title: Effects of Community Health Nurse-Led Intervention on Childhood Routine Immunization Completion in Primary Health Care Centers in Ibadan, Nigeria.
abstract: Immunization coverage of vulnerable children is often sub-optimal in many low- and middle-income countries. The use of a reminder/recall (R/R) system has been one of the strategies shown to be effective in improving immunization rates. In the resent study, we evaluated the effect of R/R and Primary Health Care Immunization Providers' Training (PHCIPT) intervention on routine immunization completion among 595 infants in Ibadan, Nigeria. The design was a group randomized controlled trial with Local Government Area (LGA) being the unit of randomization. Four randomly selected LGAs were randomized to receive a cellphone R/R only (A), a PHCIPT only (B); combined R/R and PHCIPT (C) intervention or serve as a control group (D). Children aged 0-12 weeks were consecutively recruited into each group and followed up for 12 months. The primary outcome measure was routine immunization completion at 12 months of age. At the study endpoint, immunization completion rates were: group A, 98.6 %; group B, 70 %; group C, 97.3 %; and group D, 57.3 %. Compared to the control group, the cellphone R/R group was 72 % (RR 1.72, 95 % CI 1.50-1.98) and the combined RR/PHCIPT group 70 % (RR 1.70, 95 % CI 1.47-1.95) more likely to complete immunization. In contrast, immunization completion in the PHCIPT group was marginally different from the control group (RR 1.22, 95 % CI 1.03-1.45). These findings remained robust to adjustment for potential predictors of immunization completion as covariates. In conclusion, cellphone reminder/recall was effective in improving immunization completion in this Nigerian setting. Its use is recommended for large scale implementation.
authors.affiliation: School of Nursing, University College Hospital, Ibadan, Nigeria. vicbrown2010@gmail.com.
authors.forename: V B
authors.identifier: http://orcid.org/0000-0001-6601-4307
authors.initials: VB
authors.lastname: Brown
authors.affiliation: Department of Nursing, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: O A
authors.initials: OA
authors.lastname: Oluwatosin
authors.affiliation: Department of Epidemiology and Biostatistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: J O
authors.initials: JO
authors.lastname: Akinyemi
authors.affiliation: National Institutes of Health, Bethesda, MD, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Adeyemo
mesh_terms: D005260:Female; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D007857:Leadership; D008297:Male; D009549:Nigeria; D064691:Nurses, Community Health; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care; D017010:Reminder Systems; D011795:Surveys and Questionnaires
keywords: Cellphone reminder/recall; Childhood; Immunization; Vaccine-preventable-diseases