Mobile phone-delivered reminders and incentives to improve childhood immunisation coverage and timeliness in Kenya (M-SIMU): a cluster randomised controlled trial
Mobile phone-delivered reminders and incentives to improve childhood immunisation coverage and timeliness in Kenya (M-SIMU): a cluster randomised controlled trial
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DOI：
10.1016/s2214-109x(17)30072-4
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发表时间：
2017-04-01
影响因子：
34.3
通讯作者：
Feikin, Daniel R.
中科院分区：
文献类型：
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作者：
Gibson, Dustin G.;Ochieng, Benard;Feikin, Daniel R.
背景随着移动的电话接入在全球范围内不断扩大，利用这些技术来支持免疫服务需求并提高疫苗覆盖率的机会仍然存在。我们的目的是评估是否短消息服务（SMS）提醒和货币激励措施可以提高免疫摄取在Kenya.Methods在这一集群随机对照试验，村庄随机平均分配到四组：控制，短信只，短信加75肯尼亚先令（KES）的激励，和短信加200 KES（85 KES = 1美元）。如果照顾者的孩子小于5周，尚未接受第一剂五价疫苗，他们就有资格。干预组的参与者在预定的五价疫苗和麻疹免疫接种前收到短信提醒。此外，如果他们的孩子及时接种疫苗（在预产期前2周内接种疫苗），激励组的参与者将获得资金。护理人员和采访者没有被掩盖。12月龄时完全免疫儿童（接受卡介苗、三剂脊髓灰质炎疫苗、三剂五价疫苗和麻疹疫苗）的比例构成主要结局，并采用对数二项回归和一般估计方程进行分析，以解释聚类内的相关性。本试验已在ClinicalTrials注册。结果2013年10月14日至2014年10月17日，我们从152个村庄招募了2018名护理人员及其婴儿，分为以下四组：对照组（n=489），仅SMS组（n=476），SMS +75 KES组（n=562）和SMS +200 KES组（n=491）。总的来说，1600名成功随访的儿童中有1375名（86%）达到了主要结局，即在12个月大时完全免疫（360名对照参与者中的296名[82%]，388名仅SMS参与者中的332名[86%]，446名SMS加75名KES参与者中的383名[86%]，和406名SMS加200名KES参与者中的364名[90%]）。与对照组儿童相比，SMS +200 KES组儿童在12个月大时实现完全免疫的可能性显着更高（相对风险1.09，95%CI 1.02-1.16，p=0.014）。解释在基线免疫覆盖水平较高的环境中，短信提醒加上激励措施显着提高了免疫覆盖率和及时性。鉴于全球免疫接种覆盖率一直徘徊在85%左右，使用激励措施可能是达到剩余15%的一种选择。
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 logbinomial 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%.