Abstract
BackgroundVaccination 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.MethodsThe 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.DiscussionThe results will inform implementation science research on the effectiveness of reminders and incentives as a means of improving vaccination timeliness.Trial registrationClinicalTrials.gov, NCT03252288. Registered on 17 August 2017 (retrospectively registered).
Highlights
Vaccination is a cost-effective strategy for reducing morbidity and mortality among children under 5 years old
This study examines the efficacy of mobile phone-based reminders and incentives in the form of conditional financial transfers for offsetting demand-side barriers to timely childhood vaccinations in Tanzania
Our implementation strategy has several unique components, including the use of a Unstructured Supplementary Service Data (USSD)-based birth and vaccination event notification system, an adaptive schedule for vaccination reminders which is derived from the date of the preceding event, a tiered incentive system, and the semiautomated disbursement of mobile phone credit for eligible timely vaccinations
Summary
Vaccination is a cost-effective strategy for reducing morbidity and mortality among children under 5 years old. The majority of un- or undervaccinated children reside in low- and middle-income countries (LMICs), with those from rural, remote, and poorer households being disproportionately less likely to receive all recommended vaccines in their first year of life [1,2,3]. In Tanzania, for example, 1 in 4 children has not received all recommended vaccines in the first year of life, compared to 1 in 10 globally [4, 5]. Numerous reports indicate low timeliness of vaccinations in LMICs, including in Tanzania [8,9,10]. In the quest for universal immunization, innovative strategies are needed to improve vaccination coverage for the “last mile” and to reduce vaccination delays that leave children susceptible to unnecessary morbidity and mortality from vaccine-preventable infections [2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
