JMIR Publications

ABSTRACT

Background:

Non-attendance to vaccination appointments is a big challenge to health workers with a difficulty to track routine vaccination schedules. In Ethiopia, three out of ten children have incomplete vaccination and timely receipt of recommended vaccines is also low. Thus, innovative strategies are required to reach the last mile where mobile technology could be effectively utilized to achieve better compliance. With the unprecedented penetration of mobile devices, mHealth interventions have been proposed as a promising avenue in improving health care access and quality. Despite this promising and fast-growing technology, little is known about the possible role of text message-based mobile health interventions in improving the completeness and timely receipt of routine vaccination in the Ethiopian context.

Objective:

Objective:

This trial aimed to determine the effect of mobile text message reminders on completion and timely receipt of routine childhood vaccinations in northwest, Ethiopia.

Methods:

A two-arm, parallel, superiority randomized controlled trial was conducted in nine health facilities in northwest Ethiopia. Four hundred thirty-four participants were enrolled at the health facilities. Randomization was applied in the selected health facilities during enrollment with a 1:1 allocation ratio, using sealed and opaque envelopes. Participants assigned to the intervention group received automated mobile text message reminders one day before the scheduled vaccination visits. Due 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 outcomes between study groups. A modified intention to treat analysis approach was applied and a one-tailed test was reported considering the superiority design.

Results:

A total of 426 participants (213 in each group) were included for analysis. The study found that higher proportion of infants in the intervention group achieved penta-3 (95.8% vs 86.9%, P<.001), measles (91.5% vs 79.3%, P<.001) and full vaccination (82.6% vs 70.9%; P=.002, [RR=1.17, 95%LCI:1.07]) coverage as compared with the control group. Similarly, higher proportion of infants in the intervention group received penta-3 (88.7% vs 69.2%, P<.001), measles (87.1% vs 68.6%, P<.001) and all scheduled vaccinations (63.3% vs 39.9%; P<.001, [RR=1.59, 95%LCI:1.35]) on time as compared with the control group. Out of the automatically sent 852 mobile text messages, 764 (89.7%) were delivered successfully to the study participants.

Conclusions:

In the study setting, mobile text message reminders showed both clinically and statistically significant effect in improving on-time full vaccination. Besides, mobile text message reminders have a significant effect in improving timely receipt of specific vaccines. Thus, mobile text message reminders can be an additional tool to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on implementation challenges of mHealth interventions are recommended. Clinical Trial: This trial is registered with WHO PAN AFRICAN CLINICAL TRIAL REGISTRY (PACTR), registration number: PACTR201901533237287. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839