Use of mobile phones for improving vaccination coverage among children living in rural hard-to-reach areas and urban streets of Bangladesh.

In Bangladesh, full vaccination rates among children living in rural hard-to-reach areas and urban streets are low. We conducted a quasi-experimental pre-post study of a 12-month mobile phone intervention to improve vaccination among 0-11 months old children in rural hard-to-reach and urban street dweller areas. Software named "mTika" was employed within the existing public health system to electronically register each child's birth and remind mothers about upcoming vaccination dates with text messages. Android smart phones with mTika were provided to all health assistants/vaccinators and supervisors in intervention areas, while mothers used plain cell phones already owned by themselves or their families. Pre and post-intervention vaccination coverage was surveyed in intervention and control areas. Among children over 298 days old, full vaccination coverage actually decreased in control areas--rural baseline 65.9% to endline 55.2% and urban baseline 44.5% to endline 33.9%--while increasing in intervention areas from rural baseline 58.9% to endline 76*8%, difference +18.8% (95% CI 5.7-31.9) and urban baseline 40.7% to endline 57.1%, difference +16.5% (95% CI 3.9-29.0). Difference-in-difference (DID) estimates were +29.5% for rural intervention versus control areas and +27.1% for urban areas for full vaccination in children over 298 days old, and logistic regression adjusting for maternal education, mobile phone ownership, and sex of child showed intervention effect odds ratio (OR) of 3.8 (95% CI 1.5-9.2) in rural areas and 3.0 (95% CI 1.4-6.4) in urban areas. Among all age groups, intervention effects on age-appropriate vaccination coverage were positive: DIDs +13.1-30.5% and ORs 2.5-4.6 (p<0.001 in all comparisons). Qualitative data showed the intervention was well-accepted. Our study demonstrated that a mobile phone intervention can improve vaccination coverage in rural hard-to-reach and urban street dweller communities in Bangladesh. This small-scale successful demonstration should serve as an example to other low-income countries with high mobile phone usage.

[1]  Garrett Mehl,et al.  Prioritizing integrated mHealth strategies for universal health coverage , 2014, Science.

[2]  H. Lucas,et al.  eHealth and mHealth initiatives in Bangladesh: A scoping study , 2014, BMC Health Services Research.

[3]  James G Kahn,et al.  'Mobile' health needs and opportunities in developing countries. , 2010, Health affairs.

[4]  E. Kimani-Murage,et al.  Childhood vaccination in informal urban settlements in Nairobi, Kenya: Who gets vaccinated? , 2011, BMC public health.

[5]  D. Peters,et al.  Prospects of mHealth Services in Bangladesh: Recent Evidence from Chakaria , 2014, PloS one.

[6]  S. Agarwal,et al.  Understanding and Addressing Childhood Immunization Coverage in Urban Slums , 2005, Indian pediatrics.

[7]  D. Bishai,et al.  Cost and sustainability of a successful package of interventions to improve vaccination coverage for children in urban slums of Bangladesh. , 2014, Vaccine.

[8]  Elizabeth T Luman,et al.  Validity of vaccination cards and parental recall to estimate vaccination coverage: a systematic review of the literature. , 2013, Vaccine.

[9]  A. Khan,et al.  Child Immunization Coverage in Rural Hard-to-Reach Haor Areas of Bangladesh: Possible Alternative Strategies , 2009, Asia-Pacific journal of public health.

[10]  E. Luman,et al.  Estimating vaccination coverage: validity of household-retained vaccination cards and parental recall. , 2009, Vaccine.

[11]  E. Oliveras,et al.  Child immunization coverage in urban slums of Bangladesh: impact of an intervention package. , 2010, Health policy and planning.

[12]  J. Car,et al.  Mobile phone messaging for preventive health care. , 2012, The Cochrane database of systematic reviews.

[13]  D J Vassallo,et al.  An evaluation of the first year's experience with a low-cost telemedicine link in Bangladesh , 2001, Journal of telemedicine and telecare.

[14]  Yukun Bao,et al.  e-Health in Bangladesh: Current Status, Challenges, and Future Direction , 2014 .

[15]  N. Choudhury,et al.  Using formative research to develop MNCH programme in urban slums in Bangladesh: experiences from MANOSHI, BRAC , 2010, BMC public health.

[16]  R. Vaughan,et al.  Impact of appointment reminders on vaccination coverage at an urban clinic. , 2000, Pediatrics.

[17]  Jaranit Kaewkungwal,et al.  Application of smart phone in "Better Border Healthcare Program": A module for mother and child care , 2010, BMC Medical Informatics Decis. Mak..

[18]  A. Chib.  The promise and peril of mHealth in developing countries , 2013 .

[19]  Henry Lucas,et al.  E-health and M-Health in Bangladesh: Opportunities and Challenges , 2014 .

[20]  Karthik Natarajan,et al.  Text4Health: impact of text message reminder-recalls for pediatric and adolescent immunizations. , 2012, American journal of public health.

[21]  A. Ashraf,et al.  Health needs and health-care-seeking behaviour of street-dwellers in Dhaka, Bangladesh. , 2009, Health policy and planning.

[22]  H. Perry,et al.  A comprehensive assessment of the quality of immunization services in one major area of Dhaka City, Bangladesh , 1998, Tropical medicine & international health : TM & IH.

[23]  A. Burton,et al.  An assessment of the quality of national child immunization coverage estimates in population-based surveys. , 2002 .

[24]  Shamsuzzaman,et al.  Effectiveness of combined strategies to improve low coverage of child immunization in urban slums of Bangladesh. , 2008 .

[25]  C. Murray,et al.  Validity of reported vaccination coverage in 45 countries , 2003, The Lancet.

[26]  David K Vawdrey,et al.  Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population: a randomized controlled trial. , 2012, JAMA.

[27]  A. Labrique,et al.  Newborn health on the line: the potential mHealth applications. , 2014, JAMA.