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Use of cellular phone contacts to increase return rates for immunization services in Kenya
Evans Mokaya1, Isaac Mugoya1, Jane Raburu2
1USAID's Maternal and Child Survival Program (MCSP)/John Snow, Inc (JSI), Nairobi, Kenya.
Insights
Using phone calls to track immunization defaulters in Kenya significantly reduced dropout rates. This cost-effective method complements home visits and highlights the need for community education and better data sharing to address false defaulters.
Area of Science:
- Public Health
- Health Systems Research
- Vaccination Programs
Background:
- Immunization dropout is a significant challenge in Kenya, hindering full childhood immunization.
- Traditional home visit strategies have proven ineffective in reducing immunization defaulters.
Purpose of the Study:
- To evaluate the effectiveness of using phone contacts for tracking immunization defaulters in western Kenya.
- To assess the feasibility and cost-effectiveness of phone-based defaulter tracking.
Main Methods:
- A nine-month study in twelve Kenyan facilities tracked children who defaulted on immunization schedules.
- Caregiver phone ownership was assessed, and reasons for defaulting were collected.
- Health workers tracked defaulters via phone, recording time and cost.
Main Results:
- Caregiver phone ownership exceeded 80% in most facilities.
- Defaulter rates decreased significantly to below 10% in 11 out of 12 facilities.
- Common reasons for defaulting included competing tasks and concerns about vaccine side effects; a notable number were 'false defaulters' vaccinated elsewhere.
Conclusions:
- Phone contact follow-up is a feasible, cost-effective strategy for reducing immunization defaulters.
- This approach should supplement home visits, particularly for caregivers with phones.
- Addressing communication barriers through education and establishing systems to identify 'false defaulters' are crucial for program improvement.
Introduction:
In Kenya, failure to complete immunization schedules by children who previously accessed immunization services is an obstacle to ensuring that children are fully immunized. Home visit approaches used to track defaulting children have not been successful in reducing the drop-out rate.
Methods:
This study tested the use of phone contacts as an approach for tracking immunization defaulters in twelve purposively-selected facilities in three districts of western Kenya. For nine months, children accessing immunization services in the facilities were tracked and caregivers were asked their reasons for defaulting.
Results:
In all of the facilities, caregiver phone ownership was above 80%. In 11 of the 12 facilities, defaulter rates between pentavalent1 and pentavalent3 vaccination doses reduced significantly to within the acceptable level of < 10%. Caregivers provided reliable contact information and health workers positively perceived phone-based defaulter communications. Tracking a defaulter required on average 2 minutes by voice and Ksh 6 ($ 0.07). Competing tasks and concerns about vaccinating sick children and side-effects were the most cited reasons for caregivers defaulting. Notably, a significant number of children categorised as defaulters had been vaccinated in a different facility (and were therefore "false defaulters").
Conclusion:
Use of phone contacts for follow-up is a feasible and cost-effective method for tracking defaulters. This approach should complement traditional home visits, especially for caregivers without phones. Given communication-related reasons for defaulting, it is important that immunization programs scale-up community education activities. A system for health facilities to share details of defaulting children should be established to reduce "false defaulters".
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