title: Enhancing Routine Immunization Performance using Innovative Technology in an Urban Area of Nigeria.
abstract: BACKGROUND
  Routine Immunization (RI)is known to beone of the most cost-effective public health strategies ever, and a cornerstone among all primary healthcare efforts but has been bedevilledin Low and Middle Income Countries (LMICs) in the last two decadesby poor coverage and lack of timeliness -both due, among other factors, to clients forgetting appointments. These setback RI effectiveness from ensuring herd immunity and preventing disease. Across the world, different cost-effective mobile telephone-based reminder systems are currently in use as strategies for improving coverage and compliance in various health interventions.Their application to RI is thereforehighly recommended.
  
  
  OBJECTIVE
  This study sought to provide evidence validating the need for development and deployment of automated client Reminder-Recall systems for the Nigerian National Routine Immunisation Program and to compare its projected cost withthe cost of a health personnel-based defaulter tracking system.
  
  
  METHODS
  A multi-centre, parallel-group, Randomized Controlled Trial was carried outusing multi-stage sampling.Nine hundred and five child-caregivers were followed-upat 8 health facilities in an urban/sub-urban area in South-South Nigeria.Text messagereminders were sent to the Intervention group only, with concurrent weekly data collection, including that for controls, at each of the enrolled health facilities. Recall messages were sent to defaulters and their responses (presence at immunization session) assessed the next RI session. Receipt of DPT3 vaccine on or before the 18th week was categorized early, while receiptafter was categorized delayed.
  
  
  RESULTS
  Clients in the Interventiongroup were1.5times earlier than Controls intheir receipt of DPT3. Immunization coverage was also 8.7%better in the Interventiongroup. A first year estimate of cost of deploying this strategy was less than a quarter ofthe estimated cost of using home-visits which is the defaulter tracking method currently recommended by regulatory authorities.
  
  
  CONCLUSIONS
  Routine immunization performance was significantly better in the Interventiongroup who received SMS reminders compared to the controls who did not. Since this occurred at a cheaper rate than projected costs of home visits, in a habitual stock-out situation, this is ample evidence for health policy-makers in LMICs to leverage the ever expanding mobile telecom platforms for future sustainable improvements in routine immunisation performance and even other disease control efforts in Nigeria.
authors.affiliation: Department of Community Medicine, Delta State University Teaching Hospital, Oghara, Delta State.
authors.forename: G U
authors.initials: GU
authors.lastname: Eze
authors.forename: O O
authors.initials: OO
authors.lastname: Adeleye