icddr,b mHealth intervention improves immunisation coverage in hard-to-reach communities

Reminding mothers about immunisation of newborns through SMS messages has significantly improved vaccination coverage among hard-to-reach populations in Bangladesh, reveals a new icddr,b study.

Despite tremendous immunisation growth, vaccination coverage in Bangladesh stands at only 82% as of 2014, primarily due to the difficulty in tracking mothers and newborns in rural hard-to-reach areas and urban street dweller communities.

Targeting these two areas with automated SMS reminders for one year, an mHealth intervention developed by icddr,b scientists has helped increase full vaccination coverage among children over 298 days of age: in rural areas coverage increased from 58.9% to 76.8%, and in urban areas from 40.7% to 57.1%.


Photo by Kibae Park/UN. CC BY-NC-ND 2.0

The study shows that technology-aided vaccination reminders can be useful for Bangladesh – a country with good mobile-cellular penetration and a nation committed to the World Health Organization’s Expanded Program on Immunization (EPI) since 1979, aiming to promote universal access to all relevant vaccines for everyone at risk.

The study findings also imply that developing countries with high mobile phone usage could replicate such technology-driven interventions on a broader scale to enhance health impact, says Dr Md. Jasim Uddin, a scientist with the universal health coverage programme at icddr,b and the principal investigator of the study.

Here is how it works. Health workers registered pregnant mothers in the rural hard-to-reach areas and urban street dweller communities using an android app called ‘mTika,’ adapted in collaboration with experts from the Bangladesh Ministry of Health and Family Welfare (MOHFW), mPower Social Enterprise and the US-based Johns Hopkins Bloomberg School of Public Health.

During field visits, health workers also supported pregnant mothers in using their own mobile phones to register themselves and send SMS notifications to the web database of the government’s Directorate General of Health Services when their babies were born.

Based on this information, the mothers and health workers received simultaneous reminders about upcoming EPI sessions and vaccination administration instructions, respectively. The intervention showed good results as most enrolled mothers who received reminders took their babies for immunisation.

All data from the study are now available for analysis by interested researchers and various health departments of the government for further intervention. The EPI has also developed an “immunisation dashboard” for interactive access to broad-scale data.

So, what was the biggest challenge in getting mothers and health workers to use the mHealth intervention?

Accurately tracking children and vaccinations especially in remote rural and urban street dweller populations can be tough, says Dr Uddin. The study found that almost half of the mothers included in the study from street dweller populations did not report the births of their children, compared to one third of mothers from remote rural areas.  Therefore a large portion of the target community was not reached.

The street dweller communities live a nomadic life and are often beyond the reach of health workers, explains Dr Uddin. However, as the study showed success in improving child immunisation coverage for those who did participate, he hopes mHealth interventions can be developed further to become a powerful tool for health outreach to slums by linking residents to nearby health services. The long-term aim is to harness these types of technologies to make measurable health impacts in Bangladesh.