title: Reducing routine vaccination dropout rates: evaluating two interventions in three Kenyan districts, 2014.
abstract: BACKGROUND
  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. We evaluated the impact of text messaging and sticker reminders to reduce dropouts from the vaccination program.
  
  
  METHODS
  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. We calculated dropout rate as a percentage of the difference between first and third pentavalent dose.
  
  
  RESULTS
  We enrolled 1,116 children; 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 >5 km 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 between those who received stickers and controls (OR 0.9, CI 0.5-1.6).
  
  
  CONCLUSIONS
  Text message reminders can reduce vaccination dropout rates in Kenya. We recommend the extended implementation of text message reminders in routine vaccination services.
authors.affiliation: College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya. hajiadam661@gmail.com.|Field Epidemiology and Laboratory Training Program, Kenya Ministry of Health, Nairobi, Kenya. hajiadam661@gmail.com.|Division of Vaccines and Immunization, Kenya Ministry of Health, Nairobi, Kenya. hajiadam661@gmail.com.
authors.forename: Adam
authors.initials: A
authors.lastname: Haji
authors.affiliation: Global Immunization Division, US Centers of Disease Control, and Prevention, Nairobi, Kenya.
authors.forename: S
authors.initials: S
authors.lastname: Lowther
authors.affiliation: College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
authors.forename: Z
authors.initials: Z
authors.lastname: Ngan'ga
authors.affiliation: Field Epidemiology and Laboratory Training Program, Kenya Ministry of Health, Nairobi, Kenya.
authors.forename: Z
authors.initials: Z
authors.lastname: Gura
authors.affiliation: Division of Vaccines and Immunization, Kenya Ministry of Health, Nairobi, Kenya.
authors.forename: C
authors.initials: C
authors.lastname: Tabu
authors.affiliation: Division for Global Health Protection, US Centers of Disease Control and Prevention, Nairobi, Kenya.
authors.forename: H
authors.initials: H
authors.lastname: Sandhu
authors.affiliation: Field Epidemiology and Laboratory Training Program, Kenya Ministry of Health, Nairobi, Kenya.|Division for Global Health Protection, US Centers of Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Wences
authors.initials: W
authors.lastname: Arvelo
mesh_terms: D000328:Adult; D002675:Child, Preschool; D005260:Female; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007630:Kenya; D008297:Male; D010290:Parents; D010352:Patient Dropouts; D017010:Reminder Systems; D060145:Text Messaging; D014611:Vaccination; D014612:Vaccines
chemical_list: D014612:Vaccines