The Effect of mHealth on Childhood Vaccination in Africa: A Systematic Review and Meta-analysis

Arba Minch University (Gilano, Sako, Molla); Maastricht University Medical Centre+ (Dekker, Fijten)
"mHealth has been shown to significantly improve childhood vaccination completion compared to standard of care..."
Africa is one of the continents where mHealth has been tested as an intervention to improve vaccination rates. For example, reminders and vaccination information, which can be delivered through mobile phones, can potentially improve childhood vaccination rates. However, there are not only opportunities but also challenges regarding the application of mHealth to childhood vaccination in Africa. This sytematic review asks: Do mHealth-supported children have a higher percentage of childhood vaccination than non-mHealth-supported children in Africa?
The researchers conducted a systematic review and meta-analysis for studies published from 2000 to 2023 applying mHealth in Africa for vaccination decisions. Eighteen articles [14 randomised controlled trials (RCTs) and 4 quasi-experiments] fulfilled the eligibility criteria out of 1,365 screened studies. The included studies account for a total sample size of 21,070 [11,246 mHealth and 9,824 usual care], of which 11,861 [6,686 interventions and 5,175 controls] used childhood vaccination [59.45% versus 52.67%].
Except for one study, all mHealth studies showed an improvement in childhood vaccination outcomes compared to usual care. The average effect size using the random-effects model was an odds ratio (OR) of 2.15 [95% confidence interval (CI): 1.70-2.72; P<0.001; I2 = 90%]. The subgroup analysis showed that regional differences cause heterogeneity.
Eight studies reported pentavalent-3 vaccine as an outcome and showed a significant pentavalent-3 vaccination improvement among children [OR = 2.21, 95% CI: 1.62-3.02; P<0.002; I2 = 81%; RD = 0.11, 95% CI: 0.07-0.15]. Three studies reported polio vaccination and showed a significant change in mHealth intervention groups compared to usual care [OR = 2.27; 95% CI: 1.51-3.40; p<0.30; I2 = 18]. Six studies reported measles vaccination as an outcome and showed a significant improvement through the mHealth intervention [OR = 2.19, 95% CI: 1.63-2.96; P<0.001; I2 = 80%]
Some studies had additional intervention arms, among which three had incentive intervention arms. Three studies used monetary incentives and reported significant improvement in childhood vaccination [OR = 1.59, 95% CI: 1.22-2.08; P<0.47; I2 = 0%] compared to controls and SMS-only intervention. However, the SMS intervention indicated pentavalent, polio, and measles vaccination improvement.
The subgroup analysis by region showed that there is a substantial variation in effect size among regions. Funnel plots and Harbord tests showed the absence of publication bias, while the GRADE scale showed a moderate-quality body of evidence.
Despite these encouraging findings, the researchers point to mHealth-related challenges in Africa, including poor usability, lack of system integration, poor data security and privacy, poor network access, and poor reliability. In addition, other challenges such as low literacy, cultural constraints to accept mHealth, and limited healthcare-seeking behaviour are prominent in Africa. Other challenges are related to standardisation, regulatory frameworks, and health system readiness. These findings indicate that the implementation of mHealth in Africa needs multifactorial considerations.
In conclusion: "Although heterogeneous, this systematic review and meta-analysis showed that the application of mHealth could potentially improve childhood vaccination in Africa. It increased childhood vaccination by more than double [2.15 times] among children whose mothers are motivated by mHealth services. MHealth is more effective in less developed regions and when an additional incentive party with the messaging system. However, it can be provided at a comparably low cost based on the development level of regions and can be established as a routine service in Africa."
PLoS ONE 19(2): e0294442. https://doi.org/10.1371/journal.pone.0294442. Image credit: Freepik
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