Tying Community Engagement With Appropriate Technology At The Last Mile: A Cluster Randomized Trial To Determine The Effectiveness Of A Novel, Digital Pendant And Voice Reminder Platform On Increasing Infant Immunization Adherence Among Mothers In Rural Udaipur, India

Background: 500,000 children under the age of five die from vaccine preventable diseases in India every year. More than just improving coverage, increasing timeliness of immunizations is critical to ensuring infant health in the first year of life. Novel, culturally-appropriate, community engagement strategies are worth exploring to close the immunization gap. In this case, a digital pendant and voice call reminder (components of the Khushi Baby platform) are tested for the effectiveness in improving DTP3 adherence within two monthly camps from DTP1 administration. Methodology: A cluster randomized trial was conducted in which 96 village health camps were randomized to three arms: NFC sticker, NFC pendant, and NFC pendant with voice call reminder in local dialect across 5 blocks in the Udaipur District serviced by Seva Mandir from August 2015 to April 2016. Results: The pendant and pendant with voice call reminder arms did not significantly improve adherence compared to the sticker group. Point estimates suggested that there was a higher odds of on-time completion in the pendant with voice call group compared to both the pendant group and the sticker group. Conclusions: Despite the null results for adherence, the fact that the pendant was well retained and well accepted by the community suggests that the pendant can be a valuable social symbol and community engagement tool. Low power and short term follow-up may have masked true effects of the system. A larger randomized trial slated to begin in August 2016 will look to replicate and build off the study findings in the Udaipur district