Does exposure to health information through mobile phones increase immunisation knowledge, completeness and timeliness in rural India?

Arpita Chakraborty, Diwakar Mohan, Kerry Scott, Agrima Sahore, Neha Shah, Nayan Kumar, Osama Ummer, Jean Juste Harrisson Bashingwa, Sara Chamberlain, Priyanka Dutt, Anna Godfrey, Amnesty Elizabeth LeFevre, Kilkari Impact Evaluation Team, Smisha Agarwal, Salil Arora, Jean Jh Bashingwa, Aarushi Bhatanagar, Sara Chamberlain, Rakesh Chandra, Arpita Chakraborty, Neha Dumke, Priyanka Dutt, Anna Godfrey, Suresh Gopalakrishnan, Nayan Kumar, Simone Honikman, Alain Labrique, Amnesty LeFevre, Jai Mendiratta, Molly Miller, Radharani Mitra, Diwakar Mohan, Deshen Moodley, Nicola Mulder, Angela Ng, Dilip Parida, Nehru Penugonda, Sai Rahul, Shiv Rajput, Neha Shah, Kerry Scott, Aashaka Shinde, Aaditya Singh, Nicki Tiffin, Osama Ummer, Rajani Ved, Falyn Weiss, Sonia Whitehead, Arpita Chakraborty, Diwakar Mohan, Kerry Scott, Agrima Sahore, Neha Shah, Nayan Kumar, Osama Ummer, Jean Juste Harrisson Bashingwa, Sara Chamberlain, Priyanka Dutt, Anna Godfrey, Amnesty Elizabeth LeFevre, Kilkari Impact Evaluation Team, Smisha Agarwal, Salil Arora, Jean Jh Bashingwa, Aarushi Bhatanagar, Sara Chamberlain, Rakesh Chandra, Arpita Chakraborty, Neha Dumke, Priyanka Dutt, Anna Godfrey, Suresh Gopalakrishnan, Nayan Kumar, Simone Honikman, Alain Labrique, Amnesty LeFevre, Jai Mendiratta, Molly Miller, Radharani Mitra, Diwakar Mohan, Deshen Moodley, Nicola Mulder, Angela Ng, Dilip Parida, Nehru Penugonda, Sai Rahul, Shiv Rajput, Neha Shah, Kerry Scott, Aashaka Shinde, Aaditya Singh, Nicki Tiffin, Osama Ummer, Rajani Ved, Falyn Weiss, Sonia Whitehead

Abstract

Introduction: Immunisation plays a vital role in reducing child mortality and morbidity against preventable diseases. As part of a randomised controlled trial in rural Madhya Pradesh, India to assess the impact of Kilkari, a maternal messaging programme, we explored determinants of parental immunisation knowledge and immunisation practice (completeness and timeliness) for children 0-12 months of age from four districts in Madhya Pradesh.

Methods: Data were drawn from a cross-sectional survey of women (n=4423) with access to a mobile phone and their spouses (n=3781). Parental knowledge about immunisation and their child's receipt of vaccines, including timeliness and completeness, was assessed using self-reports and vaccination cards. Ordered logistic regressions were used to analyse the factors associated with parental immunisation knowledge. A Heckman two-stage probit model was used to analyse completeness and timeliness of immunisation after correcting for selection bias from being able to produce the immunisation card.

Results: One-third (33%) of women and men knew the timing for the start of vaccinations, diseases linked to immunisations and the benefits of Vitamin-A. Less than half of children had received the basic package of 8 vaccines (47%) and the comprehensive package of 19 vaccines (44%). Wealth was the most significant determinant of men's knowledge and of the child receiving complete and timely immunisation for both basic and comprehensive packages. Exposure to Kilkari content on immunisation was significantly associated with an increase in men's knowledge (but not women's) about child immunisation (OR: 1.23, 95% CI 1.02 to1.48) and an increase in the timeliness of the child receiving vaccination at birth (Probit coefficient: 0.08, 95% CI 0.08 to 0.24).

Conclusion: Gaps in complete and timely immunisation for infants persist in rural India. Mobile messaging programmes, supported by mass media messages, may provide one important source for bolstering awareness, uptake and timeliness of immunisation services.

Trial registration number: NCT03576157.

Keywords: child health; cross-sectional survey; health policy; immunisation.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Exposure to Kilkari immunisation messages among subscribers surveyed during postpartum data collection who were randomised to receive Kilkari calls in four districts of MP from 2018 to 2020.

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