title: The feasibility of using mobile-phone based SMS reminders and conditional cash transfers to improve timely immunization in rural Kenya.
abstract: BACKGROUND
  Demand-side strategies could contribute to achieving high and timely vaccine coverage in rural Africa, but require platforms to deliver either messages or conditional cash transfers (CCTs). We studied the feasibility of using short message services (SMS) reminders and mobile phone-based conditional cash transfers (CCTs) to reach parents in rural Western Kenya.
  
  
  METHODS
  In a Health and Demographic Surveillance System (HDSS), mothers with children aged 0-3 weeks old were approached to determine who had access to a mobile phone. SMS reminders were sent three days prior to and on the scheduled day of immunization for 1st (age 6 weeks) and 2nd doses (age 10 weeks) of DTP-HepB-Hib (Pentavalent) vaccine, using open-source Rapid SMS software. Approximately $2.00 USD was sent as cash using mPESA, a mobile money transfer platform (2/3 of mothers), or airtime (1/3 of mothers) via phone if the child was vaccinated within 4 weeks of the scheduled date. Follow-up surveys were done when children reached 14 weeks of age.
  
  
  RESULTS
  We approached 77 mothers; 72 were enrolled into the study (26% owned a phone and 74% used someone else's). Of the 63 children with known vaccination status at 14 weeks of age, 57 (90%) received pentavalent1 and 54 (86%) received pentavalent2 within 4 weeks of their scheduled date. Of the 61 mothers with follow-up surveys administered at 14 weeks of age, 55 (90%) reported having received SMS reminders. Of the 54 women who reported having received SMS reminders and answered the CCT questions on the survey, 45 (83%) reported receiving their CCT. Most (89%) of mothers in the mPESA group obtained their cash within 3 days of being sent their credit via mobile phone. All mothers stated they preferred CCTs as cash via mobile phone rather than airtime. Of the 9 participants who did not vaccinate their children at the designated clinic 2(22%) cited refusals by husbands to participate in the study.
  
  
  CONCLUSIONS
  The data show that in rural Western Kenya mobile phone-based strategies are a potentially useful platform to deliver reminders and cash transfers. Follow-up studies are needed that provide evidence for the effectiveness of these strategies in improving vaccine coverage and timeliness.
authors.affiliation: Kenya Medical Research Institute/Centers for Disease Control and Prevention Public Health and Research Collaboration, Kisumu, Kenya.
authors.forename: Hotenzia
authors.initials: H
authors.lastname: Wakadha
authors.forename: Subhash
authors.initials: S
authors.lastname: Chandir
authors.forename: Elijah Victor
authors.initials: EV
authors.lastname: Were
authors.forename: Alan
authors.initials: A
authors.lastname: Rubin
authors.forename: David
authors.initials: D
authors.lastname: Obor
authors.forename: Orin S
authors.initials: OS
authors.lastname: Levine
authors.forename: Dustin G
authors.initials: DG
authors.lastname: Gibson
authors.forename: Frank
authors.initials: F
authors.lastname: Odhiambo
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Feikin
mesh_terms: D000293:Adolescent; D000328:Adult; D040421:Cell Phone; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage*; D005260:Female; D018073:Haemophilus Vaccines / Q000008:administration & dosage*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D008297:Male; D010865:Pilot Projects; D012052:Reimbursement, Incentive; D017010:Reminder Systems; D012424:Rural Population; D055815:Young Adult
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D018073:Haemophilus Vaccines; D017325:Hepatitis B Vaccines; C122182:diphtheria-tetanus-acellular pertussis-Hib-hepatitis B vaccine