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. 2023 Feb 17:6:e40269.
doi: 10.2196/40269.

Evaluation of a Mobile-Based Immunization Decision Support System for Scheduling Age-Appropriate Vaccine Schedules for Children Younger Than 2 Years in Pakistan and Bangladesh: Lessons From a Multisite, Mixed Methods Study

Danya Arif Siddiqi  1 , Rozina Feroz Ali  2 , Mubarak Taighoon Shah  1 , Vijay Kumar Dharma  2 , Anokhi Ali Khan  2 , Tapash Roy  1   3 , Subhash Chandir  1   2
Affiliations

Evaluation of a Mobile-Based Immunization Decision Support System for Scheduling Age-Appropriate Vaccine Schedules for Children Younger Than 2 Years in Pakistan and Bangladesh: Lessons From a Multisite, Mixed Methods Study

Danya Arif Siddiqi et al. JMIR Pediatr Parent. .

Abstract

Background: Missed opportunities for vaccination (MOVs), that is, when children interact with the health system but fail to receive age-eligible vaccines, pose a crucial challenge for equitable and universal immunization coverage. Inaccurate interpretations of complex catch-up schedules by health workers contribute to MOVs.

Objective: We assessed the feasibility of a mobile-based immunization decision support system (iDSS) to automatically construct age-appropriate vaccination schedules for children and to prevent MOVs.

Methods: A sequential exploratory mixed methods study was conducted at 6 immunization centers in Pakistan and Bangladesh. An android-based iDSS that is packaged in the form of an application programming interface constructed age-appropriate immunization schedules for eligible children. The diagnostic accuracy of the iDSS was measured by comparing the schedules constructed by the iDSS with the gold standard of evaluation (World Health Organization-recommended Expanded Programme on Immunization schedule constructed by a vaccines expert). Preliminary estimates were collected on the number of MOVs among visiting children (caused by inaccurate vaccination scheduling by vaccinators) that could be reduced through iDSS by comparing the manual schedules constructed by vaccinators with the gold standard. Finally, the vaccinators' understanding, perceived usability, and acceptability of the iDSS were determined through interviews with key informants.

Results: From July 5, 2019, to April 11, 2020, a total of 6241 immunization visits were recorded from 4613 eligible children. Data were collected for 17,961 immunization doses for all antigens. The iDSS correctly scheduled 99.8% (17,932/17,961) of all age-appropriate immunization doses compared with the gold standard. In comparison, vaccinators correctly scheduled 96.8% (17,378/17,961) of all immunization doses. A total of 3.2% (583/17,961) of all due doses (across antigens) were missed in age-eligible children by the vaccinators across both countries. Vaccinators reported positively on the usefulness of iDSS, as well as the understanding and benefits of the technology.

Conclusions: This study demonstrated the feasibility of a mobile-based iDSS to accurately construct age-appropriate vaccination schedules for children aged 0 to 23 months across multicountry and low- and middle-income country settings, and underscores its potential to increase immunization coverage and timeliness by eliminating MOVs.

Keywords: catch-up immunizations; missed opportunities for vaccination; mobile-based immunization decision support system.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
A screenshot showcasing features of the immunization decision support system app. BCG: bacille Calmette-Guérin; HepB: Hepatitis B; OPV: oral polio vaccine; PCV; pneumococcal vaccine; Penta: pentavalent vaccine; Rota: rotavirus vaccine.
Figure 2
Figure 2
Study participant flow for all enrolled children and subsequent immunization visits from July 5, 2019, to April 11, 2020, in Pakistan and Bangladesh.
Figure 3
Figure 3
Diagnostic accuracy of vaccine schedules constructed by the immunization decision support system compared with the gold standard presented as a forest plot. BCG: bacille Calmette-Guérin; CI: Confidence Interval; FN: false negative; FP: false positive; LCL: lower confidence level; OPV: oral polio vaccine; PCV: pneumococcal vaccine; Penta: pentavalent vaccine; ROC: receiver operating curve; Rota: rotavirus vaccine; TP: true positive; TN: true negative; UCL: upper confidence level.
Figure 4
Figure 4
Diagnostic accuracy of manual vaccine schedules constructed by vaccinators compared with the gold standard presented as a forest plot. BCG: bacille Calmette-Guérin; CI: Confidence Interval; FN: false negative; FP: false positive; LCL: lower confidence level; OPV: oral polio vaccine; PCV: pneumococcal vaccine; Penta: pentavalent vaccine; ROC: receiver operating curve; Rota: rotavirus vaccine; TP: true positive; TN: true negative; UCL: upper confidence level.
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