171 9311Department of International Health and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, Baltimore, MD USA
| | - Chizoba Wonodi
- grid.21107.350000 0001 2171 9311Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health Baltimore, Baltimore, MD USA
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Rezaei SJ, de Walque D, Mateen FJ. Conditional cash transfers to improve health-focused outcomes: a global scoping review. Glob Public Health 2022; 17:3368-3385. [PMID: 35727705 DOI: 10.1080/17441692.2022.2092186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This scoping review assesses the use of conditional cash transfer (CCT) interventions - direct distribution of money to individuals conditional on their compliance to certain requirements - in randomised controlled trials, quasi-experimental studies and large community-based randomised trials with health-focused outcomes. Five databases were searched to identify 68 records published 2004-2021 from 25 countries (8 low- (32%), 5 lower middle- (20%), 6 upper middle- (24%) and 6 high-income (24%), according to the World Bank Categorisation (2017). Forty-six studies were unique (after excluding multiple publications on a single study). The most common outcomes assessed were infectious diseases (30%); maternal health (24%); vaccination rates (17%); and childhood developmental measures (17%). The number of participants receiving CCT in each study ranged from 47 to 5,788, with a median of 487 individuals. The number of total participants ranged from 72 to 14,000, with a median of 1,289 individuals. Fifteen percent of studies involved mobile CCT disbursement. More than a quarter of payments were greater than 50 USD (29%), and most payments were 20 USD or less (58%). Seventy-eight percent of unique full-length studies reported statistically significant CCT effects. Although CCTs remain controversial, a growing evidence base is emerging for their potential impact in specific health conditions.
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Affiliation(s)
- Shawheen J Rezaei
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
| | | | - Farrah J Mateen
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
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Wariri O, Okomo U, Kwarshak YK, Utazi CE, Murray K, Grundy C, Kampmann B. Timeliness of routine childhood vaccination in 103 low-and middle-income countries, 1978-2021: A scoping review to map measurement and methodological gaps. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000325. [PMID: 36962319 PMCID: PMC10021799 DOI: 10.1371/journal.pgph.0000325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Abstract
Empiric studies exploring the timeliness of routine vaccination in low-and middle-income countries (LMICs) have gained momentum in the last decade. Nevertheless, there is emerging evidence suggesting that these studies have key measurement and methodological gaps that limit their comparability and utility. Hence, there is a need to identify, and document these gaps which could inform the design, conduct, and reporting of future research on the timeliness of vaccination. We synthesised the literature to determine the methodological and measurement gaps in the assessment of vaccination timeliness in LMICs. We searched five electronic databases for peer-reviewed articles in English and French that evaluated vaccination timeliness in LMICs, and were published between 01 January 1978, and 01 July 2021. Two reviewers independently screened titles and abstracts and reviewed full texts of relevant articles, following the guidance framework for scoping reviews by the Joanna Briggs Institute. From the 4263 titles identified, we included 224 articles from 103 countries. China (40), India (27), and Kenya (23) had the highest number of publications respectively. Of the three domains of timeliness, the most studied domain was 'delayed vaccination' [99.5% (223/224)], followed by 'early vaccination' [21.9% (49/224)], and 'untimely interval vaccination' [9% (20/224)]. Definitions for early (seven different definitions), untimely interval (four different definitions), and delayed vaccination (19 different definitions) varied across the studies. Most studies [72.3% (166/224)] operationalised vaccination timeliness as a categorical variable, compared to only 9.8% (22/224) of studies that operationalised timeliness as continuous variables. A large proportion of studies [47.8% (107/224)] excluded the data of children with no written vaccination records irrespective of caregivers' recall of their vaccination status. Our findings show that studies on vaccination timeliness in LMICs has measurement and methodological gaps. We recommend the development and implement of guidelines for measuring and reporting vaccination timeliness to bridge these gaps.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Chigozie Edson Utazi
- WorldPop, School of geography and Environmental Science, University of Southampton, Southampton, United Kingdom
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Kris Murray
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- MRC Centre for Global Infectious Disease Analysis, Imperial College School of Public Health, Imperial College London, London, United Kingdom
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Keddy KH, Saha S, Kariuki S, Kalule JB, Qamar FN, Haq Z, Okeke IN. Using big data and mobile health to manage diarrhoeal disease in children in low-income and middle-income countries: societal barriers and ethical implications. THE LANCET INFECTIOUS DISEASES 2022; 22:e130-e142. [DOI: 10.1016/s1473-3099(21)00585-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022]
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Venkataramanan R, Subramanian S, Alajlani M, Arvanitis TN. Effect of mobile health interventions in increasing utilization of Maternal and Child Health care services in developing countries: A scoping review. Digit Health 2022; 8:20552076221143236. [DOI: 10.1177/20552076221143236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/17/2022] [Indexed: 12/15/2022] Open
Abstract
Background Mobile health (mHealth) technology is being used predominantly in low- and middle-income countries. Developing countries with low level of investment in health infrastructure can augment existing capacity by adopting low-cost affordable technology. The aim of the review was to summarize the available evidence on mHealth interventions that aimed at increasing the utilization of Maternal and Child Health (MCH) care services. Further, this review investigated the barriers which prevent the use of mHealth among both health care workers as well as beneficiaries. Methodology A scoping review of literature was undertaken using the five-stage framework developed by Arksey and O’Malley. The articles published between 1990 and 2021 were retrieved from three databases (PubMed, Cochrane Reviews, and Google Scholar) and grey literature for this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was followed to present the findings. Result A total of 573 studies were identified. After removing duplicates, studies not related to mHealth and MCH and publications of systematic reviews and protocols for studies, a total of 28 studies were selected for review. The study design of the research articles which appeared during the search process were mostly observational, cross-sectional, and randomized controlled trials (RCTs). We have classified the studies into four categories based on the outcomes for which the mHealth intervention was implemented: MCH care services, child immunization, nutrition services, and perceptions of stakeholders toward using technology for improving MCH outcomes. Conclusion This brief review concludes that mHealth interventions can improve access to MCH services. However, further studies based on large sample size and strong research design are recommended.
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Affiliation(s)
- Ramachandran Venkataramanan
- Institute of Digital Healthcare, WMG – The University of Warwick, Coventry, USA
- Research Division, Karkinos Healthcare, Mumbai, India
| | - S.V. Subramanian
- Harvard Center for Population & Development Studies, Cambridge, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mohannad Alajlani
- Institute of Digital Healthcare, WMG – The University of Warwick, Coventry, USA
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OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022; 116:686-693. [DOI: 10.1093/trstmh/trac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/17/2021] [Accepted: 02/13/2022] [Indexed: 11/13/2022] Open
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van Heemskerken PG, Decouttere CJ, Broekhuizen H, Vandaele NJ. Understanding the complexity of demand-side determinants on vaccine uptake in sub-Saharan Africa. Health Policy Plan 2021; 37:281-291. [PMID: 34918093 DOI: 10.1093/heapol/czab139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/28/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Routine vaccination annually prevents millions of deaths worldwide but is underutilized in sub-Saharan Africa (SSA). The complexity of socio-cultural factors impacting vaccine uptake is not well understood. Hence, this paper aims to review the socio-cultural determinants of vaccine uptake and visualize their interrelationships. We conducted a literature search using Pubmed and Embase databases, including articles published from 2000 to 2019 describing socio-cultural demand-side determinants for vaccine uptake. Using the Andersen and Newman Framework of Health Services Utilization, demand-side determinants were categorized as predisposing, enabling or need factors. A qualitative system dynamics approach was employed to visualize how these factors and their dynamic interrelationships influence vaccine uptake. This visualization, by means of a causal-loop diagram (CLD), was mostly based on a qualitative input, with the majority being statements of the authors. These statements were abstracted from the papers found in the review. Quantification was done by counting direct (statistical) associations between each determinant and 'timely and full routine immunization coverage'. A total of 90 articles, primarily from Nigeria (n = 23), Ethiopia (n = 17) and Kenya (n = 11), met the inclusion criteria. We find that maternal autonomy and the perceived benefits caregivers attach to vaccination and exert their influences on many other factors through several feedback loops, thereby influencing timely and full routine immunization coverage. Utilization of health services (supply-related) and access to information (demand-related) were considered as high-potential leverage points. Quantification has shown that maternal autonomy and perceived benefit have an unclear evidence base. Future research should focus on these key players as they play a central role in multiple complex pathways, through which they could influence the uptake of vaccines in SSA.
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Affiliation(s)
- Phylisha G van Heemskerken
- Department of Health Evidence, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands
| | | | - Henk Broekhuizen
- Department of Health Evidence, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands.,Department of Health and Society, Wageningen University and Research, Hollandseweg 1, 6706 KN, Wageningen 3000, The Netherlands
| | - Nico J Vandaele
- Access-To-Medicines Research Center, KU Leuven, Naamsestraat 69, Leuven, Belgium
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Kazi AM, Ahsan N, Jamal S, Khan A, Mughis W, Allana R, Kazi AN, Kalimuddin H, Ali SA, McKellin W, Collet JP. Characteristics of mobile phone access and usage among caregivers in Pakistan - A mHealth survey of urban and rural population. Int J Med Inform 2021; 156:104600. [PMID: 34638012 DOI: 10.1016/j.ijmedinf.2021.104600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/02/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Globally mobile ownership and access is becoming very common, and breakthroughs in mobile technology have shaped digital communication, with 7 billion mobile phone users globally. Developing countries account for 80% of newly purchased mobile phone devices with majority of such countries having low Routine Immunization coverage and a high risk of vaccine preventable diseases. The use of mobile phones provides a tremendous potential for public health involvement. OBJECTIVE The aim of this study is to assess the acceptability and usability of mobile phones among infant caregivers in a LMIC setup and to explore the role of mHealth to improve immunization uptake and coverage. METHODS This is a cross-sectional survey exploring the regional differences in mobile phone ownership, usability and preferences, along with level of trust with others while sharing a mobile phone. The study was conducted with caregivers of infants in an urban and rural sites of Pakistan. RESULTS A total of 4472 households were approached, of which 3337 participants were eligible for the study (74.61 %). The reasons for not participating in the study (n = 1135) included (i) household locked or refusal to participate for 594 families (52%), (ii) child older than 14 days of life in 409 cases (36%), (iii) 80 (7%) families did not have access to a functional mobile phone, (iv) 36 (3%)families did not provide a mobile phone number, and (v) 14 (1%) could not stay within the HDSS for 6 months. Access to mobile phone with SMS features was considerably high at both sites: 99.1% in Matiari (rural site) and 96.7% in Karachi (urban). In Matiari 96.6% of the respondents reported having daily access to the phone, contrasting with only 51.4% in Karachi. In Karachi, the predominant spoken language was Urdu, whereas majority of the respondents in Matiari spoke Sindhi (34.6% vs. 70.9%). CONCLUSION Our study indicates high access to mobile phone in both urban and rural setup, However access to smart phone is still limited, urban and rural setup. Further, the acceptance of overall health- and barrier-based child immunization messages through mobile phone were quite high in both settings. Lastly automated calls were preferred over SMS due to literacy and local settings. This bears important implications for improving child immunization uptake through mobile phones in developing regions such as Pakistan.
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Affiliation(s)
- Abdul Momin Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan; Department of Experimental Medicine, University of British Columbia, Graduate and Postdoctoral Studies 170-6371 Crescent Road Vancouver, BC, V6T 1Z2, Canada.
| | - Nazia Ahsan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Saima Jamal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Ayub Khan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Waliyah Mughis
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Raheel Allana
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Abdul Nafey Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Hussain Kalimuddin
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Syed Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - William McKellin
- Department of Anthropology, University of British Columbia, Vancouver, BC, Canada.
| | - Jean-Paul Collet
- Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada.
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Eze P, Lawani LO, Acharya Y. Short message service (SMS) reminders for childhood immunisation in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2021-005035. [PMID: 34290051 PMCID: PMC8296799 DOI: 10.1136/bmjgh-2021-005035] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/29/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Childhood vaccine delivery services in the low- and middle-income countries (LMIC) are struggling to reach every child with lifesaving vaccines. Short message service (SMS) reminders have demonstrated positive impact on a number of attrition-prone healthcare delivery services. We aimed to evaluate the effectiveness of SMS reminders in improving immunisation coverage and timeliness in LMICs. Methods PubMed, Embase, Scopus, Cochrane CENTRAL, CINAHL, CNKI, PsycINFO and Web of Science including grey literatures and Google Scholar were systematically searched for randomised controlled trials (RCTs) and non-RCTs that evaluated the effect of SMS reminders on childhood immunisation and timeliness in LMICs. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 assessment tool for RCTs and Cochrane Risk of Bias in Non-randomised Studies of Interventions tool for non-RCTs. Meta-analysis was conducted using random-effects models to generate pooled estimates of risk ratio (RR). Results 18 studies, 13 RCTs and 5 non-RCTs involving 32 712 infants (17 135 in intervention groups and 15 577 in control groups) from 11 LMICs met inclusion criteria. Pooled estimates showed that SMS reminders significantly improved childhood immunisation coverage (RR=1.16; 95% CI: 1.10 to 1.21; I2=90.4%). Meta-analysis of 12 included studies involving 25 257 infants showed that SMS reminders significantly improved timely receipt of childhood vaccines (RR=1.21; 95% CI: 1.12 to 1.30; I2=87.3%). Subgroup analysis showed that SMS reminders are significantly more effective in raising childhood immunisation coverage in lower middle-income and low-income countries than in upper middle-income countries (p<0.001) and sending more than two SMS reminders significantly improves timely receipt of childhood vaccines than one or two SMS reminders (p=0.040). Conclusion Current evidence from LMICs, although with significant heterogeneity, suggests that SMS reminders can contribute to achieving high and timely childhood immunisation coverage. PROSPERO registration number CRD42021225843.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Lucky Osaheni Lawani
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yubraj Acharya
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, USA
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Mekonnen ZA, Gelaye KA, Were M, Tilahun B. Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia. JMIR Mhealth Uhealth 2021; 9:e27603. [PMID: 34128813 PMCID: PMC8277338 DOI: 10.2196/27603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 01/19/2023] Open
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.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Martin Were
- Department of Biomedical Informatics, Vanderbilt Medical Center, Nashville, TN, United States
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Ibraheem R, Akintola M, Abdulkadir M, Ameen H, Bolarinwa O, Adeboye M. Effects of call reminders, short message services (SMS) reminders, and SMS immunization facts on childhood routine vaccination timing and completion in Ilorin, Nigeria. Afr Health Sci 2021; 21:951-959. [PMID: 34795755 PMCID: PMC8568234 DOI: 10.4314/ahs.v21i2.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Reminders via mobile devices deployed as short message services (SMS) or calls have been identified to be a useful strategy in improving routine immunization uptake in several countries. OBJECTIVE To identify the timeliness of appointments with reminders (calls or SMS), SMS health education and the routine care, and the vaccination completion rates in Ilorin, Nigeria. METHOD Mother-infant pairs presenting for the first vaccination appointment were randomized into four (three interventions, one control) groups, each consisting of 140 participants. Intervention groups were reminders via calls (A), SMS reminders (B), immunization fact SMS messages (C) and controls on usual care (D). Reminders were made a day before the appointment while SMS immunization facts were sent at five weeks, nine weeks and eight months. Appropriate timing was defined as the scheduled visit ±3 days. RESULTS The immunization completion rates after the nine months' visit were 99.2%, 99.3%, 97% and 90.4% for Groups A, B, C and D respectively. Compared with controls, Group A had the highest odds [AOR 8.78 (6.10, 12.63)] of presenting at an appropriate time, followed by Group B [AOR 2.56 (1.96, 3.35)], then Group C [AOR 2.44 (1.87, 3.18)]. CONCLUSION Reminders/SMS immunization facts improve vaccination completion rates.
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Affiliation(s)
- Rasheedat Ibraheem
- University of Ilorin, Department of Paediatrics and Child Health; University of Ilorin Teaching Hospital, Paediatrics and Child Health
| | - Moshood Akintola
- Ladoke Akintola University of Technology Teaching Hospital, Department of Paediatrics
| | - Mohammed Abdulkadir
- University of Ilorin, Department of Paediatrics and Child Health; University of Ilorin Teaching Hospital, Paediatrics and Child Health
| | - Hafsat Ameen
- University of Ilorin, Department of Epidemiology and Community Health
| | | | - Muhammed Adeboye
- University of Ilorin, Department of Paediatrics and Child Health; University of Ilorin Teaching Hospital, Paediatrics and Child Health
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Ellis GK, Manda A, Topazian H, Stanley CC, Seguin R, Minnick CE, Tewete B, Mtangwanika A, Chawinga M, Chiyoyola S, Chikasema M, Salima A, Kimani S, Kasonkanji E, Mithi V, Kaimila B, Painschab MS, Gopal S, Westmoreland KD. Feasibility of upfront mobile money transfers for transportation reimbursement to promote retention among patients receiving lymphoma treatment in Malawi. Int Health 2021; 13:297-304. [PMID: 33037426 PMCID: PMC8079308 DOI: 10.1093/inthealth/ihaa075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/22/2020] [Accepted: 09/28/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cancer outcomes in sub-Saharan Africa (SSA) remain suboptimal, in part due to poor patient retention. Many patients travel long distances to receive care, and transportation costs are often prohibitively expensive. These are well-known and established causes of delayed treatment and care abandonment in Malawi and across SSA. METHODS We sent visit reminder texts and offered upfront money to cover transportation costs through a mobile money transfer (MMT) platform to lymphoma patients enrolled in a prospective cohort in Malawi. The primary aim was to test the feasibility of upfront MMTs. RESULTS We sent 1034 visit reminder texts to 189 participating patients. Of these texts, 614 (59%) were successfully delivered, with 536 (52%) responses. 320/536 (60%) MMTs were sent to interested patients and 312/320 (98%) came to their appointment on time. Of 189 total patients, 120 (63%) were reached via text and 84 (44%) received MMTs a median of three times (IQR 2-5). Median age of reachable patients was 41 (IQR 30-50), 75 (63%) were male, 62 (52%) were HIV+ and 79 (66%) resided outside of Lilongwe. CONCLUSION MMTs were a feasible way to cover upfront transportation costs for patients reachable via text, however many of our patients were unreachable. Future studies exploring barriers to care, particularly among unreachable patients, may help improve the efficacy of MMT initiatives and guide retention strategies throughout SSA.
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Affiliation(s)
| | | | - Hillary Topazian
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | | | | | | | | | - Stephen Kimani
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Matthew S Painschab
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Satish Gopal
- National Cancer Institute, Center for Global Health, Rockville, MD, USA
| | - Katherine D Westmoreland
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Mekonnen ZA, Gelaye KA, Were MC, Tilahun B. Mothers intention and preference to use mobile phone text message reminders for child vaccination in Northwest Ethiopia. BMJ Health Care Inform 2021; 28:e100193. [PMID: 33608258 PMCID: PMC7898827 DOI: 10.1136/bmjhci-2020-100193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/29/2020] [Accepted: 02/03/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES With the unprecedented penetration of mobile devices in the developing world, mHealth applications are being leveraged for different health domains. Among the different factors that affect the use of mHealth interventions is the intention and preference of end-users to use the system. This study aimed to assess mother's intention and preference to use text message reminders for vaccination in Ethiopia. METHODS A cross-sectional study was conducted among 460 mothers selected through a systematic random sampling technique. Initially, descriptive statistics were computed. Binary logistic regression analysis was also used to assess factors associated with the outcome variable. RESULTS In this study, of the 456 mothers included for analysis, 360 (78.9%) of mothers have intention to use text message reminders for vaccination. Of these, 270 (75%) wanted to receive the reminders a day before the vaccination due date. Mothers aged 35 years or more (AOR=0.35; 95% CI: 0.15 to 0.83), secondary education and above (AOR=4.43; 95% CI: 2.05 to 9.58), duration of mobile phone use (AOR=3.63; 95% CI: 1.66 to 7.94), perceived usefulness (AOR=6.37; 95% CI: 3.13 to 12.98) and perceived ease of use (AOR=3.85; 95% CI: 2.06 to 7.18) were predictors of intention to use text messages for vaccination. CONCLUSION In conclusion, majority of mothers have the intention to use text message reminders for child vaccination. Mother's age, education, duration of mobile phone use, perceived usefulness and perceived ease of use were associated with intention of mothers to use text messages for vaccination. Considering these predictors and user's preferences before developing and testing text message reminder systems is recommended.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health,College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health,College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Martin C Were
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health,College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Exploring Strategies to Improve Adherence to Immunization Schedule: A Study among Children Attending Maternal and Child Health Clinic at Kenyatta National Hospital, Nairobi, Kenya. Int J Pediatr 2020; 2020:4730205. [PMID: 32849883 PMCID: PMC7439158 DOI: 10.1155/2020/4730205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background Globally, immunization is among the major contributors to public health, preventing 20% of childhood mortality annually. The highest fatality rates from vaccine preventable diseases are usually among children under five. Despite immunization guidelines put in place by the World Health Organization, globally, 1.5 million children die annually related to inadequate vaccination coverage. Existing literature indicate that there is an increase in nonadherence to immunization schedule in developing countries, and therefore, there is an increased demand to improve adherence to immunization schedule. Objective To explore strategies that will improve adherence to immunization schedule among children under 24 months attending the Maternal and Child Health clinic at Kenyatta National Hospital. Methods A cross-sectional mixed method study involving caregivers (n = 214) of well babies attending the Maternal and Child Health clinic. Data was collected using semistructured questionnaires, focus group discussions, and key informant interviews and analyzed using SPSS V.20. Results There was a significant relationship between the level of education and marital status of the caregivers and adherence to immunization schedule. Barriers found that is related to adherence to immunization schedule included far distance from health facility, baby's sickness, and vaccine stock-outs while employment of a caregiver was a constrainer factor. Conclusion The enabling factors to current strategies of improving adherence to immunization schedule were having more health facilities near residential areas, using text messages reminders a day before the clinic date to remind caregivers of the due date for the clinic, and constant availability of vaccines. The health system strategies that would improve adherence to immunization schedules were more flexible clinic hours, availability of vaccines on daily basis, phone call reminders by health care providers, and increasing awareness on the importance of both vaccinations and adherence to immunization schedule.
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Kawakatsu Y, Oyeniyi Adesina A, Kadoi N, Aiga H. Cost-effectiveness of SMS appointment reminders in increasing vaccination uptake in Lagos, Nigeria: A multi-centered randomized controlled trial. Vaccine 2020; 38:6600-6608. [PMID: 32788139 DOI: 10.1016/j.vaccine.2020.07.075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/25/2020] [Accepted: 07/31/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE It is expected that mHealth largely contribute to increasing the coverages of key maternal and child health services. This study aims to estimate the cost-effectiveness of the SMS text reminders in clients' return visits to the health facilities for child vaccinations (incl. vitamin A supplementations), antenatal care (ANC) and family planning (FP), in urban communities of Lagos, Nigeria. METHODS A multi-centered randomized control trial was conducted at 33 primary health centers (PHCs) in Lagos, Nigeria. All the clients having visited any of the 33 PHCs for child vaccinations, ANC and FP were randomly assigned either to intervention group or to control group. The participants in the intervention group were sent an SMS text reminder two days before their appointments. Those not having showed up on the appointment dates received an additional SMS text reminder seven days after original appointment dates as defaulter tracing. The primary outcome was whether a client made return visit to PHCs for the upcoming appointments. RESULTS Of 12,779 appointments for 9,368 clients during the period of 1stApril to 30thJune 2019, 12,175 were included in the analysis. The return rate for child vaccinations in the intervention group was significantly higher (p < 0.001) by 4.8% - 6.0% than that in the control group, consistently across all the five different timings (on time as scheduled, and by 7 days, 14 days, 30 days, and 3 months after appointment dates). No significant difference between the two groups was detected in the increase in return rates for ANC and FP services. The incremental recurrent cost was estimated at 7.90 US Dollars per return case. CONCLUSION SMS text reminders led to a significant increase in the number of return visits for child vaccinations, Lagos, Nigeria, while no significant increase in return visits was confirmed for ANC and FP appointments.
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Affiliation(s)
| | | | - Nobuhiro Kadoi
- Project for Strengthening Pro-poor Community Health Services in Lagos State, Nigeria
| | - Hirotsugu Aiga
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Strader C, Ashby J, Vervoort D, Ebrahimi A, Agbortoko S, Lee M, Reiner N, Zeme M, Shrime MG. How much is enough? Exploring the dose-response relationship between cash transfers and surgical utilization in a resource-poor setting. PLoS One 2020; 15:e0232761. [PMID: 32407327 PMCID: PMC7224483 DOI: 10.1371/journal.pone.0232761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/21/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Cash transfers are a common intervention to incentivize salutary behavior in resource-constrained settings. Many cash transfer studies do not, however, account for the effect of the size of the cash transfer in design or analysis. A randomized, controlled trial of a cash-transfer intervention is planned to incentivize appropriate surgical utilization in Guinea. The aim of the current study is to determine the size of that cash transfer so as to maximize compliance while minimizing cost. Methods Data were collected from nine coastal Guinean hospitals on their surgical capabilities and the cost of receiving surgery. These data were combined with publicly available data about the general Guinean population to create an agent-based model predicting surgical utilization. The model was validated to the available literature on surgical utilization. Cash transfer sizes from 0 to 1,000,000 Guinean francs were evaluated, with surgical compliance as the primary outcome. Results Compliance with scheduled surgery increases as the size of a cash transfer increases. This increase is asymptotic, with a leveling in utilization occurring when the cash transfer pays for all the costs associated with surgical care. Below that cash transfer size, no other optima are found. Once a cash transfer completely covers the costs of surgery, other barriers to care such as distance and hospital quality dominate Conclusion Cash transfers to incentivize health-promoting behavior appear to be dose-dependent. Maximal impact is likely only to occur when full patient costs are eliminated. These findings should be incorporated in the design of future cash transfer studies.
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Affiliation(s)
- Christopher Strader
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
- Department of General Surgery, University of Massachusetts, Worcester, MA, United States of America
| | - Joanna Ashby
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
- School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Dominique Vervoort
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Aref Ebrahimi
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States of America
| | | | - Melissa Lee
- Harvard College, Cambridge, MA, United States of America
| | - Naomi Reiner
- Harvard Graduate School of Education, Cambridge, MA, United States of America
| | - Molly Zeme
- Harvard College, Cambridge, MA, United States of America
| | - Mark G. Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, MA, United States of America
- Center for Health and Wellbeing, Princeton University, Princeton, NJ, United States of America
- * E-mail:
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Mildon A, Sellen D. Use of mobile phones for behavior change communication to improve maternal, newborn and child health: a scoping review. J Glob Health 2020; 9:020425. [PMID: 31893032 PMCID: PMC6925966 DOI: 10.7189/jogh.09.020425] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Behavior change communication (BCC) to improve health and caring practices is an integral component of efforts to improve maternal, newborn and child health (MNCH). Mobile phones are widely available in low- and middle-income countries (LMIC), presenting new opportunities for BCC delivery. There is need for delivery science to determine how best to leverage mobile phone technology for BCC to improve MNCH practices. Methods We conducted a scoping review of studies and project reports documenting the feasibility, implementation or effectiveness of using mobile phones for BCC delivery related to MNCH in LMIC. Data were extracted and synthesized from three sources: i) systematic search of three electronic databases (PubMed, MedLine, Scopus); ii) grey literature search, including mHealth databases and websites of organizations implementing mHealth projects; iii) consultation with researchers and programme implementers. Records were screened using pre-determined inclusion criteria and those selected were categorized according to their primary intervention delivery approaches. We then performed a descriptive analysis of the evidence related to both effectiveness and implementation for each delivery approach. Results The systematic literature search identified 1374 unique records, 64 of which met inclusion criteria. The grey literature search added 32 records for a total of 96 papers in the scoping review. Content analysis of the search results identified four BCC delivery approaches: direct messaging, voice counseling, job aid applications and interactive media. Evidence for the effectiveness of these approaches is growing but remains limited for many MNCH outcomes. The four approaches differ in key implementation elements, including frequency, length and complexity of communication, and potential for personalization. These elements influence resource allocation and are likely to impact effectiveness for BCC targeting complex, habitual MNCH practices. Conclusions This scoping review contributes to the evidence-base on the opportunities and limitations of using mobile phones for BCC delivery aiming to improve MNCH practices. The incorporation of mobile phone technology in BCC interventions should be guided by formative research to match both the content and delivery approach to the local context. We recommend five areas for further research, including both effectiveness and implementation studies on specific delivery approaches.
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Affiliation(s)
- Alison Mildon
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Sellen
- Joannah & Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
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Zaidi S, Shaikh SA, Sayani S, Kazi AM, Khoja A, Hussain SS, Najmi R. Operability, Acceptability, and Usefulness of a Mobile App to Track Routine Immunization Performance in Rural Pakistan: Interview Study Among Vaccinators and Key Informants. JMIR Mhealth Uhealth 2020; 8:e16081. [PMID: 32053115 PMCID: PMC7055833 DOI: 10.2196/16081] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There has been a recent spate of mobile health (mHealth) app use for immunizations and other public health concerns in low- and middle-income countries. However, recent evidence has largely focused on app development or before-and-after effects on awareness or service coverage. There is little evidence on the factors that facilitate adoption of mHealth programs, which is critical to effectively embed digital technology into mainstream health systems. OBJECTIVE This study aimed to provide the qualitative experiences of frontline health staff and district managers while engaging with real-time digital technology to improve the coverage of routine childhood immunization in an underserved rural district in Pakistan. METHODS An Android-based app was iteratively developed and used for a 2-year period in 11 union councils of the Tando Muhammad Khan district, an underserved rural district with poor immunization coverage in Pakistan. We used iterative methods to examine the (1) acceptability and operability of the app, (2) validity of the collected data, and (3) use of the collected data. In addition, we collected the barriers and enablers for uptake of the mHealth app. Each of these topics was further explored related to changes in work as well as the enabling factors for and barriers to app use. In-depth interviews were conducted with the 26 vaccinators posted in the 11 union councils and 7 purposively selected key informants (government district managers) involved with the Expanded Program for Immunization. Findings were triangulated in line with the three broad research areas. RESULTS Digital immunization tracking was considered acceptable by vaccinators and district managers. Real-time immunization data were used to monitor vaccination volume, track children with incomplete vaccinations, develop outreach visit plans, correct existing microplans, and disburse a fuel allowance for outreach sessions. The validity of the app data was perceived to be superior to that of data from manual records. Ease of operability, satisfaction with data, personal recognition, links to field support, and a sense of empowerment served as powerful enablers. Taking twice the time to complete both manual and digital entries and outdated phones over time were considered constraints. An unintended knock-on effect was improved coordination and strengthening of Expanded Program for Immunization review platforms across district stakeholders through digitalized data. CONCLUSIONS Embedding digital technology into mainstream health systems relies on use by both end users and district stakeholders. Ease of operability, satisfaction with data reliability, personal recognition, links to field support, and empowerment are powerful enablers, whereas improved coordination as a result of easy, transparent data access can be an important by-product of digitalization. Findings are relevant not only for wide-scale implementation of immunization tracking apps in Pakistan but also for informing the use of digital technology for results-based delivery by frontline health workers.
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Affiliation(s)
- Shehla Zaidi
- Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan.,Department of Community Health Sciences, Karachi, Pakistan
| | | | - Saleem Sayani
- E-Health Resource Centre, Aga Khan Development Network, Karachi, Pakistan
| | - Abdul Momin Kazi
- Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan
| | - Adeel Khoja
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Rabia Najmi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Mekonnen ZA, Tilahun B, Alemu K, Were M. 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. BMJ Open 2019; 9:e031254. [PMID: 31694849 PMCID: PMC6858152 DOI: 10.1136/bmjopen-2019-031254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Non-attendance and delay in vaccination schedules remain a big challenge to healthcare workers. With the continuous growth of mobile network coverage and exponential penetration of mobile devices in the developing world, adoption of short message service has been shown to increase attendance for health services by targeting participant characteristics such as forgetfulness. Therefore, the aim of this trial is to determine the effect of mobile text message reminders on completeness and timeliness of childhood vaccination in North-West, Ethiopia. METHODS AND ANALYSIS A two-arm, parallel, superiority, randomised controlled trial study will be employed. The study arms are the intervention group (text message reminders plus routine care) and the control group (routine care only). Mother-infant pairs will be randomised to one of the groups during enrolment. The trial will consider a sample size of 434 mother-infant pairs with 1:1 allocation ratio. Mothers assigned to the intervention group will receive text message reminder 1 day before the scheduled vaccination visit at 6 weeks, 10 weeks, 14 weeks and at 9 months. Initially, descriptive statistics will be computed. For the primary outcome log-binomial regression model will be used to identify associated factors, and relative risk with 95% CI will be reported. Primarily, iIntention-to-treat analysis principle will be applied. STATA V.14 software will be used for the analysis. ETHICS AND DISSEMINATION This study obtained ethical approval from the University of Gondar Institutional Ethical Review Board. The trial findings on the effectiveness of mobile text message reminders in improving vaccination uptake will help to inform decision makers on the use of mobile health interventions in developing countries like Ethiopia. The scientific findings of the trial will also be published in reputable journals. TRIAL REGISTRATION NUMBER PACTR201901533237287.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Health Informatics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Binyam Tilahun
- Health Informatics, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Martin Were
- Institute of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Mekonnen ZA, Hussien FN, Tilahun B, Gelaye KA, Mamuye A. Development of automated text-message reminder system to improve uptake of child vaccination in Ethiopia. Online J Public Health Inform 2019; 11:e15. [PMID: 31632609 PMCID: PMC6788892 DOI: 10.5210/ojphi.v11i2.10244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Non-attendance and delay for vaccination schedules remains a big challenge to healthcare workers. Among the frequently mentioned reasons for missed vaccination in children is forgetfulness of caretakers to show up in vaccination schedules. This necessitates developing an automated reminder system with integration of mobile technologies. OBJECTIVES This paper aimed to develop and test an automated mobile text message reminder system in the local context of Ethiopia. METHODS This system is developed using iterative development process through phases of requirement analysis, design, development, testing and refinement. Requirement gathering was done before development of the system. Front end application was developed using java technologies while back end applications were developed with oracle database. Finally, pilot testing of the automated reminder system was done on 30 participants. RESULTS The automated system has been developed based on requirements. The text message reminder system has two components: 1. Web based application for client registration and automatic reminder scheduling; 2. SMS application for automatic SMS text messaging. In the pilot testing, all the text messages (100%) were dispatched from the automated system to the respective participants. Finally, the system has shown a notification that the text messages have been sent successfully. CONCLUSION Text message reminder system has been developed for routine childhood immunization program in Ethiopian context. Text message based mHealth interventions should be carefully designed, developed, tested and refined before actual implementation.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of health informatics, Institute of Public Health, University of
Gondar, Gondar, Ethiopia
| | | | - Binyam Tilahun
- Department of health informatics, Institute of Public Health, University of
Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics,
Institute of Public Health, University of Gondar, Gondar,
Ethiopia
| | - Adane Mamuye
- Department of computer science, Faculty of
Informatics, University of Gondar, Gondar, Ethiopia
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Domek GJ, Contreras-Roldan IL, Bull S, O'Leary ST, Bolaños Ventura GA, Bronsert M, Kempe A, Asturias EJ. Text message reminders to improve infant immunization in Guatemala: A randomized clinical trial. Vaccine 2019; 37:6192-6200. [PMID: 31492475 DOI: 10.1016/j.vaccine.2019.08.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/15/2019] [Accepted: 08/21/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Millions of infants worldwide remain under-immunized and at risk for unnecessary morbidity and mortality. Text messaging may offer a low-cost solution. We aimed to evaluate text message reminders to improve infant immunization in Guatemala. METHODS A randomized clinical trial was conducted at four public health clinics in rural and urban Guatemala. Infants ages six weeks to six months presenting for the first visit of the primary immunization series were randomly and equally allocated to an intervention or usual care group. Intervention participants were sent three text reminders before the second and third vaccine visits. The main outcome was timeliness of the second and third visits of the primary immunization series. RESULTS Of 1088 families approached for enrollment between March to November 2016, 871 were eligible and 720 (82.7%) participated; only 54 families did not own a cell phone. Due to country-wide vaccine shortages, visit completion was used as a proxy for overall immunization coverage. In intention to treat analysis, both intervention and usual care groups had high rates of visit completion, but intervention participants presented on the scheduled date more often (151 [42.2%] of 358 intervention vs. 111 [30.7%] of 362 usual care participants for visit 2, p = 0.001, and 112 [34.0%] of 329 intervention vs. 90 [27.0%] of 333 usual care participants for visit 3, p = 0.05). Intervention caregivers were significantly more likely to want to receive future text message reminders for vaccines and other appointments and were more willing to pay for these reminders. CONCLUSION Caregivers who were sent text message reminders in urban and rural Guatemala were less delayed for their child's immunization visits and reported high user satisfaction. Text message reminders may be an effective tool to increase infant vaccination coverage in low-income settings by reminding parents to vaccinate. TRIAL REGISTRATION NCT02567006 at clinicaltrials.gov.
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Affiliation(s)
- Gretchen J Domek
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E. 16th Ave., Aurora, CO 80045, USA; Center for Global Health, Colorado School of Public Health, A090, 13199 E. Montview Blvd., Suite 310, Aurora, CO 80045, USA.
| | - Ingrid L Contreras-Roldan
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Av. 11-95, Zona 15, Vista Hermosa III, Guatemala City, Guatemala
| | - Sheana Bull
- Center for Global Health, Colorado School of Public Health, A090, 13199 E. Montview Blvd., Suite 310, Aurora, CO 80045, USA; Department of Community and Behavioral Health, Colorado School of Public Health, B119, 13001 E. 17th Place, Aurora, CO 80045, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E. 16th Ave., Aurora, CO 80045, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, F443, 13199 E. Montview Blvd., Suite 300, Aurora, CO 80045, USA
| | | | - Michael Bronsert
- Center for Global Health, Colorado School of Public Health, A090, 13199 E. Montview Blvd., Suite 310, Aurora, CO 80045, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, F443, 13199 E. Montview Blvd., Suite 300, Aurora, CO 80045, USA
| | - Allison Kempe
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E. 16th Ave., Aurora, CO 80045, USA; Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, F443, 13199 E. Montview Blvd., Suite 300, Aurora, CO 80045, USA
| | - Edwin J Asturias
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E. 16th Ave., Aurora, CO 80045, USA; Center for Global Health, Colorado School of Public Health, A090, 13199 E. Montview Blvd., Suite 310, Aurora, CO 80045, USA; Department of Epidemiology, Colorado School of Public Health, B119, 13001 E. 17th Place, Aurora, CO 80045, USA
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Lamanna C, Byrne L. A pilot study of a novel, incentivised mHealth technology to monitor the vaccine supply chain in rural Zambia. Pan Afr Med J 2019; 33:50. [PMID: 31448013 PMCID: PMC6689832 DOI: 10.11604/pamj.2019.33.50.16318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 04/14/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction The World Health Organization estimates that up to half of vaccines are wasted, however only a minority of mHealth programs in Africa have been directed at vaccine supply chain optimisation. We piloted a novel mHealth solution dependent only on short message services (SMS) technology that allowed workers in rural health centres in Zambia to report vaccine stock levels directly to an online platform. Small airtime incentives were offered to encourage users to engage with the system, as well as weekly reminder messages asking for stock updates. Methods The primary outcome measured was the percentage-of-doses-tracked, calculated over the study period. Each vaccine box was randomly allocated to offer either a standard or double airtime incentive and either weekly or daily reminders, in a 2 x 2 design; ANOVA was used to calculate if any of these factors affected time-to-reply. Results Over the study period, the total percentage-of-doses-tracked was 39.9%. Within the subset of users who sent at least one message to the platform, the percentage-of-doses-tracked was 93.8%. There was no significant difference in average time-to-reply between the standard airtime incentive and double airtime incentive groups, nor was there a significant difference between the standard reminder and daily follow-up reminder groups. Conclusion This pilot study found that in an active subgroup of health workers, an incentivised mHealth solution was able to collect tracking data for 93.8% of doses. More research is needed to identify methods to encourage healthcare workers to engage in timely stock reporting practices.
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Affiliation(s)
- Camillo Lamanna
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Lauren Byrne
- Department of Emergency Medicine, University of Sydney, Sydney, Australia
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Gibson DG, Kagucia EW, Were J, Obor D, Hayford K, Ochieng B. Text Message Reminders and Unconditional Monetary Incentives to Improve Measles Vaccination in Western Kenya: Study Protocol for the Mobile and Scalable Innovations for Measles Immunization Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e13221. [PMID: 31290405 PMCID: PMC6647752 DOI: 10.2196/13221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/11/2019] [Accepted: 04/28/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Globally, 21 million children do not receive the measles vaccine each year. With high levels of mobile phone access and ownership, opportunities exist to leverage mobile health technologies to generate demand for immunization. OBJECTIVE The aim of the Mobile and Scalable Innovations for Measles Immunization trial is to determine if text message (short message service, SMS) reminders, either with or without mobile phone-based incentives, can improve measles immunization coverage and timeliness in rural western Kenya. METHODS This is a 3-arm, parallel, randomized controlled trial (RCT). Using simple randomization, caregivers in Siaya County, Kenya, will be randomized and evenly allocated to 1 of 3 study arms: (1) control, (2) SMS reminders only, and (3) SMS reminders plus a 150 Kenyan Shilling (KES) incentive. Participants assigned to the SMS group will be sent SMS reminders 3 days before and on the day before the measles immunization visit scheduled for when the child is 9 months of age. Participants in the incentive arm will, in addition to SMS reminders as above, be sent an unconditional 150 KES mobile-money incentive to their mobile phone 3 days before the child becomes 9 months of age. Children will be followed up to the age of 12 months to assess the primary outcome, a measles vaccination by 10 months of age. Log-binomial regressions will be used to calculate relative risks. RESULTS Enrollment was completed in March 2017. We enrolled 537 caregivers and their infants into the following groups: control (n=179), SMS reminders only (n=179), and SMS reminders plus 150 KES (n=179). Results will be made publicly available in 2020. CONCLUSIONS Few RCTs have examined the effect of text message reminders to improve measles immunization coverage. This is the first study to assess the effect of SMS reminders with and without unconditionally provided mobile-money incentives to improve measles immunization coverage. TRIAL REGISTRATION ClinicalTrials.gov NCT02904642; https://clinicaltrials.gov/ct2/show/NCT02904642 (Archived by WebCite® at http://www.webcitation.org/78r7AzD2X). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/13221.
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Affiliation(s)
- Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - E Wangeci Kagucia
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joyce Were
- Center for Global Health Research, Kenya Medical Research Institute, Kisian, Kenya
| | - David Obor
- Center for Global Health Research, Kenya Medical Research Institute, Kisian, Kenya
| | - Kyla Hayford
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Benard Ochieng
- Center for Global Health Research, Kenya Medical Research Institute, Kisian, Kenya
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Ostermann J, Vasudevan L, Baumgartner JN, Ngadaya E, Mfinanga SG. Do mobile phone-based reminders and conditional financial transfers improve the timeliness of childhood vaccinations in Tanzania? Study protocol for a quasi-randomized controlled trial. Trials 2019; 20:397. [PMID: 31272487 PMCID: PMC6611039 DOI: 10.1186/s13063-019-3430-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Vaccination is a cost-effective strategy for reducing morbidity and mortality among children under 5 years old. To be fully protected from diseases such as tuberculosis, diphtheria, pertussis, and polio, children must receive all recommended vaccinations in a timely manner. In many countries, including Tanzania, high overall vaccination rates mask substantial regional variation in vaccination coverage and low rates of vaccination timeliness. This study evaluates the efficacy of mobile phone-based (mHealth) reminders and incentives for improving vaccination timeliness in the first year of life. Methods The study, conducted in Mtwara Region in Tanzania, includes 400 late-stage pregnant women enrolled from rural and urban health facilities and surrounding communities. The primary outcome is timeliness of vaccinations among their children at 6, 10, and 14 weeks after birth. Timeliness is defined as vaccination receipt within 28 days after the vaccination due date. The quasi-randomized controlled trial includes three arms: (1) standard of care (no reminders or incentives), (2) mobile phone-based reminders, and (3) mobile phone-based reminders and incentives in the form of conditional financial transfers. Assignment into study arms is based on scheduled vaccination dates. Reminder messages are sent to arms 2 and 3 participants via mobile phones 1 week and 1 day prior to each scheduled vaccination. For arm 3 participants, reminder messages offer an incentive that is provided in the form of a mobile phone airtime recharge voucher code for each timely vaccination. Vaccination dates are recorded via participant contact with an mHealth system, phone calls with mothers, and a review of government-issued vaccination cards during an end-line survey. Random effects logistic regression models will be used to estimate the effects of reminders and incentives on the timeliness of vaccinations. Discussion The results will inform implementation science research on the effectiveness of reminders and incentives as a means of improving vaccination timeliness. Trial registration ClinicalTrials.gov, NCT03252288. Registered on 17 August 2017 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s13063-019-3430-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Ostermann
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.,Duke Global Health Institute, Durham, NC, 27708, USA
| | - Lavanya Vasudevan
- Duke Global Health Institute, Durham, NC, 27708, USA. .,Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, 27705, USA.
| | | | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, Dar-es-Salaam, Tanzania
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Mekonnen ZA, Gelaye KA, Were MC, Gashu KD, Tilahun BC. Effect of mobile text message reminders on routine childhood vaccination: a systematic review and meta-analysis. Syst Rev 2019; 8:154. [PMID: 31253186 PMCID: PMC6598255 DOI: 10.1186/s13643-019-1054-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/26/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The World Health Organization estimates that 29% of under-five mortality could be prevented with existing vaccines. However, non-consistent attendance for immunization appointments remains a global challenge to healthcare providers. Thus, innovative strategies are required to reach the last mile where technology could be effectively utilized to achieve better compliance with children immunization schedules. Therefore, the aim of the review was to systematically collect and summarize the available evidence on the effectiveness of text message reminders on childhood vaccination. METHODS This review was conducted according to a priori published protocol on PROSPERO. A systematic literature search of databases (PubMed/MEDLINE, EMBASE, Cochrane/Wiley library, and Science direct) was conducted. Eligibility and risk of bias assessments were performed independently by two reviewers. PRISMA flow diagrams were used to summarize the study selection process. Taking into account the level of heterogeneity, a random effects model was used and risk ratios with their 95% CI were used to present the pooled estimates. To investigate the sources of heterogeneity, subgroup analysis and meta-regression analysis were also considered. In this review, publication bias was assessed statistically using Harbord test. RESULTS A total of 1771 articles were searched. Out of those 1771 articles, 558 duplicated articles were removed. About 1213 articles were further screened, and finally, ten articles met the inclusion criteria. The meta-analysis showed that there is a significant effect of text message reminders on childhood vaccination coverage (RR = 1.11; 95% CI 1.05-1.17) with a moderate level of heterogeneity (I2 = 64.3%, P = 0.003). The results from the Harbord test suggested that there is no evidence for publication bias (P = 0.340). CONCLUSION This review highlights the potential benefits of incorporating mobile text message reminders into the standard management of childhood immunizations, especially in low- and middle-income countries. The frequency and timing of the text message reminders are also crucial in determining the effectiveness of text message reminders. Hence, mHealth interventions deserve more attention as a potential innovation to improve healthcare programs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017074230.
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Affiliation(s)
- Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Martin C Were
- Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Kassahun Dessie Gashu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Binyam Chakilu Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Pima FM, Oshosen M, Ngowi KM, Habte BM, Maro E, Teffera BE, Kisigo G, Swai IU, Msangi SS, Ermias A, Mmbaga BT, Both R, Sumari-de Boer M. Feasibility of Using Short Message Service and In-Depth Interviews to Collect Data on Contraceptive Use Among Young, Unmarried, Sexually Active Men in Moshi, Tanzania, and Addis Ababa, Ethiopia: Mixed Methods Study With a Longitudinal Follow-Up. JMIR Form Res 2019; 3:e12657. [PMID: 31244476 PMCID: PMC6617913 DOI: 10.2196/12657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 01/03/2023] Open
Abstract
Background Data on contraceptive needs and use among young unmarried men are limited. Conventional ways of data collection may lead to limited and unreliable information on contraceptive use due to sensitivity of the topic, as many young men feel ashamed to discuss their behavior of using contraceptives. As short message service (SMS) is anonymous and a commonly used means of communication, we believe that if deployed, it will create a promising user-friendly method of data collection. Objective The objective was to investigate the feasibility of using SMS to collect data on sexually active, young, unmarried men’s sexual behavior and contraceptive preferences, practices, and needs in Addis Ababa, Ethiopia, and Moshi, Tanzania. Methods We enrolled men aged 18-30 years who were students (in Ethiopia and Tanzania), taxi or local bus drivers/assistants (Ethiopia and Tanzania), Kilimanjaro porters (Tanzania), or construction workers (Ethiopia). Young men were interviewed using a topic list on contraceptive use. They were followed up for 6 months by sending fortnightly SMS texts with questions about contraceptive use. If the young men indicated that they needed contraceptives during the reporting period or were not satisfied with the method they used, they were invited for a follow-up interview. At the end of the study, we conducted exit interviews telephonically using a semistructured questionnaire to explore the feasibility, acceptability, and accuracy of using SMS to validate the study findings in both countries. Results We enrolled 71 young unmarried men—35 in Tanzania and 36 in Ethiopia. In Moshi, 1908 messages were delivered to participants and 1119 SMS responses were obtained. In Ethiopia, however, only 525 messages were sent to participants and 248 replies were received. The question on dating a girl in the past weeks was asked 438 times in Tanzania and received 252 (58%) replies, of which 148 (59%) were “YES.” In Ethiopia, this question was asked 314 times and received 64 (20%) replies, of which 52 (81%) were “YES” (P=.02 for difference in replies between Tanzania and Ethiopia). In Tanzania, the question on contraceptive use was sent successfully 112 times and received 108 (96%) replies, of which 105 (94%) were “YES.” In Ethiopia, the question on contraceptive use was asked 17 times and received only 2 (11%) replies. Exit interviews in Tanzania showed that SMS was accepted as a means of data collection by 22 (88%) of the 25 interviewed participants. Conclusions Despite network and individual challenges, the SMS system was found to be feasible in Moshi, but not in Addis Ababa. We recommend more research to scale up the method in different groups and regions.
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Affiliation(s)
- Francis Maganga Pima
- Department of Clinical Trials, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Martha Oshosen
- Department of Clinical Trials, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Kennedy Michael Ngowi
- Department of Clinical Trials, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania.,Department of Medical Psychology, University Medical Centre Amsterdam - Amsterdam Medical Centre, Amsterdam, Netherlands
| | | | - Eusebious Maro
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | | | - Godfrey Kisigo
- Department of Clinical Trials, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Iraseni Ufoo Swai
- Department of Clinical Trials, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Salim Semvua Msangi
- Department of Clinical Trials, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Amha Ermias
- SEGEL Research and Training Consulting PLC, Addis Ababa, Ethiopia
| | - Blandina T Mmbaga
- Department of Clinical Trials, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Rosalijn Both
- SEGEL Research and Training Consulting PLC, Addis Ababa, Ethiopia
| | - Marion Sumari-de Boer
- Department of Clinical Trials, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania.,Department of International Health, Radboud University Medical Centre, Nijmegen, Netherlands
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Lester R, Park JJ, Bolten LM, Enjetti A, Johnston JC, Schwartzman K, Tilahun B, Delft AV. Mobile phone short message service for adherence support and care of patients with tuberculosis infection: Evidence and opportunity. J Clin Tuberc Other Mycobact Dis 2019; 16:100108. [PMID: 31720432 PMCID: PMC6830136 DOI: 10.1016/j.jctube.2019.100108] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To attain the Global End Tuberculosis (TB) goals, the treatment of persons with TB requires advancements in coordinated approaches that are low-cost and highly accessible. Treating TB successfully requires prolonged medication regimens with good adherence, which in turn requires patients to be adequately supported. Furthermore, TB care-providers often wish to monitor treatment-taking by patients in order to track the success of their programs and ensure adequate completion of therapies by individuals. The standard-of-care for treatment monitoring in TB programs often includes directly observed therapy (DOT). Video observed therapy (VOT) has emerged as a method to mimic in-person visits or observations, especially in the smartphone era with internet data connections, but remains simply inaccessible to patients in areas where TB is most endemic. Both approaches may be considered more intensive than necessary for many patients, leaving an opportunity for more affordable and acceptable approaches. The rapid increase in mobile phone penetration provides an opportunity to reach patients between clinical visits. Short message services (SMS) are available on almost every mobile phone and are supported by first generation cellular communication networks, thus providing the farthest reach and penetration globally. Evidence from non-TB conditions suggests SMS, used in a variety of ways, may support outpatients for better medication adherence and quality of care but the evidence in TB remains limited. In this paper, we discuss how basic mobile phones and SMS-related services may be used in supporting global care of persons with TB, with a focus on patient-centered approaches.
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Affiliation(s)
| | - Jay Jh Park
- University of British Columbia, Vancouver, Canada
| | | | | | - James C Johnston
- University of British Columbia, Vancouver, Canada.,Provincial TB Services, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Kevin Schwartzman
- Respiratory Division, Montreal Chest Institute, Respiratory Epidemiology and Clinical Research Unit, and McGill International Tuberculosis Centre, McGill University, Montreal, Quebec, Canada
| | | | - Arne von Delft
- TB Proof, 29 Almond Drive, Somerset West, Western Cape 7130, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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One-way SMS and healthcare outcomes in Africa: Systematic review of randomised trials with meta-analysis. PLoS One 2019; 14:e0217485. [PMID: 31170176 PMCID: PMC6553734 DOI: 10.1371/journal.pone.0217485] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background The impact of one-way SMS on health outcomes in Africa is unclear. We aimed to conduct a systematic review of one-way SMS randomised trials in Africa and a meta-analysis of their effect on healthcare appointments attendance and medicine adherence. Methods PubMed, Embase, CENTRAL, The Global Health Library, ClinicalTrials.gov, ICTRP, and PACTR were searched for published and unpublished trials in Africa without language restriction (up to April 2018). Trials reporting effect estimates on healthcare appointment attendance and medicine adherence were assessed for risk of bias and included in meta-analyses using random-effects models. Other outcomes were reported descriptively. The protocol is registered in PROSPERO, ID:CRD42018081062. Results We included 38 one-way SMS trials conducted in Africa within a broad range of clinical conditions. Eighteen trials were included in the meta-analyses, and four were assessed as overall low risk of bias. One-way SMS improved appointment attendance, OR:2·03; 95% CI:1·40–2·95 (12 trials, 6448 participants), but not medicine adherence, RR:1·10; 95% CI:0·98–1·23 (nine trials, 4213 participants). Subgroup analyses showed that one-way SMS had the highest impact on childhood immunization attendance, OR:3·69; 95% CI:1·67–8·13 (three trials, 1943 participants). There was no clear evidence of one-way SMS improving facility delivery, knowledge level (reproductive/antenatal health, hypertension), diabetes- and hypertension management. Conclusion In an African setting, the clinical effect of one-way SMS is uncertain except for appointment attendance where the effect seems to vary depending on which clinical condition it is used in.
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Kazi AM, Ahsan N, Khan A, Jamal S, Kalimuddin H, Ghulamhussain N, Wajidali Z, Muqeet A, Zaidi F, Subzlani M, McKellin W, Ali A, Collet JP. Personalized Text Messages and Automated Calls for Improving Vaccine Coverage Among Children in Pakistan: Protocol for a Community-Based Cluster Randomized Clinical Trial. JMIR Res Protoc 2019; 8:e12851. [PMID: 31148544 PMCID: PMC6658276 DOI: 10.2196/12851] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/14/2019] [Accepted: 04/02/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A major reason for poor childhood vaccine coverage in developing countries is the lack of awareness among parents and caregivers regarding the need for immunization and the importance of completing the entire series of vaccines. Short message service (SMS)-based interventions have been quite effective in different programs such as smoking cessation, treatment adherence, health care scheduled appointment attendance, antenatal care attendance, and compliance to immunization. However, there are limited data from low- and middle-income countries on the role of SMS and automated call-based messages and interventions to improve routine immunization (RI) coverage. OBJECTIVE The primary objective of this study is to evaluate whether automated mobile phone-based personalized messages (SMS or automated call) can improve RI uptake at 6, 10, and 14 weeks of age per the expanded program immunization schedule, compared with a usual care control group. Secondary objectives include assessing the effects of different types of automated SMS text or calls on RI coverage at 20 weeks of age. METHODS This is a mixed methods study using a clustered randomized controlled trial with 4 intervention arms and 1 control arm, augmented by qualitative interviews for personalizing the message. The study is being conducted in Pakistan (an urban site in Karachi and a rural site Matiari). In Karachi, 250 administrative structures are taken as 1 cluster, whereas in Matiari, a catchment area of 4 Lady Health Workers is considered as 1 cluster. The intervention targets families to receive weekly 1-way or 2-way (interactive) personalized automated SMS or automated phone call messages regarding vaccination. Possible barriers to vaccination are assessed in each family at the time of inclusion to determine the type of personalized messages that should be sent to the family to increase the chance of a positive response. Finally, in-depth interviews using purposive sampling are conducted before and after the trial to determine the family's vaccination experience and related factors. RESULTS All study participants for the cluster randomized trial were enrolled by January 14, 2019. Study exit interviews at 20-weeks follow-up visits will be completed by June 2019. CONCLUSIONS The results of this study will be useful to understand the respective effects of SMS text messages versus automated phone-based communication to improve RI coverage and timelines. Moreover, information regarding families' perceptions of vaccination and the daily life challenges for timely visits to the vaccine clinic will be used for developing more complex interventions that use mobile phone messages and possibly other approaches to overcome barriers in the uptake of correct and timely immunization practices. TRIAL REGISTRATION ClinicalTrials.gov NCT03341195; https://clinicaltrials.gov/ct2/show/NCT03341195 (Archived by WebCite at http://www.webcitation.org/78EWA56Uo). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12851.
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Affiliation(s)
- Abdul Momin Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Nazia Ahsan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ayub Khan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Saima Jamal
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Hussain Kalimuddin
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Zabin Wajidali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Abdul Muqeet
- Digital Health Resource Center, Aga Khan Development Network, Karachi, Pakistan
| | - Fabiha Zaidi
- Digital Health Resource Center, Aga Khan Development Network, Karachi, Pakistan
| | - Meraj Subzlani
- Digital Health Resource Center, Aga Khan Development Network, Karachi, Pakistan
| | - William McKellin
- Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jean-Paul Collet
- Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Beijing Tiantan Hospital and Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Mannik J, Figol A, Churchill V, Aw J, Francis S, Karino E, Chesire JK, Opot D, Ochieng B, Hawkes MT. Community-based screening for cardiovascular risk using a novel mHealth tool in rural Kenya. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:176-182. [PMID: 30398461 DOI: 10.14236/jhi.v25i3.1012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/03/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An increasing burden of cardiovascular disease (CVD) in low-resource settings demands innovative public health approaches. OBJECTIVES To design and test a novel mHealth tool for use by community health workers (CHWs) to identify individuals at high CVD risk who would benefit from education and/or pharmacologic interventions. METHODS We designed and implemented a novel two-way mobile phone application, "AFYACHAT," to rapidly screen for CVD risk in rural Kenya. AFYACHAT collects and stores SMS text message data entered by a CHW on a subject's age, sex, smoking, diabetes, and systolic blood pressure, and returns as SMS text message the category of 10-year CVD risk: "GREEN" (<10% 10 year risk of cardiovascular event), "YELLOW" (10 to <20%), "orange"(20 to <30%), or "RED" (≥30%). CHWs were equipped and trained to use an automated blood pressure device and the mHealth tool. RESULTS Five CHWs screened 2,865 subjects in remote rural communities in Kenya over a 22 month period (2015-17). The median age of subjects was 50 (IQR 43 to 60) and 1581 (55%) were female. Point prevalence of hypertension (systolic blood pressure>140mmHg), diabetes, and tobacco use were 23%, 3.2%, and 22%, respectively. Overall, the 10-year risk of CVD among patients was <10% in 2778 (97%) patients, 10 to <20% in 65 (2.3%), 20 to <30% in 12 (0.4%), and ≥30% in 10 (0.2%). CONCLUSION We have developed a mHealth tool that can be used by CHWs to screen for CVD risk factors, demonstrating proof-of-concept in rural Kenya.
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Gibson DG, Tamrat T, Mehl G. The State of Digital Interventions for Demand Generation in Low- and Middle-Income Countries: Considerations, Emerging Approaches, and Research Gaps. GLOBAL HEALTH, SCIENCE AND PRACTICE 2018; 6:S49-S60. [PMID: 30305339 PMCID: PMC6203418 DOI: 10.9745/ghsp-d-18-00165] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/08/2018] [Indexed: 01/08/2023]
Abstract
The recent introduction of digital health into generating demand for health commodities and services has provided practitioners with an expanded universe of potential tools to strengthen demand and ensure service delivery receipt. However, considerable gaps remain in our understanding of which interventions are effective, which characteristics mediate their benefit for different target populations and health domains, and what is necessary to ensure effective deployment. This paper first provides an overview of the types of digital health interventions for demand generation, including untargeted client communication, client-to-client communication, on-demand information services, personal health tracking, client financial transactions, and targeted client communication. It then provides a general overview of 118 studies published between January 1, 2010, and October 3, 2017, that used digital interventions to generate demand for health interventions. The majority (61%) of these studies used targeted client communication to provide health education or reminders to improve treatment adherence, and the most frequently (27%) studied health condition was HIV/AIDS. Intervention characteristics that have been found to have some effect on gains in demand generation include modality, directionality, tailoring, phrasing, and schedule. The paper also explores new emergent digital approaches that expand the potential effect of traditional demand generation in terms of personalization of content and services, continuity of care, and accountability tracking. Applying existing frameworks for monitoring and evaluation and reporting, research on emerging approaches will need to consider not only their feasibility but also their effectiveness in achieving demand generation outcomes. We propose a research agenda to help guide the field of digital demand generation studies and programs within a broader health systems strengthening agenda, including establishing and documenting the influence of intervention characteristics within different populations and health domains and examining the long-term effects and cost-effectiveness of digital demand generation interventions, as well as equity in access to such interventions.
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Affiliation(s)
- Dustin G Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Tigest Tamrat
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Garrett Mehl
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Karageorgos G, Andreadis I, Psychas K, Mourkousis G, Kiourti A, Lazzi G, Nikita KS. The Promise of Mobile Technologies for the Health Care System in the Developing World: A Systematic Review. IEEE Rev Biomed Eng 2018; 12:100-122. [PMID: 30188840 DOI: 10.1109/rbme.2018.2868896] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Evolution of mobile technologies and their rapid penetration into people's daily lives, especially in the developing countries, have highlighted mobile health, or m-health, as a promising solution to improve health outcomes. Several studies have been conducted that characterize the impact of m-health solutions in resource-limited settings and assess their potential to improve health care. The aim of this review is twofold: 1) to present an overview of the background and significance of m-health and 2) to summarize and discuss the existing evidence for the effectiveness of m-health in the developing world. A systematic search in the literature was performed in Pubmed, Scopus, as well as reference lists, and a broad sample of 98 relevant articles was identified, which were then categorized into five wider m-health categories. Although statistically significant conclusions cannot be drawn since the majority of studies relied on small-scale trials and limited assessment of long-term effects, this review provides a systematic and extensive analysis of the advantages, disadvantages, and challenges of m-health in developing countries in an attempt to determine future research directions of m-health interventions.
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Kazi AM. The role of mobile phone-based interventions to improve routine childhood immunisation coverage. LANCET GLOBAL HEALTH 2018; 5:e377-e378. [PMID: 28288737 DOI: 10.1016/s2214-109x(17)30088-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Abdul Momin Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan; Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Kazi AM, Ali M, Zubair K, Kalimuddin H, Kazi AN, Iqbal SP, Collet JP, Ali SA. Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial. JMIR Public Health Surveill 2018. [PMID: 29514773 PMCID: PMC5863012 DOI: 10.2196/publichealth.7026] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Improved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide. Objective The 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. Methods This 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. Results Out 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. Conclusions Automated 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 Registration ClinicalTrials.gov NCT01859546; https://clinicaltrials.gov/ct2/show/NCT01859546 (Archived by WebCite at http://www.webcitation.org/6xFr57AOc)
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Affiliation(s)
- Abdul Momin Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Murtaza Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Khurram Zubair
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Hussain Kalimuddin
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Abdul Nafey Kazi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Jean-Paul Collet
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Syed Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Menson WNA, Olawepo JO, Bruno T, Gbadamosi SO, Nalda NF, Anyebe V, Ogidi A, Onoka C, Oko JO, Ezeanolue EE. Reliability of Self-Reported Mobile Phone Ownership in Rural North-Central Nigeria: Cross-Sectional Study. JMIR Mhealth Uhealth 2018; 6:e50. [PMID: 29496656 PMCID: PMC5856935 DOI: 10.2196/mhealth.8760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/07/2017] [Accepted: 01/03/2018] [Indexed: 11/25/2022] Open
Abstract
Background mHealth practitioners seek to leverage the ubiquity of the mobile phone to increase the impact and robustness of their interventions, particularly in resource-limited settings. However, data on the reliability of self-reported mobile phone access is minimal. Objective We sought to ascertain the reliability of self-reported ownership of and access to mobile phones among a population of rural dwellers in north-central Nigeria. Methods We contacted participants in a community-based HIV testing program by phone to determine actual as opposed to self-reported mobile phone access. A phone script was designed to conduct these calls and descriptive analyses conducted on the findings. Results We dialed 349 numbers: 110 (31.5%) were answered by participants who self-reported ownership of the mobile phone; 123 (35.2%) of the phone numbers did not ring at all; 28 (8.0%) rang but were not answered; and 88 (25.2%) were answered by someone other than the participant. We reached a higher proportion of male participants (68/133, 51.1%) than female participants (42/216, 19.4%; P<.001). Conclusions Self-reported access to mobile phones in rural and low-income areas in north-central Nigeria is higher than actual access. This has implications for mHealth programming, particularly for women’s health. mHealth program implementers and researchers need to be cognizant of the low reliability of self-reported mobile phone access. These observations should therefore affect sample-size calculations and, where possible, alternative means of reaching research participants and program beneficiaries should be established.
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Affiliation(s)
- William Nii Ayitey Menson
- Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | | | - Tamara Bruno
- Global Health Initiative, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, United States
| | - Semiu Olatunde Gbadamosi
- Global Health Initiative, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, United States
| | | | | | - Amaka Ogidi
- Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Chima Onoka
- Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | | | - Echezona Edozie Ezeanolue
- Global Health Initiative, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, United States
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Jacobson Vann JC, Jacobson RM, Coyne‐Beasley T, Asafu‐Adjei JK, Szilagyi PG. Patient reminder and recall interventions to improve immunization rates. Cochrane Database Syst Rev 2018; 1:CD003941. [PMID: 29342498 PMCID: PMC6491344 DOI: 10.1002/14651858.cd003941.pub3] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Immunization rates for children and adults are rising, but coverage levels have not reached optimal goals. As a result, vaccine-preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care, and large demands on primary care providers, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage. One common theme across immunization programs in many nations involves the challenge of implementing a population-based approach and identifying all eligible recipients, for example the children who should receive the measles vaccine. However, this issue is gradually being addressed through the availability of immunization registries and electronic health records. A second common theme is identifying the best strategies to promote high vaccination rates. Three types of strategies have been studied: (1) patient-oriented interventions, such as patient reminder or recall, (2) provider interventions, and (3) system interventions, such as school laws. One of the most prominent intervention strategies, and perhaps best studied, involves patient reminder or recall systems. This is an update of a previously published review. OBJECTIVES To evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to January 2017. We also searched grey literature and trial registers to January 2017. SELECTION CRITERIA We included randomized trials, controlled before and after studies, and interrupted time series evaluating immunization-focused patient reminder or recall interventions in children, adolescents, and adults who receive immunizations in any setting. We included no-intervention control groups, standard practice activities that did not include immunization patient reminder or recall, media-based activities aimed at promoting immunizations, or simple practice-based awareness campaigns. We included receipt of any immunizations as eligible outcome measures, excluding special travel immunizations. We excluded patients who were hospitalized for the duration of the study period. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane and the Cochrane Effective Practice and Organisation of Care (EPOC) Group. We present results for individual studies as relative rates using risk ratios, and risk differences for randomized trials, and as absolute changes in percentage points for controlled before-after studies. We present pooled results for randomized trials using the random-effects model. MAIN RESULTS The 75 included studies involved child, adolescent, and adult participants in outpatient, community-based, primary care, and other settings in 10 countries.Patient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (risk ratio (RR) of 1.28, 95% confidence interval (CI) 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.Three types of single-method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single-method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).Based on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non-influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants). AUTHORS' CONCLUSIONS Patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations.
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Affiliation(s)
- Julie C Jacobson Vann
- The University of North Carolina at Chapel HillSchool of NursingCarrington HallChapel HillNorth CarolinaUSA27599‐7460
| | - Robert M Jacobson
- Mayo ClinicPediatric and Adolescent Medicine200 First Street, SWRochesterMinnesotaUSA55905‐0001
| | - Tamera Coyne‐Beasley
- University of North CarolinaGeneral Pediatrics and Adolescent MedicineChapel HillNorth CarolinaUSA
| | - Josephine K Asafu‐Adjei
- University of North Carolina at Chapel HillDepartment of Biostatistics, School of Nursing120 North Medical Drive, 2005 Carrington HallChapel HillNorth CarolinaUSA27599
| | - Peter G Szilagyi
- University of California Los AngelesDepartment of Pediatrics90024Los AngelesCaliforniaUSA90024
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Domek GJ, Contreras-Roldan IL, Asturias EJ, Bronsert M, Bolaños Ventura GA, O’Leary ST, Kempe A, Bull S. Characteristics of mobile phone access and usage in rural and urban Guatemala: assessing feasibility of text message reminders to increase childhood immunizations. Mhealth 2018; 4:9. [PMID: 29780812 PMCID: PMC5945665 DOI: 10.21037/mhealth.2018.03.05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/21/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite efforts to promote vaccination in low- and middle-income countries (LMICs), over 20 million infants remain under-immunized and at risk for unnecessary morbidity and mortality. Mobile health technologies, such as Short Message Service (SMS) texts, have tremendous and untapped potential for disease management. Patient reminder systems are an important mechanism for improving childhood vaccination coverage and can be easily adapted to SMS platforms. However, current research lacks an understanding of the barriers and facilitators to mHealth program design, implementation, and scale in LMICs. METHODS We analyzed survey data collected March-November 2016 at the enrollment visit from a randomized controlled trial conducted at public health clinics in urban and rural Guatemala. Participants included eligible infants 6 weeks to 6 months of age receiving the first dose of the primary immunization series. At least one parent needed to own a mobile phone and be capable of deciphering SMS. Chi-square or Fisher's exact and Student's t-test were used to assess significance levels in demographic differences to describe factors that contribute to the feasibility of using an SMS-based vaccination reminder system. RESULTS Of 1,088 families approached for enrollment, 871 were eligible and 720 (82.7%) participated with equal numbers of urban and rural children enrolled; 54 parents did not own a mobile phone with SMS capability and three parents could not use SMS. There was no significant difference between urban and rural maternal mobile phone ownership (94.4% vs. 93.3%, P=0.53), but more urban fathers owned mobile phones (72.8% vs. 47.1%, P<0.0001) and, overall, more mothers compared to fathers owned mobile phones (93.9% vs. 61.1%, P<0.0001). Most families (90.4%) chose to have reminders sent to the mother. Urban participants reported more mobile phones present in the home (P<0.0001), but rural participants reported more telephone landlines (34.7% vs. 15.6%, P<0.0001). Most participants reported a daily average of ≤5 telephone calls made (87.4%), ≤10 texts sent (91.0%), and ≤10 texts received (89.9%), with urban families reporting greater telephone usage (P=0.006, P<0.001, and P<0.001 respectively). Parents preferred to make calls over sending texts (74.7% vs. 25.3%, P<0.0001), with more urban families preferring text messaging (31.9% vs. 18.6%, P<0.0001). CONCLUSIONS Our study results provide important insight into mobile phone access, usage, and preferences for voice and text communication across rural and urban populations of an LMIC that can be used to inform future mHealth interventions. Our findings suggest that offering a combination of more traditional communication methods with newer, modern technologies may be more effective at reminding families about vaccination visits, particularly for our rural population, and that targeting mothers for mobile phone interventions may provide the greatest benefits. Overall, our study suggests that using SMS reminders in LMICs can be a feasible tool for public health interventions.
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Affiliation(s)
- Gretchen J. Domek
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Center for Global Health, Colorado School of Public Health; Mail Stop A090, 13199 E Montview Blvd., Suite 310, Aurora, CO 80045, USA
| | | | - Edwin J. Asturias
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Center for Global Health, Colorado School of Public Health; Mail Stop A090, 13199 E Montview Blvd., Suite 310, Aurora, CO 80045, USA
| | - Michael Bronsert
- Center for Global Health, Colorado School of Public Health; Mail Stop A090, 13199 E Montview Blvd., Suite 310, Aurora, CO 80045, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Sean T. O’Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Allison Kempe
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Sheana Bull
- Center for Global Health, Colorado School of Public Health; Mail Stop A090, 13199 E Montview Blvd., Suite 310, Aurora, CO 80045, USA
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO 80045, USA
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Clouse K, Mongwenyana C, Musina M, Bokaba D, Long L, Maskew M, Ahonkhai A, Fox MP. Acceptability and feasibility of a financial incentive intervention to improve retention in HIV care among pregnant women in Johannesburg, South Africa. AIDS Care 2017; 30:453-460. [PMID: 29067861 DOI: 10.1080/09540121.2017.1394436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Women initiating antiretroviral therapy during pregnancy are at high risk of dropping out of HIV care after delivery. We assessed the acceptability and feasibility of a financial incentive - a one-time R50 (∼USD4) supermarket voucher for completing one postpartum visit ≤10 weeks of delivery - to improve postpartum retention. We enrolled 100 pregnant, HIV-positive women at a primary health clinic in Johannesburg, South Africa. Participants were interviewed at enrollment and we reviewed files to assess retention ≥14 weeks postpartum. Median (IQR) respondent age was 28 years (24-31) and 31% were employed. Most (86%) said the incentive would motivate them to return and 76% supported clinics offering incentives. Among the 23% who found the intervention unacceptable, the most frequent reason was perceived personal responsibility for health. Feasibility was demonstrated, as 79.7% (51/64) of eligible participants received a voucher. When asked to rank preferred hypothetical incentive interventions, assistance with social services ranked first (29%), followed by infant formula (22%) and cash (21%); assistance with social services was the top-ranked choice by both those who found the voucher incentive intervention acceptable and unacceptable. To encourage HIV-positive women to remain in care, respondents most frequently suggested health education (34%), counseling (29%), financial incentives (25%), home visits (13%), and better service (6%). Our results suggest financial incentives are acceptable, but women frequently expressed preference for integrated services and improved education and counseling to improve retention. Interventions exploring the feasibility and efficacy of education and counseling interventions to improve postpartum HIV care are warranted.
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Affiliation(s)
- Kate Clouse
- a Vanderbilt Institute for Global Health , Vanderbilt University , Nashville , TN , USA.,b Department of Medicine, Division of Infectious Diseases , Vanderbilt University , Nashville , TN , USA.,c Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Constance Mongwenyana
- c Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Melda Musina
- c Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Dorah Bokaba
- d Hikhensile Clinic , City of Johannesburg , Johannesburg , South Africa
| | - Lawrence Long
- c Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Mhairi Maskew
- c Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Aima Ahonkhai
- a Vanderbilt Institute for Global Health , Vanderbilt University , Nashville , TN , USA.,b Department of Medicine, Division of Infectious Diseases , Vanderbilt University , Nashville , TN , USA
| | - Matthew P Fox
- c Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,e Department of Global Health , Boston University School of Public Health, Boston University , Boston , MA , USA.,f Department of Epidemiology , Boston University School of Public Health, Boston University , Boston , MA , USA
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Oliver-Williams C, Brown E, Devereux S, Fairhead C, Holeman I. Using Mobile Phones to Improve Vaccination Uptake in 21 Low- and Middle-Income Countries: Systematic Review. JMIR Mhealth Uhealth 2017; 5:e148. [PMID: 28978495 PMCID: PMC5647459 DOI: 10.2196/mhealth.7792] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 11/13/2022] Open
Abstract
Background The benefits of vaccination have been comprehensively proven; however, disparities in coverage persist because of poor health system management, limited resources, and parental knowledge and attitudes. Evidence suggests that health interventions that engage local parties in communication strategies improve vaccination uptake. As mobile technology is widely used to improve health communication, mobile health (mHealth) interventions might be used to increase coverage. Objective The aim of this study was to conduct a systematic review of the available literature on the use of mHealth to improve vaccination in low- and middle-income countries with large numbers of unvaccinated children. Methods In February 2017, MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, and Web of Science, as well as three health organization websites—Communication Initiative Network, TechNet-21, and PATH—were searched to identify mHealth intervention studies on vaccination uptake in 21 countries. Results Ten peer-reviewed studies and 11 studies from white or gray literature were included. Nine took place in India, three in Pakistan, two each in Malawi and Nigeria, and one each in Bangladesh, Zambia, Zimbabwe, and Kenya. Ten peer-reviewed studies and 7 white or gray studies demonstrated improved vaccination uptake after interventions, including appointment reminders, mobile phone apps, and prerecorded messages. Conclusions Although the potential for mHealth interventions to improve vaccination coverage seems clear, the evidence for such interventions is not. The dearth of studies in countries facing the greatest barriers to immunization impedes the prospects for evidence-based policy and practice in these settings.
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Affiliation(s)
- Clare Oliver-Williams
- Homerton College, University of Cambridge, Cambridge, United Kingdom.,Cardiovascular Epidemiology Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Elizabeth Brown
- Gonville and Caius College, University of Cambridge, Cambridge, United Kingdom.,University College London, London, United Kingdom
| | - Sara Devereux
- Trinity College, University of Cambridge, Cambridge, United Kingdom.,Queens' College, University of Cambridge, Cambridge, United Kingdom
| | - Cassandra Fairhead
- University College London, London, United Kingdom.,King's College, University of Cambridge, Cambridge, United Kingdom
| | - Isaac Holeman
- Judge Business School, University of Cambridge, Cambridge, United Kingdom.,Global Health Academy, University of Edinburgh, Edinburgh, United Kingdom.,Medic Mobile, San Francisco, CA, United States
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Mokaya E, Mugoya I, Raburu J, Shimp L. Use of cellular phone contacts to increase return rates for immunization services in Kenya. Pan Afr Med J 2017; 28:24. [PMID: 29138660 PMCID: PMC5681005 DOI: 10.11604/pamj.2017.28.24.12631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 09/04/2017] [Indexed: 12/27/2022] Open
Abstract
Introduction In Kenya, failure to complete immunization schedules by children who previously accessed immunization services is an obstacle to ensuring that children are fully immunized. Home visit approaches used to track defaulting children have not been successful in reducing the drop-out rate. Methods This study tested the use of phone contacts as an approach for tracking immunization defaulters in twelve purposively-selected facilities in three districts of western Kenya. For nine months, children accessing immunization services in the facilities were tracked and caregivers were asked their reasons for defaulting. Results In all of the facilities, caregiver phone ownership was above 80%. In 11 of the 12 facilities, defaulter rates between pentavalent1 and pentavalent3 vaccination doses reduced significantly to within the acceptable level of < 10%. Caregivers provided reliable contact information and health workers positively perceived phone-based defaulter communications. Tracking a defaulter required on average 2 minutes by voice and Ksh 6 ($ 0.07). Competing tasks and concerns about vaccinating sick children and side-effects were the most cited reasons for caregivers defaulting. Notably, a significant number of children categorised as defaulters had been vaccinated in a different facility (and were therefore “false defaulters”). Conclusion Use of phone contacts for follow-up is a feasible and cost-effective method for tracking defaulters. This approach should complement traditional home visits, especially for caregivers without phones. Given communication-related reasons for defaulting, it is important that immunization programs scale-up community education activities. A system for health facilities to share details of defaulting children should be established to reduce “false defaulters”.
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Affiliation(s)
- Evans Mokaya
- USAID's Maternal and Child Survival Program (MCSP)/John Snow, Inc (JSI), Nairobi, Kenya
| | - Isaac Mugoya
- USAID's Maternal and Child Survival Program (MCSP)/John Snow, Inc (JSI), Nairobi, Kenya
| | - Jane Raburu
- Kisumu County Health Team/Ministry of Health, Kisumu, Kenya
| | - Lora Shimp
- USAID's Maternal and Child Survival Program (MCSP)/John Snow, Inc (JSI), Washington DC, USA
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Duclos V, Yé M, Moubassira K, Sanou H, Sawadogo NH, Bibeau G, Sié A. Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso. Health Res Policy Syst 2017; 15:47. [PMID: 28722558 PMCID: PMC5516845 DOI: 10.1186/s12961-017-0211-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of mobile health (mHealth) projects in low- and middle-income countries raises high and well-documented expectations among development agencies, policymakers and researchers. By contrast, the expectations of direct and indirect mHealth users are not often examined. In preparation for a proposed intervention in the Nouna Health District, in rural Burkina Faso, this study investigates the expected benefits, challenges and limitations associated with mHealth, approaching these expectations as a form of situated knowledge, inseparable from local conditions, practices and experiences. METHODS The study was conducted within the Nouna Health District. We used a qualitative approach, and conducted individual semi-structured interviews and group interviews (n = 10). Participants included healthcare workers (n = 19), godmothers (n = 24), pregnant women (n = 19), women with children aged 12-24 months (n = 33), and women of childbearing age (n = 92). Thematic and content qualitative analyses were conducted. RESULTS Participants expect mHealth to help retrieve patients lost to follow-up, improve maternal care monitoring, and build stronger relationships between pregnant women and primary health centres. Expected benefits are not reducible to a technological realisation (sending messages), but rather point towards a wider network of support. mHealth implementation is expected to present considerable challenges, including technological barriers, organisational challenges, gender issues, confidentiality concerns and unplanned aftereffects. mHealth is also expected to come with intrinsic limitations, to be found as obstacles to maternal care access with which pregnant women are confronted and on which mHealth is not expected to have any significant impact. CONCLUSIONS mHealth expectations appear as situated knowledges, inseparable from local health-related experiences, practices and constraints. This problematises universalistic approaches to mHealth knowledge, while nevertheless hinting at concrete, expected benefits. Findings from this study will help guide the design and implementation of mHealth initiatives, thus optimising their chances for success.
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Affiliation(s)
- Vincent Duclos
- Department of Global Studies and Modern Languages, Center for Science, Technology & Society, Drexel University, 3101 Market Street, 2nd Floor Suite, Philadelphia, PA, 19104, USA.
| | - Maurice Yé
- Nouna Health Research Center, Nouna, P.O. BOX 02, Burkina Faso
| | | | - Hamidou Sanou
- Nouna Health Research Center, Nouna, P.O. BOX 02, Burkina Faso
| | | | - Gilles Bibeau
- Département d'anthropologie, Université de Montréal, Pavillon Lionel-Groulx, 3150 rue Jean-Brillant, Montréal, QC, H3T 1N8, Canada
| | - Ali Sié
- Nouna Health Research Center, Nouna, P.O. BOX 02, Burkina Faso
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Manakongtreecheep K, Davis R. A review of measles control in Kenya, with focus on recent innovations. Pan Afr Med J 2017; 27:15. [PMID: 29296150 PMCID: PMC5745932 DOI: 10.11604/pamj.supp.2017.27.3.12118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/01/2017] [Indexed: 11/24/2022] Open
Abstract
Despite the existence of a highly effective measles vaccine and the decrease in worldwide deaths from measles by more than 79% from the 2000 baseline levels, measles today remains one of the leading causes of vaccine-preventable deaths in the world. The African region is a key player in the global fight against measles. Africa has made tremendous progress in its effort to immunize children and to control the disease, increasing its regional measles vaccination coverage from 56% in 2001 to 85% in 2010. The Republic of Kenya has been a strong follower of the World Health Assembly and Measles Elimination 2020 resolutions, which aims to eliminate measles from the country. Since the beginning of the 21st century, Kenya has faced many challenges, but also aid, in the form of new innovations, in their fight against measles. In 2002, Kenya started its first SIA using A-D syringes, and from 2003-2005, GAVI funded injection safety support (INS) to Kenya, as an effort to scale-up safe injection in sub-Saharan Africa. In 2016, the Kenya introduced Measles-Rubella (MR) combined vaccine in its nationwide SIA campaign, after recognizing that rubella is a disease that must be controlled along with measles. In 2009 and 2012 SIAs, Red Cross volunteers conducted H2H visits to promote immunization as well as document information from the community with regards to immunization, including the current coverage, to campaign management levels. Case-based surveillance, using real-time PCR, measles-specific IgM detection and Epi-link were used to confirm and map measles infection during outbreaks. Alternative serosurveys such as Dried Blood Spot and Urine sample surveys were also tested in Kenya. In 2013 and 2016, two studies were also conducted in Kenya on the use of SMS reminder system for routine immunization. These studies, which showed SMS to significantly improve the vaccination coverage, paved way for use of SMS in a larger scale in Kenya.
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