Abstract
BackgroundReminder/recall systems are effective ways to improve immunization rates, but their feasibility in primary health care (PHC) settings in Nigeria has not been adequately evaluated. In this study we describe the acceptability and adaptability of immunization reminder/recall system in an urban setting in southwest Nigeria.MethodsThis is a descriptive report of a cluster randomized controlled trial. Four local government areas (LGAs) were randomly assigned into a cellphone reminder/recall intervention group or a usual care control group. Within each LGA, PHC centers were purposively selected to participate in the study. In each PHC center, mothers and their infants aged 0–3 months were enrolled into the two groups during the infants’ first immunization visit. Mothers (or other contact persons) in the intervention group received cellphone calls reminding them to take their child for scheduled immunizations. Follow-up of all the children lasted till the final scheduled immunization visit for each child. The intervention lasted for 13 months.ResultsA total of 595 mothers/infants pairs (295 in the intervention group and 300 in the control group) participated in the study. Almost all mothers (n = 590, 99.2%) had access to their own cellphone or had access to a cellphone belonging to a significant other. Ninety-eight percent (n = 584) of all mothers were willing to receive immunization reminder/recall phone calls.Eighty-seven percent (n = 2023) of all calls (n = 2324) for the reminder/recall intervention went through to the recipients and of these calls, 1948 (96.3%) were received. The mean cost of each call in US Dollars was about 5 cents. Immunization compliance rate (the receipt of required number of doses of routine vaccines at the appropriate age at recommended interval) was 79.2% among the children in intervention group and 46.4% in the control group (p < 0.001).ConclusionResults demonstrate that cellphone reminder/recall interventions to improve routine childhood immunization are feasible in PHC settings in limited-resource settings with wide cellphone coverage, such as urban areas in Nigeria. Further research to test the potential for scale up in a variety of settings is recommended.Trial registrationPACTR201702002043415; Date of registration: 17 February 2017. (Retrospectively registered).
Highlights
Reminder/recall systems are effective ways to improve immunization rates, but their feasibility in primary health care (PHC) settings in Nigeria has not been adequately evaluated
The 2013 Nigeria Demographic and Health Survey showed that only 25.8% of children aged 12–23 months in Oyo State were fully immunized with recommended routine vaccines [22]
The results from this study demonstrate the feasibility of a cellphone-based childhood immunization reminder/recall system in a low-resource setting, such as Nigeria
Summary
Reminder/recall systems are effective ways to improve immunization rates, but their feasibility in primary health care (PHC) settings in Nigeria has not been adequately evaluated. Vaccine-preventable diseases (VPDs) constitute about a quarter of the eight million annual deaths among children under five children especially in low-income countries [2]. About 22 million infants are not fully immunized with routine vaccines and more than 1.5 million children under five years of age die from diseases that could be prevented by existing vaccines [5]. Compliance to and completion of recommended routine vaccines among children in Nigeria is sub-optimal with more than 3.2 million children aged 12 months old unimmunized, leading to outbreaks of VPDs across the country. Effective and novel strategies are required to enable the country to meet the WHO recommended 95% level for the sustained control of VPDs and reduce under-five mortality
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