Project Details

PRIMM Trial (Phone Reminder for IMMunization) in Ondo State, Nigeria

Osayame Ekhaguere, MBBS, MPH, MSc

Summary

BACKGROUND: Worldwide, vaccine preventable diseases account for 29% of all deaths between 1 month and 5 years, underscoring the importance of immunizations. In Nigeria, routine childhood immunization rates are unacceptably inconsistent and low, ranging from 35-85% at 14 weeks and 10-37% for all routine immunizations at 12-24 months. Text messaging reminders improve immunization completion in urban but not rural settings in sub-Saharan Africa. Low adult literacy may account for this difference. GAP: The feasibility and impact of combined automated voice and text reminders on immunization completion in rural sub-Saharan Africa is unknown. HYPOTHESIS: Given ~90% of the adult population in Nigeria uses a mobile phone, a customized mHealth immunization reminder (automated text plus phone voice call reminders) system will be feasible and acceptable; and will significantly improve immunization rates in this rural setting of Ondo State, Nigeria. METHODS: We randomized parturient women at the Mother and Child Hospitals Ondo State, Nigeria, owning a mobile phone and planning for child immunization at these study sites to receive automated call and text immunization reminders or standard care. We assessed the completion of the third pentavalent vaccine (Penta-3) at 18 weeks of age, immunization completion at 12 months and within 1 week of recommended dates. We assessed selected demographic characteristics associated with completing immunizations at 12 months using a generalized binomial linear model with ‘log’ link function. Feasibility was assessed as proportion of reminders received. RESULTS: Each group had 300 mother−baby dyads with similar demographic characteristics. At 18 weeks, 257 (86%) and 244 (81%) (risk ratio (RR) 1.05, 95% CI 0.98 to 1.13; p=0.15) in the intervention and control groups received Penta-3 vaccine. At 12 months, 220 (74%) and 196 (66%) (RR 1.12, 95% CI 1.01 to 1.25; p=0.04) in the intervention and control groups received the measles vaccine. Infants in the intervention group were more likely to receive Penta-3 (84% vs 78%, RR 1.09, 95% CI 1.01 to 1.17; p=0.04), measles (73% vs 65%, RR 1.13, 95% CI 1.02 to 1.26; p=0.02) and all scheduled immunizations collectively (57% vs 47%, RR 1.13, 95% CI 1.02 to 1.26; p=0.01) within 1 week of the recommended date. No demographic character predicted immunization completion. In the intervention group, 92% and 86% reported receiving a verification reminder and at least one reminder during the study period, respectively. The reported barriers to receiving and completing the immunization series included long wait times in 308 (55%) and transportation cost in 187 (34%). Forgetfulness (12; 2.2%) was one of the least reported barriers to completing the routine immunization series Conclusion: Automated immunization text plus call reminders significantly improved immunization completion and timeliness. Our results add to the body of literature on the impact of phone reminders on immunization completion and inform research on innovative solutions capable of improving access to and efficiency of immunization clinics. IMPACT: With improved immunization utilization rates, this project can potentially reduce the proportion of all under five mortality caused by vaccine preventable diseases. Website Link: https://clinicaltrials.gov/ct2/show/NCT02819895?term=PRIMM+Trial&rank=1

Publications:

Ekhaguere OA, Oluwafemi RO, Badejoko B, Oyeneyin LO, Butali A, Lowenthal ED, Steenhoff AP. Automated phone call and text reminders for childhood immunizations (PRIMM): a randomized controlled trial in Nigeria. BMJ Global Health. 2019 Apr 1;4(2):e001232