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SMS REMINDER PROJECT IN UGANDA

Project name: Evaluating a caregiver SMS reminder intervention to reduce immunization drop-out in Arua, Uganda—a andomized controlled trial.

Background 

According to its 2011 Demographic and Health Survey, only 40% of 12-23 month olds in Uganda had received all recommended vaccinations by 12 months of age. In 2013, Uganda ranked twelfth in the world in total number of children having not received their first dose of measles vaccination, resulting in ongoing measles outbreaks. Immunization coverage has fallen in the face of a growing population and a stagnating national health spending. Faced with high rates of immunization drop-out, this research proposes to build upon a growing Health system in Uganda to use SMS to remind mothers of upcoming vaccination visits. 

In the first 3 months, the project developed an SMS reminder system that registers recruited caregivers, randomizes them into intervention and control arms and then sends out SMS reminders to children who are due for an immunization visit. These reminders are sent to the phones of the caregivers. Since January 2016 to-date, the project successfully recruited 1,955 participants and they’re currently being followed up for the evaluation phase.

General goal 

To evaluate a routine immunization SMS caregiver reminder intervention to reduce immunization drop-out for children 12 months of age and younger in select health centers in Arua District.

The main objectives of these three months in service training programs are: 

1. To measure the impact of a routine immunization SMS caregiver reminder intervention to increase Penta3 and MCV coverage for children 12 months of age and younger in select health facilities in Arua District,

2. To measure the impact of a routine immunization SMS caregiver reminder intervention to increase the probability that their children will receive Penta3 within 12 weeks of Penta1 receipt and MCV by 10 months of age, 

3. To assess caregiver acceptability of a routine immunization SMS caregiver reminder intervention,

4. To determine the costs and cost-effectiveness of a caregiver SMS reminder intervention to improve vaccination coverage.

Achievements/ Success Stories to date

• AFENET successfully hired study coordinator and 3 research assistants.

• AFENET successfully led the protocol through IRB approvals.

• HISP successfully set up the SMS reminder system.

• The SMS messages were developed in English and translated into Lugbara, the common indigenous language in the study area.

• The SMS system was developed and tested and found to be able to register participants, randomize them, schedule the SMS reminders and send them out. This was successfully launched as of 1st February 2016.

• Database and data entry forms have been developed, tested and are currently being used for the recruitment form and pre-intervention questionnaire.

• Participants were enrolled at the study sites, achieving the sample size of 1,955.

• The pre-intervention survey was completed in August 2016.

• Data collection is ongoing, using the post-intervention survey to evaluate the intervention.

• Data is being entered by research assistants and reviewed by the study coordinator, using RedCap software.

Challenges

• In the pilot of the SMS reminder system, not all SMS messages reached the intended recipients. As such we’ve increased the number of reminders to be  sent per scheduled visit from 3 to 6. 

• AFENET approval for use of RedCap software for data entry and database management took longer than expected, so we were not able to finalize the data entry forms before study launch.

• AFENET procurement of tablets and cell phones and other items took longer than expected, so we first had to conduct paper-based interviews for the first few weeks of the study until we acquired the tablets and field tested the electronic questionnaires.

• In the current follow-up phase, it is difficult to trace study participants at home. An amendment has been submitted to the IRB, to alter the protocol and have the caregivers come to the health facilities for post-intervention interviews.

Project coordinator: Joseph Magoola

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Principal Investigator: Daniel C. Ehlman 

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