Tunatar da ni. The Immunization Reminder and Information SMS System (IRISS)

Summary

In 2016, only 33% of Nigerian children aged 12-23 months had been vaccinated with the 3rd dose of the pentavalent vaccine. Lack of knowledge was the leading reason for non-vaccination. To overcome this knowledge gap, this project, "Tunatar da ni", will deliver targeted text messages to community leaders and individualized text messages to parents and caregivers in Kebbi state, Northwest Nigeria, a state with very low coverage of immunization (19% penta 3 coverage in 2018).

These text messages, also known as Short Messaging System (SMS) messages will be managed, scheduled and sent from a purpose-built, cloud-based Immunization Reminder and Information SMS System (IRISS). The messages will be deployed in three ways, as:

1. General broadcast of messages on the importance of immunization to all active mobile phone subscribers in the intervention area.
2. Targeted educational, informational, normative and motivational messages on immunization, and reminders on the local immunization clinic schedules, to community members who voluntarily registered into IRISS for these messages, and to traditional and religious leaders who then share these information with their communities.
3. Individualized reminders of a child's immunization due dates and local clinic schedule to parents who voluntarily registered their child's information on IRISS in order to receive these reminders.

Study investigators hypothesize that providing community leaders with positive and actionable messages on immunization services will improve their understanding of the value of vaccines and provide them facts to drive discussions, build positive norms and increase acceptance of vaccination. Providing targeted reminders to parents about their child's vaccination due date and the schedule of their local vaccination clinics will motivate their timely action to seek vaccination services for their children.

Intervention will be evaluated using a two-arm cluster randomized controlled trial design. All 21 Local Government Areas (LGAs) in Kebbi state will be involved. Based on a 2:1 ratio, 14 LGAs will be randomly assigned to receive the SMS intervention while 7 LGAs will serve as controls.

The primary outcome measure will be the proportion of children aged 0-11 months who are appropriately vaccinated for age. The data to compare this outcome between the intervention and control arms, will be obtained from the quarterly lot quality assurance surveys done by the Nigerian government.

Conditions

• Low Immunization Uptake

Interventions

OTHER

Community engagement

The government will conduct a cascade of sensitization meetings with traditional leaders at all levels to promote newborn line listing (birth registration), reconciliation of child's vaccination status and defaulter tracking (home-based follow up of children who have missed their vaccination doses) by health providers and community leaders

OTHER

IRISS advert for opt-in

A module to advertise and demonstrate how individuals can opt-in to IRISS to receive the messages will be included in the community engagement sensitization meetings.

OTHER

One-time SMS broadcast on immunization

General broadcast of SMS messages on the importance of immunization to all active mobile phone subscribers in the intervention LGAs

OTHER

Scheduled weekly SMS reminder of health facility RI schedule to community leaders

Traditional and religious leaders who have a phone or access to a phone and have been registered on IRISS will receive SMS messages on the immunization session schedule of the health facilities in their communities, so they can disseminated the information through their town announcers to inform parents and caregivers. For example, "Ribah clinic is holding a vaccination session tomorrow from 8am to 2pm. Please take your child there to vaccinate them and encourage your neighbors to vaccinate their children."

OTHER

Scheduled bi weekly RI messages to community leaders

Traditional and religious leaders who own or have access to a phone and have been registered on IRISS will receive SMS messages on immunization, to share same with community members. The message categories are: 1) Educational messages that provide facts and increase knowledge, e.g. "Have you heard of Penta vaccine? It protects against 5 diseases: they are diphtheria, whooping cough, tetanus, HiB and Hepatitis B." 2) Informative messages that dispel myths about immunization, e.g. "Getting more than one vaccine at the same time does not harm a child. It is very important to completely receive all vaccine doses for full protection." 3) Normative messages to promote positive norms, e.g. "Our religious leaders have immunized their children, what are we waiting for"? 4) Motivational messages to inspire action, e.g. "Each visit to the health center for vaccination will reap many health benefits. Say YES to good health, be on time and complete your child's vaccination."

OTHER

Responsive individualized child vaccination schedule reminder to caregivers who opt-in

Parents and caregivers who voluntarily registered their child's information into IRISS will receive a reminder, a day before, about their child's due vaccines and the schedule of vaccination sessions in the health facilities within their locality (wards), e.g. "Greetings! Amina is due for Penta 1 tomorrow, kindly visit Ribah clinic. They vaccinate on Mondays and Thursdays."

OTHER

Responsive one-time SMS message on hand washing to those that erroneously register on IRISS

If individuals from control LGAs encounter IRISS adverts inadvertently and erroneously register into IRISS expecting a message, to avoid a loss in trust if no message is sent, they will receive a one-time general message about the importance of hand-washing, e.g. "Wash your hand with soap and water every time you finish from to the toilet, to maintain clean hands and avoid germs that make you sick."

Sponsors & Collaborators

• Bill and Melinda Gates Foundation

  collaborator OTHER

• Direct Consulting and Logistics

  collaborator UNKNOWN

• Johns Hopkins Bloomberg School of Public Health

  lead OTHER

Principal Investigators

• Chizoba B Wonodi, MD,MPH,DrPH · Johns Hopkins Bloomberg School of Public Health

• Alain Labrique, MD,MHS,PHD · Johns Hopkins Bloomberg School of Public Health

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2019-06-15

Primary Completion

2020-10-30

Completion

2020-11-29

Countries

• Nigeria

Study Locations