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Clinical Trial. Gov, registration number is NCT018595 Strengths• We plan to test the effectiveness of Short Message System (SMS) reminders to parents/caregivers on cell phones in improving the uptake and on-time RI for children in Pakistan. SMS text reminders for RI can potentially be used in connecting health care services to parents and caregivers of children eligible for RI directly detouring different hurdles confronted during physical visits [1,2].• In places where maternal and child services are available and affordable but not availed, mHealth can have a significant role in improving the coverage [3]. In this study we evaluated the role of SMS texts reminders for improvement in RI coverage at 6, 10 and 14 weeks of life.• With increased shared phone access and acceptance of technological advances there is a higher chance of improving the reach to majority of population. This provides great opportunity to improve engagement through text reminders for completion of RI of child after birth.• Pakistan being the major contributor for the polio epidemic, any strategy to support and improvement in the RI will have a direct impact on the Polio end game strategy. LimitationsA small sample size; the sample size estimation was done with assumption of 20% increase in coverage of the intervention arm. Participants will be recruited from the catchment population of the health demographic surveillance area, of a peri-urban population. AbstractIntroduction: Routine Immunization (RI) is considered one of the best public health interventions to decrease child morbidity and mortality. The RI coverage in Pakistan is still well below the desired level, leading to continued polio transmission, large measles outbreaks and thousands of deaths from vaccine-preventable illnesses. Different innovative and cost effective strategies are required to look into for enhancement in vaccination uptake and coverage. We plan to test the effectiveness of reminders to parents/caregivers on cell phones through short messaging system (SMS) in improving vaccine uptake and on-time routine immunization for children in Pakistan. Methods and Analysis:A parallel-randomized controlled trial will be conducted to assess the effectiveness of short messaging service (SMS) text reminders on the mobile phones in improving the uptake and on-time vaccination for routine immunization in children at 6,10 and 14 weeks of age according to the EPI schedule in Pakistan. The trial consists of 300 children with allocation of parallel 1:1 to the SMS reminders or to standard care (control group). The intervention arm in addition to the standard counseling will receive four SMS reminders according to the language preference in the week that the enrolled child is due for routine immunization at 6, 10 and 14-week schedule. The primary outcome is to evaluate whether text reminders can improve uptake and on-time vaccination for routine immunization at 6, 10 and 14 weeks' schedule. Assumptions used for calculating sample size are increase in coverage rate from 60% to 80%, pow...