Kenya - Randomized Controlled Trial of the Impact of Mobile Phone Delivered Reminders and Travel Subsidies to Improve Childhood Immunization Coverage Rates and Timeliness in Western Kenya
SMS reminder messages and small incentives have been used to increase the uptake of a wide range of positive health behaviors, but little to no evidence exists for their use with immunizations in lower income countries. Our pilot study conducted in Siaya County, Kenya found that using a mobile phone based system to deliver reminder messages and incentives for pediatric vaccinations was technically feasible and welcomed by the community. In collaboration with investigators from the Kenyan Medical Research Institute and Center for Disease Control and Prevention (KEMRI/CDC) we are conducting a village-randomized controlled trial to test the impact of reminder messages with and without monetary incentives to increase the timeliness and coverage of infant vaccinations (BCG, pentavalent, polio and measles). This trial will provide the rigorous evidence needed to determine if SMS reminders and/or incentives can improve vaccine coverage and timeliness in a rural Kenyan setting. The results of this study, along with future cost-effective analyses, will be presented to the Ministry of Health, GAVI, and WHO.
Global Health Mentor: Andrea Renee Sutherland, MD
I arrived in Nairobi airport on a windy day in October 2014. The rain just stopped and the air smelled fresh. I had an Ebola screening before I could step out the airport. At the time Ebola was confined to western Africa, so I wasn’t very worried. I waited in the airport for another connecting small plane to the town of Kisumu. It is a small city on the shore of Lake Victoria, the largest lake in Africa, which is not far from the border of Uganda. I heard of the place before in a book about Marburg virus. The small plane was in air turbulence all the time for almost an hour before I reached the town, but the seat belt light never turned on. I thought I would never travel with small jet flight again. The flight landed safely. The plain of Kenya came to my sight, and the red earth impressed me at the first sight. We drove into the town, and saw small vans, tricycles, women with baskets on their head selling fruits, churches and the clock in the city center. Our apartment was on a quiet side of the town.
I reported to work the second day. It was hosted by KEMRI/CDC, a collaborative research institute between U.S. and Kenya governments. It has a beautiful garden and a comfortable working environment. The research project I was working with is a randomized community trial investigating effectiveness of mobile text message reminders and conditional cash transfer on coverage and timeliness of immunization. I mainly worked on data management. I have been in several studies before I came to Hopkins, and I would say this is the best research experience I had. The study was very well implemented and all the field staff were competent and have good supervisory support. I spent quite a lot of time visiting the field, observing the interviews and learn the real-life setting of rural Kenya. The team had a strong focus on assuring quality of data collection. Every week, we had a teleconference with investigators in the U.S. to discuss the progress and issues coming up. The team spent lots of time discussing how to deal with issues that may threat data quality and introduce confounders. I really appreciated these discussions which helped me improve my skills of using epidemiological thinking in study implementation.
1. A busy town
2. Community health center where people can get lots of primary health care
3. KEMERI-CDC, a modern research institute
4. Our daily transportation