Improving the Timeliness of Administering Birth Dose Vaccines Using a Digital Platform in Nairobi Slums: A Stepped Wedge Design

Vaccine-preventable diseases such as tuberculosis and polio still contribute substantially to child mortality in sub-Saharan Africa. One reason for this is delays in administering vaccines at the recommended age. When birth dose vaccines are administered late, young children are at increased risk of infections. Vaccines may be delayed due to fragmented systems of healthcare delivery, poor data recording and communication between maternal health and child health services. Understanding these deficiencies presents opportunities for improving timely vaccinations.

The study assesses an intervention consisting of interaction between community health volunteers (CHVs), pregnant women, and healthcare workers using a digital platform linked to a central registry, implemented sequentially in eight villages of Viwandani, an informal settlement in Nairobi, Kenya (a site for the Nairobi Health and Demographic Surveillance System )

CHVs or healthcare workers will register pregnant women at home or health facility and automatically send tailored text messages from a central server, encouraging timely vaccination uptake. The project will test the feasibility of CHVs or healthcare workers using the platform and the effectiveness (including cost-effectiveness) of the intervention. Women with infants will be interviewed at baseline and at the introduction of the intervention to measure the effect of the intervention on timeliness of birth dose vaccines (BCG for tuberculosis and oral polio vaccine).

The expected findings generated from this study will include the feasibility and effectiveness of using the digital platform for improving timely vaccinations and these will be used to inform the design of a large trial in other settings. In the next phase, we expect to do a larger trial to measure the impact of the intervention on infant survival. The digital platform will be customized based on recommendations from this study to include additional features such as health sensitization videos.