Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr;5(4):e428-e438.
doi: 10.1016/S2214-109X(17)30072-4.

Mobile phone-delivered reminders and incentives to improve childhood immunisation coverage and timeliness in Kenya (M-SIMU): a cluster randomised controlled trial

Dustin G Gibson  1 , Benard Ochieng  2 , E Wangeci Kagucia  3 , Joyce Were  2 , Kyla Hayford  3 , Lawrence H Moulton  4 , Orin S Levine  3 , Frank Odhiambo  2 , Katherine L O'Brien  3 , Daniel R Feikin  3
Affiliations

Mobile phone-delivered reminders and incentives to improve childhood immunisation coverage and timeliness in Kenya (M-SIMU): a cluster randomised controlled trial

Dustin G Gibson et al. Lancet Glob Health. 2017 Apr.

Abstract

Background: As mobile phone access continues to expand globally, opportunities exist to leverage these technologies to support demand for immunisation services and improve vaccine coverage. We aimed to assess whether short message service (SMS) reminders and monetary incentives can improve immunisation uptake in Kenya.

Methods: In this cluster-randomised controlled trial, villages were randomly and evenly allocated to four groups: control, SMS only, SMS plus a 75 Kenya Shilling (KES) incentive, and SMS plus 200 KES (85 KES = USD$1). Caregivers were eligible if they had a child younger than 5 weeks who had not yet received a first dose of pentavalent vaccine. Participants in the intervention groups received SMS reminders before scheduled pentavalent and measles immunisation visits. Participants in incentive groups, additionally, received money if their child was timely immunised (immunisation within 2 weeks of the due date). Caregivers and interviewers were not masked. The proportion of fully immunised children (receiving BCG, three doses of polio vaccine, three doses of pentavalent vaccine, and measles vaccine) by 12 months of age constituted the primary outcome and was analysed with log-binomial regression and General Estimating Equations to account for correlation within clusters. This trial is registered with ClinicalTrials.gov, number NCT01878435.

Findings: Between Oct 14, 2013, and Oct 17, 2014, we enrolled 2018 caregivers and their infants from 152 villages into the following four groups: control (n=489), SMS only (n=476), SMS plus 75 KES (n=562), and SMS plus 200 KES (n=491). Overall, 1375 (86%) of 1600 children who were successfully followed up achieved the primary outcome, full immunisation by 12 months of age (296 [82%] of 360 control participants, 332 [86%] of 388 SMS only participants, 383 [86%] of 446 SMS plus 75 KES participants, and 364 [90%] of 406 SMS plus 200 KES participants). Children in the SMS plus 200 KES group were significantly more likely to achieve full immunisation at 12 months of age (relative risk 1·09, 95% CI 1·02-1·16, p=0·014) than children in the control group.

Interpretation: In a setting with high baseline immunisation coverage levels, SMS reminders coupled with incentives significantly improved immunisation coverage and timeliness. Given that global immunisation coverage levels have stagnated around 85%, the use of incentives might be one option to reach the remaining 15%.

Funding: Bill & Melinda Gates Foundation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Trial profile SMS=short message service. KES=Kenyan Shilling. *Villages that immediately bordered villages that were excluded because of eligibility requirements.
Figure 2
Figure 2
Effect of interventions on time to immunisation SMS=short message service. KES=Kenyan Shilling.
See this image and copyright information in PMC

Comment in

References

    1. WHO. UNICEF. World Bank . State of the world's vaccines and immunization. 3rd edn. World Health Organization; Geneva: 2009.
    1. WHO Data, statistics, and graphics. http://www.who.int/immunization/monitoring_surveillance/data/en/ (accessed Sept 21, 2016).
    1. Berkley S, Chan M, Elias C, Fauci A, Lake A, Phumaphi J. Decade of vaccines: foreword. Vaccine. 2013;31:B1–B2. - PubMed
    1. Global Vaccine Action Plan Decade of vaccine collaboration. Vaccine. 2013;31:B5–31. - PubMed
    1. International Telecommunications Union The World in 2015: ICT Facts and Figures. http://www.itu.int/en/ITU-D/Statistics/Documents/facts (accessed Feb 23, 2017).

MeSH terms

Substances

Associated data