Effect of Vaccine Reminder and Tracker Bracelets on Routine Childhood Immunization Coverage and Timeliness in Urban Pakistan (2017-18): a Randomized Controlled Trial

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2020 Jul 13

PMID 32652969

Citations 12

Authors

Danya Arif Siddiqi

Rozina Feroz Ali

Mehr Munir

Mubarak Taighoon Shah

Aamir Javed Khan

Subhash Chandir

Affiliations

Soon will be listed here.

Abstract

Background: Inability to track children's vaccination history coupled with parents' lack of awareness of vaccination due dates compounds the problem of low immunization coverage and timeliness in developing countries. We evaluated the impact of two types of silicone immunization reminder bracelets for children in improving immunization coverage and timeliness of Pentavalent-3 and the Measles-1 vaccines.

Methods: Children < 3 months were enrolled in either of the 2 intervention groups (Alma Sana Bracelet Group and Star Bracelet Group) or the Control group. Children in the intervention groups were provided the two different bracelets at the time of recruitment. Each time the child visited the immunization center, a hole was perforated in the silicone bracelet to denote vaccine administration. Each child was followed up till administration of Measles-1 vaccine or till 12 months of age (if they did not come to the center for vaccination). Data was analyzed using the intention-to-treat population between groups. The unadjusted and adjusted Risk Ratios (RR) and 95% confidence interval (CI) for Pentavalent-3 and Measles-1 coverage at 12 months of age were estimated through bivariate and multivariate analysis. Time-to-Pentavalent-3 and Measles-1 immunization curves were calculated using the Kaplan-Meier method.

Results: A total of 1,445 children were enrolled in the study between July 19, 2017 and October 10, 2017. Baseline characteristics among the three groups were similar. Up-to-date coverage for the Pentavalent-3 /Measles-1 vaccine at 12 months of age was 84.6%/72.0%, 85.4%/70.5% and 83.0%/68.5% in Alma Sana Bracelet group, Star Bracelet group and Control group respectively but the differences were not statistically significant. In the multivariate analysis, neither the Alma Sana bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06), (adjusted RR: 1.05; 95% CI: 0.97-1.13) nor the Star bracelet (adjusted RR = 1.01; 95% CI: 0.96-1.06) (adjusted RR: 1.03; 95% CI: 0.95-1.11) was significantly associated with Pentavalent-3 vaccination or Measles-1 vaccination.

Conclusion: Although we did not observe any significant impact of the bracelets on improved immunization coverage and timeliness, our findings add to the existing literature on innovative, low cost reminders for health and make several suggestions for enhancing practical implementation of these tools.

Trial Registration: ClinicalTrials.gov NCT03310762 . Retrospectively Registered on October 16, 2017.

Citing Articles

Impact of measles vaccination strategies on vaccination rates in low-income and middle-income countries: a systematic review and meta-analysis.

Yitbarek K, Mahimbo A, Bobo F, Woldie M, Sheel M, Frawley J BMJ Glob Health. 2025; 10(2).

PMID: 39929538 PMC: 11815466. DOI: 10.1136/bmjgh-2024-016647.

Analyzing the usage of theories of change for routine immunization programs -- a review of impact evaluations from LMICs.

Vadrevu L, Jain M, Parsekar S J Health Popul Nutr. 2024; 43(1):141.

PMID: 39252041 PMC: 11386364. DOI: 10.1186/s41043-024-00615-2.

Effectiveness of Catch-Up Vaccination Interventions Versus Standard or Usual Care Procedures in Increasing Adherence to Recommended Vaccinations Among Different Age Groups: Systematic Review and Meta-Analysis of Randomized Controlled Trials and....

Fallucca A, Priano W, Carubia A, Ferro P, Pisciotta V, Casuccio A JMIR Public Health Surveill. 2024; 10:e52926.

PMID: 39042433 PMC: 11303899. DOI: 10.2196/52926.

Interventions addressing routine childhood immunization and its behavioral and social drivers.

Parsekar S, Vadrevu L, Jain M, Menon S, Taneja G Front Public Health. 2024; 12:1364798.

PMID: 38966698 PMC: 11223502. DOI: 10.3389/fpubh.2024.1364798.

Interventions for improving coverage of childhood immunisation in low- and middle-income countries.

Oyo-Ita A, Oduwole O, Arikpo D, Effa E, Esu E, Balakrishna Y Cochrane Database Syst Rev. 2023; 12:CD008145.

PMID: 38054505 PMC: 10698843. DOI: 10.1002/14651858.CD008145.pub4.

References

Brown D, Gacic-Dobo M, Young S . Home-based child vaccination records--a reflection on form. Vaccine. 2014; 32(16):1775-7. DOI: 10.1016/j.vaccine.2014.01.098. View

Scott S, Odutola A, Mackenzie G, Fulford T, Afolabi M, Lowe Jallow Y . Coverage and timing of children's vaccination: an evaluation of the expanded programme on immunisation in The Gambia. PLoS One. 2014; 9(9):e107280. PMC: 4169419. DOI: 10.1371/journal.pone.0107280. View

Riaz A, Husain S, Yousafzai M, Nisar I, Shaheen F, Mahesar W . Reasons for non-vaccination and incomplete vaccinations among children in Pakistan. Vaccine. 2018; 36(35):5288-5293. DOI: 10.1016/j.vaccine.2018.07.024. View

Kazi A, Murtaza A, Khoja S, Zaidi A, Ali S . Monitoring polio supplementary immunization activities using an automated short text messaging system in Karachi, Pakistan. Bull World Health Organ. 2014; 92(3):220-5. PMC: 3949591. DOI: 10.2471/BLT.13.122564. View

Feldstein L, Mariat S, Gacic-Dobo M, Diallo M, Conklin L, Wallace A . Global Routine Vaccination Coverage, 2016. MMWR Morb Mortal Wkly Rep. 2017; 66(45):1252-1255. PMC: 5726243. DOI: 10.15585/mmwr.mm6645a3. View

Masters N, Wagner A, Carlson B, Boulton M . Vaccination timeliness and co-administration among Kenyan children. Vaccine. 2018; 36(11):1353-1360. DOI: 10.1016/j.vaccine.2018.02.001. View

Sullivan M, Tegegn A, Tessema F, Galea S, Hadley C . Minding the immunization gap: family characteristics associated with completion rates in rural Ethiopia. J Community Health. 2009; 35(1):53-9. DOI: 10.1007/s10900-009-9192-2. View

Andersson N, Cockcroft A, Ansari N, Omer K, Baloch M, Ho Foster A . Evidence-based discussion increases childhood vaccination uptake: a randomised cluster controlled trial of knowledge translation in Pakistan. BMC Int Health Hum Rights. 2009; 9 Suppl 1:S8. PMC: 3226240. DOI: 10.1186/1472-698X-9-S1-S8. View

Pereira J, Quach S, Heidebrecht C, Quan S, Kolbe F, Finkelstein M . Barriers to the use of reminder/recall interventions for immunizations: a systematic review. BMC Med Inform Decis Mak. 2012; 12:145. PMC: 3541955. DOI: 10.1186/1472-6947-12-145. View

10.

Haile L, Fultz H, Simmons R, Shelus V . Market-testing a smartphone application for family planning: assessing potential of the CycleBeads app in seven countries through digital monitoring. Mhealth. 2018; 4:27. PMC: 6088200. DOI: 10.21037/mhealth.2018.06.07. View

11.

Piwek L, Ellis D, Andrews S, Joinson A . The Rise of Consumer Health Wearables: Promises and Barriers. PLoS Med. 2016; 13(2):e1001953. PMC: 4737495. DOI: 10.1371/journal.pmed.1001953. View

12.

Harvey H, Reissland N, Mason J . Parental reminder, recall and educational interventions to improve early childhood immunisation uptake: A systematic review and meta-analysis. Vaccine. 2015; 33(25):2862-80. DOI: 10.1016/j.vaccine.2015.04.085. View

13.

Saville A, Beaty B, Dickinson L, Lockhart S, Kempe A . Novel immunization reminder/recall approaches: rural and urban differences in parent perceptions. Acad Pediatr. 2014; 14(3):249-55. PMC: 4128399. DOI: 10.1016/j.acap.2014.02.003. View

14.

Barley E, Lawson V . Using health psychology to help patients: theories of behaviour change. Br J Nurs. 2016; 25(16):924-7. DOI: 10.12968/bjon.2016.25.16.924. View

15.

Clark S, Butchart A, Kennedy A, Dombkowski K . Parents' experiences with and preferences for immunization reminder/recall technologies. Pediatrics. 2011; 128(5):e1100-5. DOI: 10.1542/peds.2011-0270. View

16.

Brown V, Oluwatosin A, Ogundeji M . Experiences, perceptions and preferences of mothers towards childhood immunization reminder/recall in Ibadan, Nigeria: a cross-sectional study. Pan Afr Med J. 2016; 20:243. PMC: 4919677. DOI: 10.11604/pamj.2015.20.243.6019. View

17.

Bondy J, Thind A, Koval J, Speechley K . Identifying the determinants of childhood immunization in the Philippines. Vaccine. 2008; 27(1):169-75. DOI: 10.1016/j.vaccine.2008.08.042. View

18.

Rogers K . Immunization Noncompliance: Gauging the Cause, Effect, and Management in the School Setting. NASN Sch Nurse. 2018; 34(3):140-144. DOI: 10.1177/1942602X18799868. View

19.

Zewdie A, Letebo M, Mekonnen T . Reasons for defaulting from childhood immunization program: a qualitative study from Hadiya zone, Southern Ethiopia. BMC Public Health. 2016; 16(1):1240. PMC: 5148861. DOI: 10.1186/s12889-016-3904-1. View

20.

Nagar R, Venkat P, Stone L, Engel K, Sadda P, Shahnawaz M . A cluster randomized trial to determine the effectiveness of a novel, digital pendant and voice reminder platform on increasing infant immunization adherence in rural Udaipur, India. Vaccine. 2017; 36(44):6567-6577. DOI: 10.1016/j.vaccine.2017.11.023. View