Monitoring Polio Supplementary Immunization Activities Using an Automated Short Text Messaging System in Karachi, Pakistan/Suivi Des Campagnes De Vaccination Supplementaire Contre la Poliomyelite En Utilisant Un Systeme De Messages Courts Automatiques a Karachi, Au Pakistan/Seguimiento De Las Actividades Complementarias De Inmunizacion Contra la Poliomielitis Mediante Un Sistema Automatico De Mensajes De Texto Cortos En Karachi, Pakistan

By Kazi, A. M.; Murtaza, A. et al. | Bulletin of the World Health Organization, March 2014 | Go to article overview

Monitoring Polio Supplementary Immunization Activities Using an Automated Short Text Messaging System in Karachi, Pakistan/Suivi Des Campagnes De Vaccination Supplementaire Contre la Poliomyelite En Utilisant Un Systeme De Messages Courts Automatiques a Karachi, Au Pakistan/Seguimiento De Las Actividades Complementarias De Inmunizacion Contra la Poliomielitis Mediante Un Sistema Automatico De Mensajes De Texto Cortos En Karachi, Pakistan


Kazi, A. M., Murtaza, A., Khoja, S., Zaidi, A. K., Ali, S. A., Bulletin of the World Health Organization


Background

Pakistan is one of only three countries where poliovirus remains endemic despite extensive elimination efforts. (1) Karachi, Pakistan's largest city, is now the world's only metropolitan area that has not been able to interrupt poliovirus transmission. Nine cases of poliomyelitis were confirmed in Karachi during 2011 and these cases were reported from six of the 18 "towns" or districts that form the metropolitan area. (2) Although in 2012 no cases of polio were identified in Karachi, poliovirus was found in samples of the city's sewer water. (1) The first case of polio identified in Pakistan in 2013 was in a child in Karachi. (3)

Problem

The use of supplementary immunization activities (SIAs) has helped several countries increase their immunization coverage against polio and has played a major role in decreasing the global incidence of polio by more than 99% since 1988. (4) In Karachi, however, more than 100 such activities based on oral polio vaccine have failed to interrupt local poliovirus transmission. (5) A major reason for this failure is poor vaccine coverage among vaccination-eligible children. (6) The current system of monitoring the coverage of each SIA in Pakistan has several limitations. In this system, the children receiving vaccine during an SIA are marked with black "permanent" ink on their right little fingers. (7) A third-party evaluation team then visits a randomly selected sample of households in the target area and counts the number of eligible children--that is, children aged less than 5 years--and the number of children who have black ink on their right little fingers. (8) This monitoring system is resource-intensive, utilizes convenience sampling and is prone to misreporting bias since the same individuals often supervise both the vaccinations and the evaluation of vaccine coverage. (9) It also exposes the members of the evaluation teams to the risk of violence, especially in certain locations with poor security. More than 16 vaccinators associated with polio vaccination campaigns have been assassinated in various parts of Pakistan since December 2012. (10)

In Pakistan, mobile phones have become very common over the past 10 years and there are currently more than 119 million mobile phone users. (11) Many of these phones are used to send short message service (SMS) texts. In 2011, for example, 237.58 billion person-to-person texts--the equivalent of about 175 text messages per mobile phone per month--were generated in Pakistan. (12) Mobile health ("m-health") technology is increasingly being considered for various health interventions, such as sending reminders for clinic visits, immunizations and medication adherence. (13) We recently wondered if m-health could be used to measure vaccine coverage in polio SIAs, particularly in resource-limited areas and those with poor security. We therefore conducted a feasibility study to assess if a low-cost automated system that could send SMS messages to the mobile phones of caregivers could be used to monitor the coverage of SIAs in Karachi.

Approach

The study protocol was approved by the ethical review committees of the Aga Khan University in Pakistan and the World Health Organization (WHO). Thirty clusters of households were randomly selected in each of three districts of Karachi --Gulshan-e-Iqbal, Baldia and SITE (Sindh Industrial and Trading Estate)--and across the entire city. A case of polio had been detected in each of the three study districts in 2011.2 Each cluster consisted of 200 to 250 households. (8) Within each selected cluster, at least 28 households with a member aged less than 5 years were selected by systematic random sampling. If a selected house contained more than one child younger than 5 years, then one of the children was randomly chosen for enrolment. After informed consent was obtained from a caregiver, baseline demographic information on each enrolled child, the mobile phone number of one of the child's caregivers and the phone-owning caregiver's preferred language were recorded. …

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Monitoring Polio Supplementary Immunization Activities Using an Automated Short Text Messaging System in Karachi, Pakistan/Suivi Des Campagnes De Vaccination Supplementaire Contre la Poliomyelite En Utilisant Un Systeme De Messages Courts Automatiques a Karachi, Au Pakistan/Seguimiento De Las Actividades Complementarias De Inmunizacion Contra la Poliomielitis Mediante Un Sistema Automatico De Mensajes De Texto Cortos En Karachi, Pakistan
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