mHEALTH INTERVENTIONS TO IMPROVE MEASLES VACCINATION COVERAGE AND TIMELINESS: AN ASSESSMENT OF THE IMMEDIATE AND LONG-TERM IMPACT ON VACCINE-SEEKING IN RURAL KENYA

Vaccine-preventable diseases cause considerable childhood morbidity and mortality in low- and middle-income countries (LMICs). To inform scaled use of mobile phone-based interventions (mHealth) to improve pediatric vaccination uptake in LMICs, we evaluated the following: i. Using current evidence, do short message service (SMS) reminders improve vaccination uptake? ii. Can SMS reminders with unconditional mobile money (mMoney) incentives improve first-dose measles-containing vaccine (MCV1) uptake? iii. What is the impact of temporary SMS reminders and mMoney incentives on long-term vaccine-seeking? We conducted: 1) A systematic review and meta-analysis of the impact of SMS reminders on pediatric vaccination uptake. 2) A randomized controlled trial in Kenya to assess the impact of SMS reminders with or without unconditional mMoney incentives on MCV1 uptake (the M-SIMI study). Participants received no interventions (Control), SMS reminders alone, or SMS reminders plus 150 Kenya Shillings (SMS+150KES). 3) A post-trial follow-up study (the MSBC study) in Kenya to assess vaccine-seeking after withdrawal of SMS reminders and incentives among former M-SIMU study participants. Systematic review and meta-analysis (11 studies): SMS reminders significantly improved third-dose diphtheria, tetanus and pertussis (DTP3) timeliness but not DTP3 uptake and full vaccination by age 12 months. Insufficient number of studies precluded meta-analysis for MCVs. M-SIMI study (N= 455): Compared to Control infants, MCV1 coverage within four weeks of the recommended age was significantly higher among SMS+150KES infants but not among SMS only infants. Neither intervention significantly improved MCV1 coverage by age 12 months. MSBC study (N= 218): Withdrawal of SMS reminders and incentives was associated with statistically insignificant decreases in MCV1-seeking for subsequent children (SC) and statistically significant decreases in MCV2-seeking for some former M-SIMU children. Decreased MCV1-seeking translated to lower-than-expected coverage among SC of former M-SIMU intervention caregivers compared to Control SC. SMS reminders can increase vaccination uptake. Unconditional incentives may have no added effect on MCV1 uptake over SMS reminders alone. Withdrawal of SMS reminders and incentives could reduce measles vaccine-seeking