CSU 97/2011: IMMUNIZATION ADHERENCE IN RURAL PAKISTAN

Thursday, 17th of March 2011

From the summary:

Results  We enrolled 378 mother–child pairs in redesigned card group, 376 in centre-based education group, 374 in combined intervention group and 378 in standard care group. By the end of follow-up, 39% of children in standard care group completed DTP3. Compared to this, a significantly higher proportion of children completed DTP3 in redesigned card group (66%) (crude risk ratio [RR] = 1.7; 95% CI = 1.5, 2.0), centre-based education group (61%) (RR = 1.5; 95% CI = 1.3, 1.8) and combined intervention group (67%) (RR = 1.7; 95% CI = 1.4, 2.0).

Conclusions  Improved immunization card alone, education to mothers alone, or both together were all effective in increasing follow-up immunization visits. The study underscores the potential of study interventions’ public health impact and necessitates their evaluation for complete EPI schedule at a large scale in the EPI system.

Full text is at   http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2010.02698.x/abstract

Randomized controlled trial to improve childhood immunization adherence in rural Pakistan: redesigned immunization card and maternal education

1.     Hussain R. Usman¹, Mohammad H. Rahbar², Sibylle Kristensen¹, Sten H. Vermund³, Russell S. Kirby⁴,  Faiza Habib⁵,

2.     Eric Chamot¹

Tropical Medicine & International Health

Volume 16, Issue 3, pages 334–342, March 2011

Additional Information(Show All)

How to CiteAuthor InformationPublication History

How to Cite

Usman, H. R., Rahbar, M. H., Kristensen, S., Vermund, S. H., Kirby, R. S., Habib, F. and Chamot, E. (2011), Randomized controlled trial to improve childhood immunization adherence in rural Pakistan: redesigned immunization card and maternal education. Tropical Medicine & International Health, 16: 334–342. doi: 10.1111/j.1365-3156.2010.02698.x

Author Information

1.        ¹  Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

2.        ²  Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, TX, USA

3.        ³  Vanderbilt University School of Medicine, Nashville, TN, USA

4.        ⁴  Community and Family Health, University of South Florida, FL, USA

5.        ⁵  Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan

*Correspondence: Corresponding Author Hussain Raza Usman, Department of Epidemiology, University of Alabama at Birmingham, RPHB 430, 1530 3RD AVE S, Birmingham, AL 35294-0022, USA. Tel.: +1 205 975 7694; Fax: +1 205 934 8665; E-mail hussain@uab.edu

Summary

Objective  A substantial dropout from the first dose of diphtheria-tetanus-pertussis (DTP1) to the 3rd dose of DTP (DTP3) immunization has been recorded in Pakistan. We conducted a randomized controlled trial to assess the effects of providing a substantially redesigned immunization card, centre-based education, or both interventions together on DTP3 completion at six rural expanded programme on immunization (EPI) centres in Pakistan.

Methods  Mother-child pairs were enrolled at DTP1 and randomized to four study groups: redesigned card, centre-based education, combined intervention and standard care. Each child was followed up for 90 days to record the dates of DTP2 and DTP3 visits. The study outcome was DTP3 completion by the end of follow-up period in each study group.

Results  We enrolled 378 mother–child pairs in redesigned card group, 376 in centre-based education group, 374 in combined intervention group and 378 in standard care group. By the end of follow-up, 39% of children in standard care group completed DTP3. Compared to this, a significantly higher proportion of children completed DTP3 in redesigned card group (66%) (crude risk ratio [RR] = 1.7; 95% CI = 1.5, 2.0), centre-based education group (61%) (RR = 1.5; 95% CI = 1.3, 1.8) and combined intervention group (67%) (RR = 1.7; 95% CI = 1.4, 2.0).

Conclusions  Improved immunization card alone, education to mothers alone, or both together were all effective in increasing follow-up immunization visits. The study underscores the potential of study interventions’ public health impact and necessitates their evaluation for complete EPI schedule at a large scale in the EPI system.

Objectif:  Evaluer les effets d’une carte de vaccination profondément redessinée, l’éducation centrée ou les deux interventions ensemble sur la complétion du DTC3 dans six centres ruraux du Programme Elargi de Vaccination (PEV) au Pakistan.

Méthodes:  Essai randomisé contrôlé des unités maternelles-infantiles inscrites au DTC1 et randomisées en quatre groupes d’étude: carte redessinée, éducation centrée, intervention combinée et soins standards. Chaque enfant a été suivi pendant 90 jours pour enregistrer les dates de visites pour le DTC2 et le DTC3. L’objectif de l’étude était la complétion du DTC3 avant la fin de la période de suivi dans chaque groupe d’étude.

Résultats:  Nous avons recruté 378 unités maternelles-infantiles dans le groupe de la carte redessinée, 376 dans le groupe d’éducation centrée, 374 dans le groupe d’intervention combinée et 378 dans le groupe des soins standard. A la fin du suivi, 39% des enfants du groupe de soins standard avaient complété le DTC3. En comparaison, une proportion plus significative d’enfants ont complété le DTC3 dans le groupe de la carte redessinée (66%) (rapport de risque [RR] brut = 1,7; IC95%: 1,5–2,0), dans le groupe de l’éducation centrée (61%) (RR = 1,5; IC95%: 1,3–1,8) et dans le groupe d’intervention combinée (67%) (RR = 1,7; IC95%: 1,4–2,0).

Conclusions:  La seule amélioration de la carte de vaccination, la seule éducation des mères ou les deux ensembles étaient aussi efficaces pour augmenter les visites de vaccination durant le suivi. L’étude souligne l’impact potentiel sur la santé publique des études interventions et la nécessité de leur évaluation pour le schéma complet du PEV à grande échelle dans le système PEV.

Objetivo:  Evaluar los efectos de entregar un carnet de vacunación sustancialmente rediseñado, proveer educación materna o ambas intervenciones sobre el completar DTP3, en seis centros rurales del Programa Ampliado de Inmunizaciones (PAI) de Paquistán.

Métodos:  Ensayo aleatorizado y controlado, con unidades madre-hijo, incluidas en el momento de recibir DTP1 y aleatorizadas a uno de los cuatro grupos: carnet rediseñado, educación materna, intervención combinada y cuidados estándar. Cada niño fue seguido durante 90 días para tomar nota de las fechas de las visitas de DTP2 y DTP3. El principal resultado del estudio era el haber recibido la DTP3 al final del periodo de seguimiento en cada grupo de estudio.

Resultados:  Se incluyeron 378 unidades madre-hijo en el grupo del carnet de vacunación rediseñado, 376 en el grupo de educación materna, 374 en el grupo de intervención combinada y 378 en el grupo de cuidados estándar. Al final del periodo de seguimiento, un 39% de los niños en el grupo de cuidados estándar habían completado la DTP3. En comparación, una proporción significativamente mayor de niños completó la DTP3 en el grupo con el carnet de vacunación rediseñado (66%) (análisis crudo de razón de riesgos [RR] = 1.7; 95% IC = 1.5, 2.0), grupo de educación materna (61%) (RR = 1.5; 95% CI = 1.3, 1.8), y grupo de intervención combinada (67%) (RR = 1.7; 95% IC = 1.4, 2.0).

Conclusiones:  La mejora del carnet de vacunación, la educación maternal o ambas intervenciones juntas fueron todas efectivas a la hora de aumentar las visitas de seguimiento de la inmunización. El estudio subestima el potencial impacto sobre la salud pública de los estudios de intervención, y requiere de su evaluación con el calendario completo del PA,I a gran escala, dentro del sistema de PAI.

View Full Article (HTML) Get PDF (109K)