Evaluation of SMS and sticker reminders for reducing dropout rates in routine immunization in selected Districts in Kenya.

Abstract

Globally, vaccine preventable diseases are responsible for nearly 20% of deaths annually among children <5 years old. Worldwide, many children dropout from the vaccination program, are vaccinated late, or incompletely vaccinated. In Kenya while significant strides has been made by increasing DPT 3 coverage from 63% in 2000 to 81% in 2007, dropout rates still remain high with 27% of the districts in Kenya having >10% dropout rates in 2012.Th effectiveness of text messaging and sticker reminders to reduce dropouts from the vaccination program was evaluated. The evaluation was conducted in three selected districts in Kenya: Machakos, Langata and Njoro. Three health facilities were selected in each district, and randomly allocated to send text messages or provide stickers reminding parents to bring their children for second and third dose of pentavalent vaccine, or to the control group (routine reminder) with next appointment date indicated on the well-child booklet. Children aged <12 months presenting for their first dose of pentavalent vaccine were enrolled. A dropout was defined as not returning for vaccination ≥2 weeks after scheduled date for third dose of pentavalent vaccine. Dropout rate was calculated as a percentage of the difference between first and third pentavalent dose. A total of 1,116 children were enrolled; 372 in each intervention and 372 controls between February and October 2014. Median age was 45 days old (range: 31-99 days), and 574 (51%) were male. There were 136 (12%) dropouts. Thirteen (4%) children dropped out among those who received text messages, 60 (16%) among who received sticker reminders, and 63 (17%) among the controls. Having a caregiver with below secondary education [Odds Ratio (OR) 1.8, 95% Confidence Interval (CI) 1.1- 3.2], and residing >5km from health facility (OR 1.6, CI 1.0-2.7) were associated with higher odds of dropping out. Those who received text messages were less likely to drop out compared to controls (OR 0.2, CI 0.04-0.8). There was no statistical difference in dropout rates between those who received stickers and controls (OR 0.9, CI 0.5-1.6). the study found Text message reminders to be effective in reducing vaccination dropout rates in Kenya, low education level and distance >5km from facilities were associated with missed vaccination. The study recommends the adoption of SMS reminders in routine childhood vaccination services in Kenya and strengthening of outreach services to cover hard to reach areas.