Testing a Biometric Identification System to Improve Malaria Vaccine Completion

Receiving all four doses of the malaria vaccine can significantly protect children against malaria illness, hospitalization, and death. However, in Ghana, only 46% of children complete the full vaccination sequence. More broadly, many children in Ghana do not receive the full set of recommended pediatric vaccinations. To address this, Simprints, in collaboration with Ghana Health Services, will implement a digital vaccination record system linked to biometrics. This system will automatically identify children who are behind on their vaccination schedule, providing health workers with information to prioritize community outreach. Additionally, it will send voice message reminders to caregivers to improve compliance. A cluster-randomized controlled trial (c-RCT) will be conducted in the Oti region to measure the impact of this innovation on the proportion of children completing malaria and routine vaccination schedules.

Study Overview

• Status: Recruiting
• Conditions: Vaccination
• Intervention / Treatment: Behavioral: HEALTH FACILITY INTERVENTION; Behavioral: INDIVIDUAL INTERVENTION

• Study Type: Interventional
• Enrollment (Estimated): 4715
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Elisa Maria Maffioli, PhD; Phone Number: 443-875-4930; Email: elisamaf@umich.edu
• Study Contact Backup: Name: Jessica Cohen, PhD; Email: cohenj@hsph.harvard.edu

Study Locations

• Ghana
  • Oti Region, Ghana
    • Recruiting
    • Communities in Oti Region
    • Contact: Chris Guure; Phone Number: +233242928284; Email: cbguure@ug.edu.gh

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Pregnant women (in the last two trimesters), aged 15-49 years old, who do not plan to permanently move in the next 12 months.
• Women with children under 6 months old, aged 15-49 years old, who do not plan to permanently move in the next 12 months.

Exclusion Criteria:

• Non-age-eligible women.
• Men and non-emancipated minors.
• Women who do not consent.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Treatment; Health facilities randomized in treatment clusters will be provided with a digital vaccination record system (e-tracker) linked to biometrics (facial recognition) of caregivers (if child is below 6 months) or of children (if child is above 6 months) [HEALTH FACILITY INTERVENTION]. Caregivers (if child is below 6 months) or children (if child is above 6 months) living in communities in the catchment areas of health facilities randomized in treatment clusters [INDIVIDUAL INTERVENTION] will be registered at the community level into the e-tracker and biometrics (facial recognition), and caregivers of children who are due for or missed vaccination will receive voice message appointment reminders if they provided a phone number during the registration in biometrics.	Behavioral: HEALTH FACILITY INTERVENTION; Health facilities randomized in treatment clusters will be provided with a digital vaccination record system (e-tracker) linked to biometrics (facial recognition) of caregivers (if child is below 6 months) or of children (if child is above 6 months). With the support of Ghana Health Services, Simprints will train CHWs on digital vaccination record system (e-tracker) and biometrics. Simprints will also provide Technical Assistance to CHWs for the duration of the study.; Behavioral: INDIVIDUAL INTERVENTION; Caregivers (if child is below 6 months) or children (if child is above 6 months) living in communities in the catchment areas of health facilities randomized in treatment clusters will be registered at the community level into the e-tracker and biometrics (facial recognition), and caregivers of children who are due for or missed vaccination will receive voice message appointment reminders if they provided a phone number during the registration in biometrics. Reminders will be sent before a child is due a visit to receive vaccination, as well as after a child missed his due visit.
No Intervention: Control; Health facilities randomized in control clusters, and caregivers (if child is below 6 months) or children (if child is above 6 months) living in communities in the catchment areas of health facilities randomized in control clusters will not receive any intervention during the study period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Completion of full malaria sequence (Index children)	Record of 4 doses of malaria vaccines for the index child recorded by the individual child's booklet (or self-reported by the mother if the booklet is not available)	Measured at endline, 24-26 months after baseline
Timely full malaria vaccination (Index children)	Record of 4 doses of malaria vaccines for the index child recorded by the individual child's booklet (or self-reported by the mother if the booklet is not available) taken within the appropriate time frame.	Measured at endline, 24-26 months after baseline
Completion of full routine vaccination sequence (basic antigens) (Index children)	Records of doses of routine vaccines (basic antigens) for the index child recorded in the individual child's booklet (or self-reported by the mother if the booklet is not available). Defined as receipt of all of the following: One dose of BCG vaccine; Three doses of polio vaccine given as oral polio vaccine (OPV); Inactivated polio vaccine (IPV); Three doses of Pentavalent vaccine (Penta); One dose of measles-rubella vaccine (MR).	Measured at endline, 24-26 months after baseline
Completion of full routine vaccination sequence (national schedule) (Index children)	Records of doses of routine vaccines (national schedule) for the index child recorded in the individual child's booklet (or self-reported by the mother if the booklet is not available). Full vaccination coverage based on the national schedule is defined as the index child having received all the following: BCG; Three doses of Pentavalent (Penta); Four doses of OPV (including OPV given at birth); One dose of IPV; One dose of yellow fever vaccine; Three doses of pneumococcal vaccine (PCV); Three doses of rotavirus vaccine; Two doses of measles-rubella vaccine (MR); One dose of meningitis A vaccine (MenA).	Measured at endline, 24-26 months after baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Timely full routine vaccination sequence (basic antigens) (Index children)	Records of doses of routine vaccines (basic antigens) for the index child recorded in the individual child's booklet (or self-reported by the mother if the booklet is not available). Taken within the appropriate time frame.	Measured at endline, 24-26 months after baseline
Timely full routine vaccination sequence (national schedule) (Index children)	Records of doses of routine vaccines (national schedule) for the index child recorded in the individual child's booklet (or self-reported by the mother if the booklet is not available). Full vaccination coverage based on the national schedule is defined as the index child having received all the following, taken within the appropriate time frame.	Measured at endline, 24-26 months after baseline
Early, Late or Very Late malaria vaccination (Index children)	Record of 4 doses of malaria vaccines for the index child recorded by the individual child's booklet (or self-reported by the mother if the booklet is not available). Taken outside the appropriate time frame.	Measured at endline, 24-26 months after baseline
Early, Late or Very Late full routine vaccination sequence (basic antigens) (Index children)	Records of doses of routine vaccines (basic antigens) for the index child recorded in the individual child's booklet (or self-reported by the mother if the booklet is not available). Taken outside the appropriate time frame	Measured at endline, 24-26 months after baseline
Early, Late or Very Late full routine vaccination sequence (national schedule) (Index children)	Records of doses of routine vaccines (national schedule) for the index child recorded in the individual child's booklet (or self-reported by the mother if the booklet is not available). Taken outside the appropriate time frame.	Measured at endline, 24-26 months after baseline
Number of malaria vaccines taken (Index children)	Number of recorded malaria vaccines taken (from 0 to 4) by the index child recorded by the individual child's booklet (or self-reported by the mother if the booklet is not available).	Measured at endline, 24-26 months after baseline
Number of routine vaccines taken (basic antigens) (Index children)	Number of recorded basic antigens taken (0 to 9) by the index child recorded by the individual child's booklet (or self-reported by the mother if the booklet is not available).	Measured at endline, 24-26 months after baseline
Number of routine vaccines taken (full national schedule) (Index children)	Number of recorded vaccinations taken (0 to 19) from the national schedule by the index child recorded by the individual child's booklet (or self-reported by the mother if the booklet is not available)	Measured at endline, 24-26 months after baseline
Number of timely malaria vaccines taken (Index children)	Number of recorded malaria vaccines taken (from 0 to 4) within the appropriate time frame by the index child recorded by the individual child's booklet (or self-reported by the mother if the booklet is not available).	Measured at endline, 24-26 months after baseline
Number of timely routine vaccines taken (basic antigens) (Index children)	Number of recorded basic antigens taken (0 to 9) within the appropriate time frame by the index child recorded by the individual child's booklet (or self-reported by the mother if the booklet is not available)	Measured at endline, 24-26 months after baseline
Number of timely routine vaccines taken (full national schedule) (Index children)	Number of recorded vaccinations taken (0 to 19) from the national schedule within the appropriate time frame by the index child recorded by the individual child's booklet (or self-reported by the mother if the booklet is not available)	Measured at endline, 24-26 months after baseline
Received each vaccine on time (full national schedule) (Index child), analyzed individually	Among each of the following, analyzed individually, index child received the vaccine within the appropriate time frame according to the national schedule (as recorded in the individual child's booklet or as self-reported by the mother)	Measured at endline, 24-26 months after baseline
Up to date on malaria vaccine (children under 3 years old in study households)	Record of having taken all doses of malaria vaccine as appropriate for child's age as recorded by the children's booklets (or self-reported by the mother if the booklet is not available)	Measured at endline, 24-26 months after baseline
Up to date on routine vaccines (basic antigens) (Children under 3 years old in study households)	Record of having taken all doses of basic antigens as appropriate for child's age as recorded by the children' s booklets (or self-reported by the mother if the booklet is not available)	Measured at endline, 24-26 months after baseline
Up to date on routine vaccines (full schedule) (Children under 3 years old in study households)	Record of having taken all doses of national vaccine schedule as appropriate for child's age as recorded by the children' s booklets (or self-reported by the mother if the booklet is not available)	Measured at endline, 24-26 months after baseline
Cumulative number of late days in receipt of malaria vaccination (index children)	Among those who received at least a dose of the malaria vaccine, the number of days late the vaccine(s) were relative to what the national schedule considers "on time" for each dose. Late days are equal to zero for those who received the vaccine on time or early.	Measured at endline, 24-26 months after baseline
Cumulative number of late days in receipt of basic antigens (index children)	Among those who received at least one dose of basic antigens, the number of days late the vaccine(s) were relative to what the national schedule considers "on time" for each dose. Late days are equal to zero for those who received the vaccine on time or early.	Measured at endline, 24-26 months after baseline
Cumulative number of late days in receipt of routine vaccines according to national schedule (index children)	Among those who received at least one dose of routine vaccines according to the national schedule, the number of days late the vaccine(s) were relative to what the national schedule considers "on time" for each dose. Late days are equal to zero for those who received the vaccine on time or early.	Measured at endline, 24-26 months after baseline
Mother knows when to bring the child to the clinic for the first vaccination	Mother self-reports being sure or very sure about when to bring the child to the clinic for the first vaccination	Measured at endline, 24-26 months after baseline
Facility Vaccine Data Accuracy	Discrepancy in the total number of children vaccinated based on paper-based records at the facility vs digital records in DHMIS 2. Measured as the vaccine "verification factor" for BCG, Penta 3 and MR-2 over a three month period, comparing the total number of children vaccinated with each of the three vaccines over this period reported in DHIMS 2 with the paper-based record.	Measured around endline, 24-26 months after baseline

Collaborators and Investigators

• Sponsor: University of Michigan
• Collaborators: University of Ghana; Harvard School of Public Health (HSPH)
• Investigators: Principal Investigator: Elisa Maria Maffioli, PhD, University of Michigan; Principal Investigator: Jessica Cohen, PhD, Harvard University; Principal Investigator: Chris Guure, University of Ghana

Study record dates

Study Major Dates

• Study Start (Actual): October 15, 2025
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: November 17, 2025
• First Submitted That Met QC Criteria: December 1, 2025
• First Posted (Estimated): December 3, 2025

Study Record Updates

• Last Update Posted (Estimated): December 3, 2025
• Last Update Submitted That Met QC Criteria: December 1, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Adherence; Malaria; Vaccine; Health Systems; Biometrics
• Additional Relevant MeSH Terms: Vector Borne Diseases; Mosquito-Borne Diseases; Infections; Protozoan Infections; Parasitic Diseases; Malaria
• Other Study ID Numbers: HUM00270320

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No