Gillian Levine1,2, Amadu Salifu3, Issah Mohammed3, Günther Fink1,2. 1. Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. 2. University of Basel, Basel, Switzerland. 3. Innovations for Poverty Action, Tamale, Ghana.
Abstract
BACKGROUND: Despite progress in vaccination coverage, timeliness of childhood vaccination remains a challenge in many settings. We aimed to assess if mobile phone-based reminders and incentives to health workers and caregivers could increase timely neonatal vaccination in a rural, low-resource setting. METHODS: We conducted an open-label cluster randomized controlled 1:1:1 trial with three arms in 15 communities in Northern Ghana. Communities were randomized to 1) a voice call reminder intervention; 2) a community health volunteer (CHV) intervention with incentivized rewards; 3) control. In the voice call reminder arm, a study staff member made voice calls to mothers shortly after birth to encourage vaccination and provide personalized information about available vaccination services. In the incentive arm, CHVs promoted infant vaccination and informed women with recent births about available vaccination opportunities. Both CHVs and women were provided small monetary incentives for on-time early infant vaccination in this arm, delivered using mobile phone-based banking applications. No study activities were conducted in control communities. A population-based survey compared vaccination coverage across arms in the pre-intervention and intervention periods. The primary endpoint was completion of at least one dose of Polio vaccine within 14 days of life and BCG vaccination within 28 days of life. RESULTS:Six-hundred ninety births were identified; 106, 88, and 88 from pre-intervention and 150, 135, and 123 in the intervention period, in the control, voice call reminder and CHV incentive arms, respectively. In adjusted intent-to-treat analysis, voice call reminders were associated with 10.5 percentage point (95% CI: 4.0, 17.1) higher coverage of on-time vaccination, while mobile phone-based incentives were associated with 49.5 percentage point (95% CI: 26.4, 72.5) higher coverage. CONCLUSION: Community-based interventions using mobile phone technologies can improve timely early vaccination coverage. A CHV approach with incentives to community workers and caregivers was a more effective strategy than voice call reminders. The impact of vaccination "nudges" via voice calls may be constrained in settings where network coverage and phone ownership are limited. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov; NCT03797950.
RCT Entities:
BACKGROUND: Despite progress in vaccination coverage, timeliness of childhood vaccination remains a challenge in many settings. We aimed to assess if mobile phone-based reminders and incentives to health workers and caregivers could increase timely neonatal vaccination in a rural, low-resource setting. METHODS: We conducted an open-label cluster randomized controlled 1:1:1 trial with three arms in 15 communities in Northern Ghana. Communities were randomized to 1) a voice call reminder intervention; 2) a community health volunteer (CHV) intervention with incentivized rewards; 3) control. In the voice call reminder arm, a study staff member made voice calls to mothers shortly after birth to encourage vaccination and provide personalized information about available vaccination services. In the incentive arm, CHVs promoted infant vaccination and informed women with recent births about available vaccination opportunities. Both CHVs and women were provided small monetary incentives for on-time early infant vaccination in this arm, delivered using mobile phone-based banking applications. No study activities were conducted in control communities. A population-based survey compared vaccination coverage across arms in the pre-intervention and intervention periods. The primary endpoint was completion of at least one dose of Polio vaccine within 14 days of life and BCG vaccination within 28 days of life. RESULTS: Six-hundred ninety births were identified; 106, 88, and 88 from pre-intervention and 150, 135, and 123 in the intervention period, in the control, voice call reminder and CHV incentive arms, respectively. In adjusted intent-to-treat analysis, voice call reminders were associated with 10.5 percentage point (95% CI: 4.0, 17.1) higher coverage of on-time vaccination, while mobile phone-based incentives were associated with 49.5 percentage point (95% CI: 26.4, 72.5) higher coverage. CONCLUSION: Community-based interventions using mobile phone technologies can improve timely early vaccination coverage. A CHV approach with incentives to community workers and caregivers was a more effective strategy than voice call reminders. The impact of vaccination "nudges" via voice calls may be constrained in settings where network coverage and phone ownership are limited. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov; NCT03797950.
Authors: Ahmad Ibrahim Al-Mustapha; Musa Imam Abubakar; Muftau Oyewo; Rita Enyam Esighetti; Oluwaseun Adeolu Ogundijo; Lukman Dele Bolanle; Oluwatosin Enoch Fakayode; Abdullateef Saliman Olugbon; Michael Oguntoye; Nusirat Elelu Journal: Front Public Health Date: 2022-01-05
Authors: Russell James McCulloh; Paul Darden; Jessica Snowden; Songthip Ounpraseuth; Jeannette Lee; Martina Clarke; Sophia R Newcomer; Linda Fu; DeAnn Hubberd; Jaime Baldner; Maryam Garza; Ellen Kerns Journal: Res Sq Date: 2022-10-10
Authors: Julio S Solís Arce; Shana S Warren; Niccolò F Meriggi; Alexandra Scacco; Nina McMurry; Maarten Voors; Georgiy Syunyaev; Amyn Abdul Malik; Samya Aboutajdine; Opeyemi Adeojo; Deborah Anigo; Alex Armand; Saher Asad; Martin Atyera; Britta Augsburg; Manisha Awasthi; Gloria Eden Ayesiga; Antonella Bancalari; Martina Björkman Nyqvist; Ekaterina Borisova; Constantin Manuel Bosancianu; Magarita Rosa Cabra García; Ali Cheema; Elliott Collins; Filippo Cuccaro; Ahsan Zia Farooqi; Tatheer Fatima; Mattia Fracchia; Mery Len Galindo Soria; Andrea Guariso; Ali Hasanain; Sofía Jaramillo; Sellu Kallon; Anthony Kamwesigye; Arjun Kharel; Sarah Kreps; Madison Levine; Rebecca Littman; Mohammad Malik; Gisele Manirabaruta; Jean Léodomir Habarimana Mfura; Fatoma Momoh; Alberto Mucauque; Imamo Mussa; Jean Aime Nsabimana; Isaac Obara; María Juliana Otálora; Béchir Wendemi Ouédraogo; Touba Bakary Pare; Melina R Platas; Laura Polanco; Javaeria Ashraf Qureshi; Mariam Raheem; Vasudha Ramakrishna; Ismail Rendrá; Taimur Shah; Sarene Eyla Shaked; Jacob N Shapiro; Jakob Svensson; Ahsan Tariq; Achille Mignondo Tchibozo; Hamid Ali Tiwana; Bhartendu Trivedi; Corey Vernot; Pedro C Vicente; Laurin B Weissinger; Basit Zafar; Baobao Zhang; Dean Karlan; Michael Callen; Matthieu Teachout; Macartan Humphreys; Ahmed Mushfiq Mobarak; Saad B Omer Journal: Nat Med Date: 2021-07-16 Impact factor: 87.241