Introduction
The purpose of this research is to evaluate the impact of mobile phone text message reminders on the obtainment of higher immunization rates among children in Northwest Ethiopia. In general, the improvement of vaccination coverage is among the major goals of the global healthcare system as full vaccination “is associated with 22% lower mortality in children” (Mekonnen et al., 2021, p. 2). At the same time, the effectiveness of vaccines is closely connected with the time of their administration.
However, in middle- and low-income countries, missed or delayed vaccination appointments remain a considerable challenge for local healthcare providers. Although vaccination coverage is generally high, “there is a gap in the timeliness of childhood immunization” (Mekonnen et al., 2021, p. 2). In Ethiopia, routine vaccines for children are administered at birth, fourth, sixth, and tenth weeks, and nine months, however, the timeliness and completeness of vaccination cannot be regarded as optimal. According to the latest national surveys, 43% of children in the country received all basic vaccines (Mekonnen et al., 2021). However, Ethiopia is among the African states with the highest level of incomplete vaccination coverage. In addition, there is a high proportion of children who do not receive vaccines on time.
The current situation has led to the necessity of efficient measures to eliminate the issue of missed and delayed vaccination among children. On the one hand, difficulties in the tracking of vaccination appointment schedules are mentioned among the major reasons for this issue. On the other hand, modern technologies, especially mobile phone technologies provide multiple services, including reminding, and access to them are expanding in Ethiopia. Thus, the research aims to explore their potential role in health care and the obtainment of higher childhood immunization rates in particular.
Explanation of Research Design
The design of this research is a two-arm, parallel, superior, individually randomized controlled trial with a 1:1 allocation ratio. It was conducted in Gondar City between May 2019 and June 2020 and involved participants from eight health centers and one comprehensive specialized hospital (Mekonnen et al., 2021). All participants were divided into two groups – in the intervention group, mothers received routine reminders related to their next visit verbally from a healthcare provider in a medical facility and additionally mobile phone reminders in the format of text messages one day before a visit. In the usual care group, mothers received only traditional reminders in a medical facility. Subsequently, the results were compared with the use of log-binomial regression analyses and a two-sample proportion test.
Discussion of Sample
The research’s sample size is 434 mother-infant pairs with 426 of them included in subsequent analysis. The division into groups was randomized, however, there were several criteria for inclusion and exclusion. In particular, adult mothers with permanent residence who had mobile phones and agreed to provide informed consent were chosen for the study. In turn, mothers with already vaccinated children and those who do not have access to the mobile network or cannot read messages were excluded from the study.
Description of Data Collection Methods
For data collection, only validated tools were used, and data concerning infants’ vaccination status were collected regularly. During the follow-up period, a research assistant was responsible for the management of the automated mobile reminder system (Mekonnen et al., 2021). Subsequently, data related to vaccination were collected from vaccination records that were written in the programs of immunization in medical facilities. The comparison of the two groups’ outcomes allowed us to make particular conclusions.
Summary of Findings
According to the results, mobile phone text message reminders have a positive impact on childhood vaccination rates and their timeliness in Ethiopia. Thus, in the intervention group, more infants received measles (91.5% vs 79.3%), Penta-3 (95.8% vs86.9%), and full vaccination (82.6% vs 70.9%) in comparison with children from the usual care group (Mekonnen et al., 2021). Moreover, in the intervention group, more infants received vaccines in a time-sensitive manner and according to a vaccination schedule in comparison with children from the usual care group. In general, according to the authors, the outcomes of this research support the results of previous studies conducted in other African countries where the issue of delayed and missed immunization remains significant.
Strengths of the Study
This study may be regarded as highly comprehensive, and it may be easily repeated in other settings – thus, it is highly applicable for further research. In addition, the randomized allocation of participants allowed to ensure balanced demographic characteristics between groups and provide valid results (Mekonnen et al., 2021). Moreover, the reliability of outcomes was determined by the fact that the research applied allocation concealment that provided additional objectivity.
Limitations of the Study
At the same time, the study has several limitations – first of all, the enrollment of mothers from several medical facilities in one city may limit generalizability and access to the country’s population. In addition, although all measures for the study’s blinding had been taken, nevertheless, it was not possible due to information contamination caused by participants’ interaction. Moreover, the delivery of text message reminders did not guarantee that they were read and followed. Finally, it was challenging to assess whether mothers followed a vaccination schedule due to reminders or their characteristics, such as good memory and responsibility.
Conclusion
As previously mentioned, the study’s design is characterized by high comprehensiveness and applicability – thus, it may be applied to other regions and countries to evaluate the impact of reminders on vaccination rates there and assess the potential influence of population characteristics on the results. In addition, as the outcomes demonstrate the effectiveness of mobile phone text message reminders, they may be implemented in healthcare practice as an additional tool of local childhood vaccination programs. In addition, the study may be used for further research dedicated to the improvement of reminders to provide more reliable results. For instance, taking into consideration that in the case of text messages, the fact that they are read is unknown, the use of phone calls or the system of confirmation may be evaluated as well.
Reference
Mekonnen, Z. A., Gelaye, K. A., Were, M., & Tilahun, B. (2021). Effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations: Superiority randomized controlled trial in Northwest Ethiopia. JMIR Nhealth Uhealth, 9(6), 1-18.