Vaccine indicator and reminder (VIR) band community intervention: formative evaluation study, Karachi, Pakistan

Summary

BCG coverage has reached 90% but the ever-constantan dropout rate between the first and fourth visit of the routine immunization (RI) schedule has to be addressed as DTP-3 is at 85%. The Vaccine Indicator and Reminder Band (VIR) is a low-cost silicon band with a built-in Timestrip indicator to remind parents when it is time to return to the vaccination center for timely completion of RI schedule. The VIR band community engagement study enrolled 497 neonates 15 days of age at four EPI vaccination centers in peri-urban settlements in Karachi, Pakistan. Each infant received three color-coded VIR bands, one after receiving BCG, Penta-1, and Penta-2 vaccine. They graduated from the study after receiving Penta-3 vaccine. Data collected at enrollment and during each follow-up visit was entered into a digital database in real-time, with connectivity to the cloud. The band type-wise retention rate was 79.6% for the Yellow Band, 86.9% for the Purple Band and 81.7 for the Aqua band. Among those who came for follow-up, 90%, across all the follow-up visits had the VIR band on the ankle of the child. Vast majority of exit survey respondents shared favorable views for recommending this useful innovation to others. The VIR band since it stays on the ankle of the child serves as a visual cue to action for RI schedule completion in a timely manner. Its ease of use, and high acceptability as documented through this study. Background/Objectives: Since 2010 BCG coverage has increased to current level of 90% but the ever-constantan dropout rate between the first and fourth visit of the routine immunization (RI) schedule has to be addressed as DTP-3 is at 85%. The Vaccine Indicator and Reminder Band (VIR) is a low-cost silicon band with a built-in Timestrip indicator to remind parents when it is time to return to the vaccination center for timely completion of RI schedule. The VIR band was designed using human-centered design method and tested in Karachi in 2015 with 367 infants for safety and functionality.

Description of Intervention and/or Methods/Design:

The study enrolled 497 neonates 15 days of age at four EPI vaccination centers in peri-urban settlements in Karachi, Pakistan. Each infant received three color-coded VIR bands, one after receiving BCG, Penta-1, and Penta-2 vaccine. They graduated from the study after receiving Penta-3 vaccine. Parents were interviewed at enrollment about vaccination knowledge and attitude, and at each subsequent visit about their experience with the VIR band and how effective it was in reminding them about the vaccination due date. Parents were also asked about what neighbors and visitors said about the VIR band. At the study exit interview parents were asked if they would recommend the VIR band to family and friends. Data collected at enrollment and during each follow-up visit was entered into a digital database in real-time, with connectivity to the cloud. Participation was voluntary and after securing written informed consent.

Results/Lessons Learned:

Nearly half of the interviewees stated that immunization protects children against diseases, while one sixth also said that immunization can prevent disabilities. One-third of the originally enrolled children (38%) were cumulatively lost to follow-up. The band type-wise retention rate was 79.6% for the Yellow Band, 86.9% for the Purple Band and 81.7 for the Aqua band. Among those who came for follow-up, 90%, across all the follow-up visits had the VIR band on the ankle of the child. Condition of the VIR bands across the follow-up visits was observed and recorded for each follow-up visit. The majority of exit survey respondents shared favorable views for recommending this useful innovation to others. When inquired about the details of VIR band, among those who knew about it, the majority (94.3%) reported that its main benefit/function is to remind about getting the routine vaccination on time.

Discussion/Implications for the Field:

Given the strengths and marked limitations of mobile-based innovations along with other approaches such as incentives, the VIR band innovation was conceived and developed as an alternative to the SMS based reminder that was not dependent on mobile phone technology. The VIR band since it stays on the ankle of the child serves as a visual cue to action for RI schedule completion in a timely manner. Its ease of use, and high acceptability as documented through this study supplements the existing body of literature pertaining to vaccine reminder approaches.

Abstract submitted by:

Dr Noor Sabah Rakhshani - Consultant Public Health Practitioner