Accepted for/Published in: JMIR Pediatrics and Parenting
Date Submitted: Jun 29, 2022
Date Accepted: Dec 25, 2022
Evaluation of a Mobile-based Immunization Decision Support System (iDSS) for Scheduling Age-Appropriate Vaccine Schedules for Under-2 children in Pakistan and Bangladesh: Lessons from a Multi-Site, Mixed Methods Feasibility Study
ABSTRACT
Background:
Missed Opportunities for Vaccination (MOVs), when children interact with the health system but fail to receive age-eligible vaccines, pose a crucial challenge for equitable and universal immunization coverage. Inaccuracies in health workers’ interpretation of complex catch-up schedules contribute to MOVs.
Objective:
We assessed the feasibility of a mobile-based immunization decision support systems (iDSS) to automatically construct age-appropriate vaccination schedules for children and prevent MOVs.
Methods:
A sequential exploratory mixed-methods study was implemented at six immunization clinics in Pakistan and Bangladesh. An android-based iDSS packaged in the form of an Application Programming Interface (API) constructed age-appropriate immunization schedules for eligible children. The diagnostic accuracy of the iDSS was measured by comparing the schedules constructed by iDSS and vaccinators with the gold standard of evaluation (WHO recommended EPI schedule constructed by a vaccines expert). Preliminary estimates were collected on the number of MOVs among children visiting study centres, and vaccinator’s understanding and perceived usability and acceptability of the iDSS through key informant interviews.
Results:
From July 5, 2019, to April 11, 2020, a total of 6,241 immunization visits were recorded from 4,613 eligible children. Data was collected on a total of 17,961 immunization doses for all antigens. The iDSS correctly scheduled 99.8% (17,932/17,961) of all the age-appropriate immunization doses relative to the gold standard. In comparison, the vaccinator correctly scheduled 96.8% (17,378/17,961) of all immunization doses. A total of 3.2% (583/17,961) of all due doses (across antigens) were missed in age-eligible children by the vaccinators across both sites. Vaccinators reported positively on the usefulness of the iDSS, including understanding and benfits of the technology.
Conclusions:
This study demonstrated the feasibility of a mobile-based iDSS to accurately construct age-appropriate vaccination schedules for 0-23 month old children across multi-country LMIC settings, and potentially increase immunization coverage and timeliness, by eliminating MOVs.
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