JMIR Publications

ABSTRACT

Background:

Globally, suboptimal vaccine coverage is a major public health concern. According to Uganda’s 2016 Demographic and Health Survey, only 49% of 12-23 month olds had received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage and reduce drop-out, including increasing awareness of caregivers to bring children for timely vaccination. This research builds upon a growing mobile health system in Uganda to use personalized, automated text messages to remind caregivers of upcoming vaccination visits.

Objective:

To evaluate a personalized, automated caregiver mobile phone delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children 12 months of age and younger in select health facilities in Arua District.

Methods:

A two arm, multi-center, parallel groups randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers were recruited and interviewed at the time of their children’s first dose of pentavalent vaccine (containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens), typically at 6 weeks of age of the child. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers, as available, and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not to receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. Study personnel conducted post-intervention follow-up interviews with participants at the health facilities during the children’s measles-containing vaccine visit or outside the health facility (generally at the caregiver’s home) after the last child in the study reached one year of age; a questionnaire was administered and data from the child’s vaccination card was extracted. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention; economic data was collected to evaluate the incremental costs and the cost-effectiveness of the intervention; and health facility records review forms were completed to capture service delivery process indicators.

Results:

Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children’s vaccination cards; data extraction from the health facility immunization registers; completion of the health facility records review forms; and focus group discussions were completed by December 2017.

Conclusions:

Prompting of health seeking behavior with reminders has been shown to improve health intervention uptake in many contexts, including via mobile technology. Mobile phone ownership continues to grow in Uganda, so their use in health interventions like this study is logical and should be evaluated with scientifically rigorous study designs. Clinical Trial: Clinicaltrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485.