Dustin Gibson*, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States Subhash Chandir, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States Hotenzia Wakadha, KEMRI/CDC, Kisumu, Kenya Frank Odhiambo, KEMRI/CDC, Kisumu, Kenya Kayla Laserson, KEMRI/CDC, Kisumu, Kenya Orin Levine, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States Daniel Feikin, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States Track: Research Presentation Topic: Mobile & Tablet Health Applications Presentation Type: Poster presentation Submission Type: Single Presentation Last modified: 2012-09-15

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Background: Vaccines are one of the most cost effective interventions for childhood survival. A vaccine’s effectiveness is diminished when given later than its scheduled date or not given at all. A recent review found a 6 week median delay in DTP3 (3 doses of diphtheria+ tetanus + pertussis) receipt in 45 lower income countries. Conditional Cash Transfers (CCTs) and reminder messages are two interventions that have shown positive gains in health care utilization and can be employed for increasing vaccine coverage. In this context, rural western Kenya is a region with high mobile phone ownership, adequate text message literacy, and a mobile banking system (M-PESA) that allows transfers of funds through cellular phones.
Objective: The goal of this pilot study is to test the feasibility and assess logistical issues surrounding the use of a mobile phone based system to employ short message reminders (SMS) and conditional cash transfers through M-PESA to improve vaccine coverage and timeliness.

Methods: This pilot study was conducted within the Kenya Health and Demographic surveillance system, (KHDSS) in Siaya District of Nyanza Province. Convenience sampling through village reporters was used to enroll 72 mothers of infants ages 0-4 weeks old who had access to a mobile phone and lived within 5km of Tin’gwani clinic. Using the RapidSMS system and following the Expanded Programme on Immunization (EPI) schedule, SMS reminders were sent 3 days before and on the day of scheduled vaccination dates for 1st (age 6 weeks) and 2nd doses (age 10 weeks) of DTP vaccine. If mothers brought their child to immunization clinic, 150 Kenyan Shillings (~2 USD) were transferred to their mobile phone through M-PESA in either cash or air-time credit. A study follow up visit occurred 4 weeks after last vaccination.

Results: 72 of 77 mothers approached by village reporter were enrolled in the study. 31% of mothers had their own phone (n=22) and 69% used someone else’s phone (n=50). Of those who used others, 34% used husbands, 38% used neighbors and 28% used others. For DTP 1 vaccine, 69 of 72 mothers were sent SMS reminders. 48 infants (70%) were vaccinated at designated facility with median date of receipt being the scheduled date and 37 mothers (77%) receiving MPESA-based cash. 7 infants (10%) were vaccinated at a different clinic, 8 infants (12%) were not vaccinated, and the status of 6 infants (9%) was unknown. Problems with RapidSMS led to 44 mothers receiving SMS for DTP2. 62% of M-PESA recipients cashed out on same day of CCT delivery. When asked what factor most influenced their decision to vaccinate child, 21(47%) said SMS reminder, 16 (36%) said neither SMS reminder nor CCT, 2 (4%) said the CCT, and 2 (4%) said both.

Conclusions: A mobile phone based system is feasible to deliver CCTs and reminders aimed at increasing vaccine coverage and timeliness. A 142 village-randomized control trial is being developed to test efficacy of SMS messages alone or SMS + CCT as compared to no intervention in improving coverage and timeliness of vaccination.