Utilization of Mobile Reminders in Improving the Completeness and Timeliness of Routine Childhood Immunization in Kano Metropolis, Nigeria: A Randomized Controlled Trial

"Mobile phone reminders were established to be effective in increasing the completeness and timeliness of childhood immunization."



Although some Nigerian parents have misconceptions about the safety of the vaccines and other concerns, many others forget to get their children vaccinated with age-appropriate vaccines. This randomised control trial (RCT) assessed the utilisation of mobile phone reminders in improving the completeness and timeliness of routine childhood immunisation in the Kano Metropolis, Kano State, northern Nigeria. The goal is to establish empirical evidence for healthcare personnel, policymakers, and other stakeholders to put the region and country on track to achieving the Immunization Agenda 2030 and Sustainable Development Goal 3 of ending preventable deaths of children aged less than 5 years by the year 2030.



This study used a cluster RCT design, in which naturally occurring groups (also referred to as clusters [e.g., schools, communities, factories, hospitals, or medical practices]) are randomised to receive the intervention or not, rather than randomising individuals. The cluster RCT was used to avoid the risk of contamination, in which individuals randomised to receive an intervention within a group may influence others within the group. The RCT included 4 primary healthcare (PHC) facilities located in Kano Metropolis. One high-volume PHC facility was randomly selected from each of 4 local government area (LGAs) and randomly assigned to be an intervention or a control site.



Eligible participants included in this trial were women who recently gave birth (with a newborn aged ≤ 3 weeks), have access to a mobile phone (ownership or having access to use a close relative's mobile phone), and are willing to receive mobile phone reminders (short message service [SMS] and calls) for childhood immunisation.



The intervention involved sending six SMS and three call reminders to the participants at specific intervals within the period of study. The reasons for these reminders were to educate them on the importance of immunisation and the dates on which they were expected to take their children to the PHC facility for immunisations. Participants in the control group did not receive any SMS or call reminders, but they were required to have access to a mobile phone to ensure the similarity of participants in the two groups.



This trial considered fully immunised to be receipt of all the doses of vaccines scheduled at 6, 10, and 14 weeks after birth, and timely immunisation as receipt of all the vaccines within a month from the due date of the vaccines.



The immunisation status of the intervention (n = 275) and control (n = 261) arms was analysed. Completeness and timeliness of the vaccine series were significantly higher (p < .001) among children of participants in the intervention (n = 169, 61.5% and n = 138, 50.2%) than those in the control group (n = 35, 13.4% and n = 13, 5%) arm. Specifically, about two-thirds of the participants in the intervention arm of this trial got their children completely immunised, and just more than one-tenth of the participants in the control arm of the trial completely vaccinated their children. Approximately half of the participants in the intervention group (50.2%) got their children immunised with all three series of vaccines on time, whereas only 5% of children in the control group were vaccinated with all three series of vaccines on time.



Results from this trial showed that despite the significant difference in the timeliness of immunisation between the intervention and treatment group, the proportion of children immunised on time was seen to decrease over time across the series of vaccines administered at 6, 10, and 14 weeks after birth in both groups.



Also, the completeness and timeliness of immunisation seen in the intervention arm of this trial is still lower than that of similar studies in other regions of the country. In view of this finding, the researchers suggest that stakeholders at all levels in the study setting and northwestern Nigeria should implement reminders along with other approaches to improve routine immunisation completeness and timeliness.



In conclusion: "Findings from this trial will provide empirical evidence for health care professionals and policymakers on the effectiveness of mobile phone reminders in the completeness and timeliness of routine childhood immunization. This simple practical and behavioral approach can be added to the list of other approaches to improving parental compliance with routine childhood immunization. This approach is economically viable as it is inexpensive and easy for health care personnel and the government to implement at all levels."