Mobile Application Clinical Trial
Official title:
To Evaluate the Role of a Personalized Smartphone-based Application to Improve Childhood Immunization Coverage and Timelines Among Children in Pakistan
The vision of the investigators is to build capacity in technology-driven healthcare innovation in LMCIs. The programme will be initiated by a feasibility and proof-of-concept (POC) study to tackle the lack of awareness around immunization, which is a major health issue in developing countries. Mobile apps and social media have been shown to be effective in various programmes worldwide, but there is limited data from LMICs on the use of digital technologies in improving routine immunization (RI) coverage.
Pakistan is one of the countries with the highest rates of child death in the world. It ranks
4th in child mortality, with 60% deaths due to vaccine-preventable diseases (VPDs). The
immunization coverage in Pakistan is estimated to be 59%, which is still well below the
desired level, leading to continued polio transmission, large measles outbreaks, and
thousands of deaths from vaccine-preventable illnesses. In addition, Pakistan is a major
polio epidemic country and among 3 countries in the world requiring proof of polio
vaccination for international travel. Pakistan demographic and health survey in 2017-2018
suggests 88% percent of children had received BCG vaccine due at birth, 86% and 95% had
received the first dose of pentavalent and polio vaccine respectively due at the 6th week.
Furthermore, 75% and 86% of children had received the third dose of the pentavalent and polio
vaccines, respectively, due at 14th week and measles vaccination was 73%, which is due at 9
months. However, these rates are at 1 year of age and much higher than vaccination coverage
rate at scheduled time and among conflict hits and displaced populations. Improved RI
coverage is recommended as the priority public health strategy to reduce VPDs and eradicate
polio in Pakistan and worldwide.
According to immunization coverage surveys, 1 in 5 children are unimmunized. A major reason
for poor childhood vaccine coverage is low immunization uptake, when parents are unable to
complete the entire series of vaccines in accordance with the scheduled timelines. Some of
the reasons include: (1) the family is not in favor of getting their child immunized, (2) low
trust in vaccines provided through Expanded Programme on Immunization (EPI) and government
health care providers, and (3) caregivers have forgotten their child's next vaccination due
date or child's EPI card is misplaced. These barriers may be modified with additional support
through education and behavior change strategies. In addition, with more pressing issues of
food and shelter, preventive health often takes the back seat, and parents and caregivers
forget or ignore the subsequent doses of vaccines for their children. There is an immense
need to encourage parents' care seeking and collaboration with the health care providers to
improve initial vaccine uptake and the completion of all doses according to the schedule. New
innovative and cost-effective techniques are necessary for practical solutions to improve
vaccination uptake and coverage.
Mobile phones offer a new medium to provide education and advocate families or caregivers to
enable behavior change so as to improve immunization uptake. Mobile phone use has also
increased in countries with low RI coverage and a high risk of VPDs. Good examples are
Nigeria and Pakistan, where there were around 170 and 140 million mobile phone subscribers,
respectively, in 2014. There are limited data from LMICs set up on the role of SMS-based
interventions for improvement of RI coverage, and conventional 1-way reminder SMS text
messages were used by most of the studies as the intervention. Overall, very few studies
compared reminders, educational, and interactive SMS messages related to childhood
vaccination uptake. Although some of the studies have shown some behavior change for
improvement in vaccination coverage, more rigorous application of health behavior change
model needs to be applied to understand the impact of reminder, educational, and interactive
messages on behavior change related to improvement in RI coverage. However, data from
developing countries regarding the role of automated calls in improving vaccine coverage are
limited.
The vision of the investigators is to build capacity in technology-driven healthcare
innovation in LMCIs. The programme will be initiated by a feasibility and proof-of-concept
(POC) study to tackle the lack of awareness around immunization, which is a major health
issue in developing countries. Mobile apps and social media have been shown to be effective
in various programmes worldwide, but there is limited data from LMICs on the use of digital
technologies in improving routine immunization (RI) coverage.
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