Home-based records and vaccination appointment stickers as parental reminders to reduce vaccination dropout in Indonesia: A cluster-randomized controlled trial

• Published in: Vaccine Vol. 37; no. 45; pp. 6814 - 6823
• Main Authors: Wallace, Aaron S., Peetosutan, Kenny, Untung, Andi, Ricardo, Marisa, Yosephine, Prima, Wannemuehler, Kathleen, Brown, David W., McFarland, Deborah A., Orenstein, Walter A., Rosenberg, Eli S., Omer, Saad B., Daniels, Danni
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 23.10.2019; Elsevier Limited
• Subjects: Appointments and Schedules; Births; Caregivers; Caregivers - statistics & numerical data; Children; Children & youth; Clinical trials; Clusters; Confidence intervals; Control methods; Diphtheria; Female; Health care; Health care facilities; Health facilities; Health Personnel - statistics & numerical data; Humans; Immunization; Immunization - statistics & numerical data; Indonesia; Infant; Infant, Newborn; Intervention; Low income groups; Male; Medical personnel; Parents; Parents & parenting; Pertussis; Public health; Randomization; Reminder Systems - statistics & numerical data; Tetanus; Vaccination; Vaccination - statistics & numerical data; Vaccination reminder; Indonesia; United States > US; Pakistan; Vaccination reminder; Vaccination; Indonesia
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2019.09.040

•Globally, high number of children start but fail to complete all recommended vaccinations.•Vaccination reminder/recall strategies aim to nudge parents to return for future visits.•Few reminder/recall strategies have been evaluated in low or middle-income countries.•In Indonesia, we evaluated a vaccination-card based reminder intervention.•The intervention showed mild positive effects on vaccination timeliness. Limited evidence is available about the effectiveness of strategies to remind caregivers when to bring children back for future vaccinations in low- and middle-income country settings. We evaluated the effectiveness of two reminder strategies based on home-based vaccination records (HBR) in Indonesia. In this cluster-randomized controlled trial involving 3616 children <1 year of age, 90 health facilities were randomly assigned to either a control group or one of two intervention groups: (1) HBR-only group, where healthcare workers provided an HBR to any child without an HBR during a vaccination visit and instructed the caregiver to keep it at home between visits, or (2) HBR + sticker group, where, in addition to HBR provision, healthcare workers placed vaccination appointment reminder stickers on the HBR. The primary outcome was receipt of the third dose of diphtheria-tetanus-pertussis-containing vaccine (DTPcv3) within 7 months and the secondary outcome was receipt of a timely DTPcv3 dose. Control group DTPcv3 coverage was 81%. In intention-to-treat analysis, neither intervention group had significantly different DTPcv3 coverage compared with the control group (RR = 0.94, 95% confidence interval [CI] 0.87; 1.02 for HBR-only group; RR = 0.97, 95% CI 0.90; 1.04 for HBR + sticker group) by study end. However, children in the HBR + sticker group were 50% more likely to have received a DTPcv3 vaccination (RR = 1.46, 95% CI 1.02, 2.09) within 60 days of DTPcv1 vaccination, compared with children in the control group; children in the HBR-only group were not more likely to have done so (RR = 1.05, 95% CI 0.71, 1.55). Reminder stickers had an immediate effect on coverage by improving the proportion of children who received a timely DTPcv3 dose but no effect on the proportion who received DTPcv3 after 7 months. Coupling reminder stickers with strategies to address other reasons why children do not return for vaccination visits should be further explored.