title: Use of mobile phones for improving vaccination coverage among children living in rural hard-to-reach areas and urban streets of Bangladesh.
abstract: In Bangladesh, full vaccination rates among children living in rural hard-to-reach areas and urban streets are low. We conducted a quasi-experimental pre-post study of a 12-month mobile phone intervention to improve vaccination among 0-11 months old children in rural hard-to-reach and urban street dweller areas. Software named "mTika" was employed within the existing public health system to electronically register each child's birth and remind mothers about upcoming vaccination dates with text messages. Android smart phones with mTika were provided to all health assistants/vaccinators and supervisors in intervention areas, while mothers used plain cell phones already owned by themselves or their families. Pre and post-intervention vaccination coverage was surveyed in intervention and control areas. Among children over 298 days old, full vaccination coverage actually decreased in control areas--rural baseline 65.9% to endline 55.2% and urban baseline 44.5% to endline 33.9%--while increasing in intervention areas from rural baseline 58.9% to endline 76*8%, difference +18.8% (95% CI 5.7-31.9) and urban baseline 40.7% to endline 57.1%, difference +16.5% (95% CI 3.9-29.0). Difference-in-difference (DID) estimates were +29.5% for rural intervention versus control areas and +27.1% for urban areas for full vaccination in children over 298 days old, and logistic regression adjusting for maternal education, mobile phone ownership, and sex of child showed intervention effect odds ratio (OR) of 3.8 (95% CI 1.5-9.2) in rural areas and 3.0 (95% CI 1.4-6.4) in urban areas. Among all age groups, intervention effects on age-appropriate vaccination coverage were positive: DIDs +13.1-30.5% and ORs 2.5-4.6 (p<0.001 in all comparisons). Qualitative data showed the intervention was well-accepted. Our study demonstrated that a mobile phone intervention can improve vaccination coverage in rural hard-to-reach and urban street dweller communities in Bangladesh. This small-scale successful demonstration should serve as an example to other low-income countries with high mobile phone usage.
authors.affiliation: Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh. Electronic address: jasim@icddrb.org.
authors.forename: Md Jasim
authors.initials: MJ
authors.lastname: Uddin
authors.affiliation: Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh.
authors.forename: Md
authors.initials: M
authors.lastname: Shamsuzzaman
authors.affiliation: Department of Infectious Diseases & Geographic Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
authors.forename: Lily
authors.initials: L
authors.lastname: Horng
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Johns Hopkins University Global mHealth Initiative, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Alain
authors.initials: A
authors.lastname: Labrique
authors.affiliation: Duke Global Health Institute, Durham, NC 27708, USA.
authors.forename: Lavanya
authors.initials: L
authors.lastname: Vasudevan
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; Johns Hopkins University Global mHealth Initiative, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Zeller
authors.affiliation: mPower Social Enterprises, House 133, Road 4, Block A, Banani, Dhaka 1213, Bangladesh.
authors.forename: Mridul
authors.initials: M
authors.lastname: Chowdhury
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada V6H 3V4; Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada V6H 3V4.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Larson
authors.affiliation: Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bishai
authors.affiliation: Centre for Population, Urbanization and Climate Change, icddr,b, Mohakhali, Dhaka 1212, Bangladesh.
authors.forename: Nurul
authors.initials: N
authors.lastname: Alam
mesh_terms: D000328:Adult; D001459:Bangladesh; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D065228:Non-Randomized Controlled Trials as Topic; D010342:Patient Acceptance of Health Care; D017010:Reminder Systems; D012424:Rural Population; D000068997:Smartphone; D060145:Text Messaging; D014505:Urban Population; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Child; Immunization; Mobile phone; Rural; Urban; mHealth