Mobile phone-delivered reminders and incentives toudimprove childhood immunisation coverage and timeliness inudKenya (M-SIMU): a cluster randomised controlled trial

摘要

Background As mobile phone access continues to expand globally, opportunities exist to leverage these technologies toudsupport demand for immunisation services and improve vaccine coverage. We aimed to assess whether short messageudservice (SMS) reminders and monetary incentives can improve immunisation uptake in Kenya.udMethods In this cluster-randomised controlled trial, villages were randomly and evenly allocated to four groups:udcontrol, SMS only, SMS plus a 75 Kenya Shilling (KES) incentive, and SMS plus 200 KES (85 KES = USD$1). Caregiversudwere eligible if they had a child younger than 5 weeks who had not yet received a first dose of pentavalent vaccine.udParticipants in the intervention groups received SMS reminders before scheduled pentavalent and measlesudimmunisation visits. Participants in incentive groups, additionally, received money if their child was timelyudimmunised (immunisation within 2 weeks of the due date). Caregivers and interviewers were not masked. Theudproportion of fully immunised children (receiving BCG, three doses of polio vaccine, three doses of pentavalentudvaccine, and measles vaccine) by 12 months of age constituted the primary outcome and was analysed with logbinomialudregression and General Estimating Equations to account for correlation within clusters. This trial isudregistered with ClinicalTrials.gov, number NCT01878435.udFindings Between Oct 14, 2013, and Oct 17, 2014, we enrolled 2018 caregivers and their infants from 152 villages intoudthe following four groups: control (n=489), SMS only (n=476), SMS plus 75 KES (n=562), and SMS plus 200 KESud(n=491). Overall, 1375 (86%) of 1600 children who were successfully followed up achieved the primary outcome, fulludimmunisation by 12 months of age (296 [82%] of 360 control participants, 332 [86%] of 388 SMS only participants,ud383 [86%] of 446 SMS plus 75 KES participants, and 364 [90%] of 406 SMS plus 200 KES participants). Children in theudSMS plus 200 KES group were significantly more likely to achieve full immunisation at 12 months of age (relative riskud1·09, 95% CI 1·02–1·16, p=0·014) than children in the control group.udInterpretation In a setting with high baseline immunisation coverage levels, SMS reminders coupled with incentivesudsignificantly improved immunisation coverage and timeliness. Given that global immunisation coverage levels haveudstagnated around 85%, the use of incentives might be one option to reach the remaining 15%.