Children Immunization App (CIMA): A Non-randomized Controlled Trial Among Syrian Refugees in Zaatari Camp, Jordan

Abstract

Approximately 20 million children are not vaccinated, especially among refugees. There is a growing access to smartphones, among refugees, which can help in improving their vaccination. We assessed the impact of an app for the vaccination follow-up visit among refugees in Jordan. We developed an app and tested it through a non-randomized trial at the Zaatari refugees camp in Jordan. The study was conducted during March – December 2019 at three vaccination clinics inside the camp. The study included two study groups (intervention and control groups) for refugees living at the camp. The intervention group included parents who own an Android smartphone and have one newborn that require between one and four first vaccination doses and they accepted to participate in the study, during their regular visit to the vaccination clinics. The control group was for the usual care. We compared both study groups for returning back to one follow-up visit, using Kaplan-Meier survival analysis. We recruited 936 babies (n = 471; 50.3% in the intervention group, both study groups were similar at baseline). The majority of mothers were literate (94.2%) with a median age of 24. The majority of the babies had a vaccination card (n = 878, 94%). One quarter (26%) of mother-babies pairs of the intervention group came back within one week (versus 22% for control group); When it comes to lost-follow-up, 22% and 28% did not have a history of returning back (intervention and control groups respectively, p = 0.06) (Relative risk reduction: 19%). The Kaplan-Meier Survival Analysis showed a statistically significant progressive reduction in the duration of coming back late for the follow-up vaccine visit. We tested a vaccination app for the first time, in a refugee population setting. The app can be used as a reminder for parents to come back on time for their children’s vaccine follow-up visits.

Exploring Vaccination Challenges among Syrian Refugees in Jordan: Insights from Camps and Communities, and Perceived Parental Barriers to Childhood Vaccination Uptake

“…These strategies were discussed to be more effective in camp-like settings due to high population density and limited infrastructure [ 51 ]. Utilizing simple technological tools, such as smartphone applications, to better facilitate vaccination appointments and follow-up visits has also been proven its effectiveness [ 52 , 53 ]. Publicly funding vaccination campaigns as well as arranging organized door-to-door immunization programs with local actors and non-governmental organizations have yielded exceptional results with more than 20,000 vaccine doses successfully delivered, studies report [ 38 , 39 , 54 ].…”

Testing the Impact of Phone Texting Reminders for Children's Immunization Appointments in Rural Cameroon: Protocol for a Nonrandomized Controlled Trial

“…We have previously tested this concept among refugees at the Zaatari camp in Jordan, a vulnerable group [ 5 ]. We used the same questionnaire in Jordan but provided CIMA in the form of an Android smartphone app because the majority of households in the camp owned at least one Android smartphone.…”

“…Therefore, this study will support new studies on assessing perceptions among parents of parenting-skills health education messages sent in the form of regular SMS messages. These messages were developed by the UNODC and have been tested in different contexts around the world, including in our study of CIMA in the Zaatari camp in Jordan [ 5 ]. In our planned study in Cameroon, we will send the messages via SMS, which will be done for the first time.…”

“…The team members have different areas of expertise: epidemiology and the usefulness of digital tool reminders for clinic appointments for vaccination [ 3 - 5 ], the usefulness of telemedicine [ 6 ], adherence to taking antiretroviral treatment on time using cell phone reminders [ 7 ], and insulin supply pickup using SMS versus phone call reminders [ 8 ]; all members are experts in the study context of Bamenda and Cameroon.…”

“…In 2021, UNICEF reported that different regions of Cameroon face the challenge of low vaccination coverage for several reasons, including armed conflict, insecurity, and underfunding of national vaccination programs [ 1 ]. Using cell phones to send reminders to parents about vaccination appointments has been shown to support adherence [ 5 , 6 ].…”