| BackgroundStrictly adherence to immunization schedule and timely vaccination can ensure the immunity outcome and maximize the protection for children. However, forgetfulness or no knowing of immunization date were the main reasons for failing to follow immunization schedule and overdue vaccination. The domestic and abroad findings in immunization reminder & recall showed that auto-dial phone, mail, postal card, text messages can improve the immunization coverage and timely immunization rate. Meanwhile, the text message was proved to be the cost-effective reminder, better intervention than mail and closer effect to phone reminders. There were limited study in dropout rate reminder and no study was found in full immunization rate for vaccines under 12 months. The huge mobile phone subscribers, high penetration of mobile phone in rural areas as well as its immunity outcome and cost-effectiveness enabled the mobile phone to be an ideal choice in improving vaccination services in remote rural areas. This study will evaluate the text message reminder outcome in vaccination services and provide reference for replication in the similar setting.Objectives1. To evaluate the receiving proportion and children guidians'attitude towards text messages reminder.2. To evaluate the changes in immunization coverage rate, timely immunization rate, dropout rate, and full immunization rate for children under 12 months3. To figure out influential factors for immunization coverage rate, timely immunization rate and dropout rate.MethodsTo understand text message receiving proportion and guardians'feedback of 0-6 children on text message, a phone retrospective study in text message sending areas were conducted. The study covered all guardians who were sent text messages in October 29th-November 4th,2014.In the selected 60 villages, the 25 text message intervention villages and 35 non-text message intervention villages were divided. The birth range were identified according to minimum age month and possibility to receive intervention during intervention period. In the text message intervention group, text messages were sent to guardians one day ahead of appointed vaccination day, while in non-text message intervention group, no text message was sent. Then rate differences were evaluated in immunization coverage rate, timely immunization rate, dropout rate and full immunization rate among two groups. Moreover, using the Logistic Pegression to explore the influenctial factors and the relevance among indicators and text message interventions, registration status, sex, immunization service frequencies, distance to immunization sites, village doctors' age, village doctors' sense of responsibility.ResultsAmong the interviewed 439 guardians,306 (69.7%) were vaccinated in immunization sites, while 133 children were not vaccinated.429 guardians provided effective responses on text message receiving.398 (92.8%) guardians received text message prior to vaccination day.397 guardians expressed their opinions in text messages interventions.397(100%) guardians were satisfied with the sending time and contents.393(99%) guardians expressed willingness to receive text message in the future.4 guardians expressed their indifference toward text message receiving. 394(99.2%) guardians thought the text message reminder was helpful.Among the 18 intervened doses,13 doses immunization rate increased with stastical difference(P<0.01), and the increase range from 10.30?30.66%, and 5 doses changed with no statistical significance(P>0.01) and the the percentage change range from-0.99%?5.31%.Among the 5 intervened doses,4 doses timely vaccination rate increased with stastical difference(P<0.01), and the increase range from 9.39%-22.27%,including OPV1 (9.39%), DTP1 (12.50%), MCV1 (14.32%), JEV-L, (22.27%) and only MFV-A1 (5.78%) increase has no statistical significance(P>0.01). The maximum increase were 8 month age, such as MCV1 and JEV-L1.The text message decreased two vacciness' dropout rate, including OPV (21.23%), DTP (22.38%).Among the 5 intervened doses for children aged 12-24 month,4 doses full immunization rate increased with statsitcal differences(P<0.01). The increase range was from 6.66% to 20.66% including MCV1 (6.66%), OPV1-3(9.34%), HepB1-3(10.60%), and DTP1-3 (20.66%). Only JEV-L1 (2.06%) increased without statsitcal difference(P> 0.01).ConclusionsIn remote and mountainous rural areas, text message effectively increase immunization coverage rate, timely vaccination rate and full immunization rate and decrease the dropout rate. The influential factors analysis showed that those results were relevant to text message intervention. Text message intervention were effective in immunization coverage rate including six-48 month children, low immunization rate doses. It was also effective in children's timely vaccination rate, especially for 8 months and full immunization rate as well as dropout rate. |
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