Effects of Community Health Nurse-Led Intervention on Childhood Routine Immunization Completion in Primary Health Care Centers in Ibadan, Nigeria

Abstract

Immunization coverage of vulnerable children is often sub-optimal in many low- and middle-income countries. The use of a reminder/recall (R/R) system has been one of the strategies shown to be effective in improving immunization rates. In the resent study, we evaluated the effect of R/R and Primary Health Care Immunization Providers' Training (PHCIPT) intervention on routine immunization completion among 595 infants in Ibadan, Nigeria. The design was a group randomized controlled trial with Local Government Area (LGA) being the unit of randomization. Four randomly selected LGAs were randomized to receive a cellphone R/R only (A), a PHCIPT only (B); combined R/R and PHCIPT (C) intervention or serve as a control group (D). Children aged 0-12 weeks were consecutively recruited into each group and followed up for 12 months. The primary outcome measure was routine immunization completion at 12 months of age. At the study endpoint, immunization completion rates were: group A, 98.6 %; group B, 70 %; group C, 97.3 %; and group D, 57.3 %. Compared to the control group, the cellphone R/R group was 72 % (RR 1.72, 95 % CI 1.50-1.98) and the combined RR/PHCIPT group 70 % (RR 1.70, 95 % CI 1.47-1.95) more likely to complete immunization. In contrast, immunization completion in the PHCIPT group was marginally different from the control group (RR 1.22, 95 % CI 1.03-1.45). These findings remained robust to adjustment for potential predictors of immunization completion as covariates. In conclusion, cellphone reminder/recall was effective in improving immunization completion in this Nigerian setting. Its use is recommended for large scale implementation.

Using Mobile Phones to Improve Vaccination Uptake in 21 Low- and Middle-Income Countries: Systematic Review

“…At all three time points, the percentage of children fully vaccinated with the relevant dose of polio, pentavalent, and pneumococcal vaccines was significantly higher in the intervention than the control group (<.001), and the delay in receiving the vaccinations was significantly less in the intervention than the control group (<.001). Another RCT by Brown et al [ 15 ] conducted in Nigeria identified increased coverage rates relative to the usual care when receiving phone call reminders 2 days and 1 day before a vaccination appointment (Relative risk 1.72, 95% CI 1.50-1.98). Uddin et al [ 16 ] similarly found that SMS reminders increased the odds of vaccination uptake in both urban and rural areas; odds ratio (OR) 2.3 (95% CI 1.1-5.5) and OR 3.6 (95% CI 1.5-8.9), respectively.…”

Automated phone call and text reminders for childhood immunisations (PRIMM): a randomised controlled trial in Nigeria

“…Findings from a study in rural Nigeria where real-time phone call immunisation reminders significantly improved immunisation completion premised our intent to use automated calls 14. The Nigeria study found a 41% increase in immunisation completion 14.…”

“…Methodological differences may explain effect size differences. While our study sent out two reminder calls 2 days and the day before the immunisation due date, the prior published study used two real-time reminder phone calls plus four recalls if immunisations were missed as the primary intervention 14. Furthermore, and likely of importance, is the absence of the human element in automated calls.…”

“…This may account for the difference in effectiveness—an indication that text reminders alone are not appropriate in this setting. In a study from a rural community in Nigeria, the use of manual phone call immunisation reminders significantly improved immunisation completion─a 41% increase from controls 14. However, this method is time and human resource dependent and unlikely to garner national application.…”

Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial (Preprint)

“…However, there is limited data looking into different perceptions and barriers that may affect SMS-based interventions for improvement in childhood RI in resource constraint settings [37].…”