EFFECT OF MOBILE-PHONE REMINDER TEST MESSAGES ON MOTHERS' KNOWLEDGE AND COMPLETION OF ROUTINE IMMUNISATION IN RURAL AREAS OF OYO STATE, NIGERIA

Abstract

Interventions aimed at promoting completion of Routine Immunisation (RI) in Nigeria have not yielded satisfactory results. Text Message Reminders (TMRs) through mobile phones have been used to promote adoption of innovations; however, its effectiveness in enhancing the completion of RI in rural areas has not been adequately investigated. This study was designed to evaluate the effects of TMRs on knowledge and completion of RI by Mothers of Infants (MI) in rural Local Government Areas (LGAs) in Oyo State, Nigeria. The adopted quasi-experimental design involved random selection of Ibarapa North (IN) and Kajola from the list of 12 rural LGAs with highest immunisation dropout rates. Ibarapa North and Kajola were randomly allocated to Intervention Group (IG) and Control Group (CG), respectively by balloting. Five Primary Health Care facilities in each LGA with RI services were randomly selected out of 10 facilities in each LGA. All consenting 179 MI in IG and 187 MI in CG who registered their children at the health facilities for RI in June 2014 were enrolled. Data were collected through Focus Group Discussion (FGD) among MI, Key Informant Interview (KII) among Health Workers (HWs), and an interviewer-administered questionnaire, which included a 25-point knowledge scale, questions on receipt of TMRs and RI appointment keeping. Knowledge Scores (KS) <13 and ≥13 were categorised as poor and good, respectively. Baseline results were used to design an intervention that involved disseminating TMRs to MI in IG thrice weekly for 10 months on the importance of RI and RI appointment keeping. A thematic approach was used to analyse qualitative data. Quantitative data were analysed using descriptive statistics, t-test and Chi-square test. Level of significance was at p=0.05. Respondents’ ages in IG and CG were 26.4±5.6 and 28.3±5.5 years, respectively. The highest level of education was high school among IG (65.2%) and CG (57.0%). The FGD participants had little knowledge of RI. Many participants in both groups supported the use of TMRs for promoting RI appointments among MI. The KII revealed that few HWs counselled RI defaulting mothers on adherence to complete RI. Majority of the IG (79.1%) received TMRs and among this sub-group, 75.5% reportedly received TMRs often. Immunisation barriers listed by respondents in IG for not completing RI included busy schedules (24.4%), children’s ill health (16.7 %) and apathy (16.7%). Baseline KS among IG and CG were 10.3±3.5 and 9.3±2.5, respectively, which increased significantly to 12.9±2.8 and 13.1±4.0 among IG and CG at Post-Intervention (PI). However, at PI, KS among IG was 12.9±2.8 and this was not significantly different from 13.1±4.0 among CG. Significantly, more MI in IG (77.4%) compared with those in CG (64.5%) completed RI. Percentage of completion of immunisation among IG was 87.1%, and this was significantly higher than the 56.7% among CG. Text message reminders were effective in improving knowledge and completion of routine immunisation among mothers of infants in Ibarapa North Local Government Area. Therefore, its use among frontline health workers is recommended.