Comparing the effect of parental reminder SMS and health education on infants’ immunisation coverage, timeliness and parent-reported barriers in borno state, Nigeria

Despite the known benefits of immunisations, several factors such as forgetfulness, lack of knowledge and myths and misconceptions impede parents or caregivers from accessing immunisation services for their children in Nigeria. This study was designed to compare the effect of parental reminder Short Message Services (SMS) and SMS-delivered health education on immunisation coverage, timeliness and parent-reported barriers among infants in Maiduguri, Nigeria. A three-arm quasi-experimental design study was conducted in three randomly selected health facilities using 786 parents of infants. 262 participants were purposively enrolled in each of the study arms based on eligibility criteria. Data on coverage and timeliness were collected at the end of each visit, while data on barriers were collected pre- and post-test. Collected data were analysed with SPSS version 29 using repeated measure logistic regression, Poisson Z test for rate, and Wilcoxon signed ranks test. The result of the study shows that parental reminder SMS significantly improve immunisation coverage (p-value= 0.001; 95% CI [12.2-40.5]); (p-value = 0.001; 95% CI [32.6-56.9]) and (p-value = 0.001; 95% CI [34.2-54.4]) for the 6th, 10th and 14th-week schedule respectively and significantly improved immunisation timeliness across the 6th, 10th and 14th-week schedule (p-value = 0.001, 95% CI [25.9 – 46.7]), (p-value 0.001, 95% CI [24.2 – 43.0]) and (p-value 0.001, 95% CI [21.1 – 36.9]) respectively. On the influence of gender, compared to the mothers, SMS reminders sent to the fathers yielded statistically significant findings (p-value = 0.038, 95% CI [0.016 - 0.579]). On barriers, SMS reminders were shown to significantly (p-value = 0.001) reduce barriers to immunisation. On the other hand, results on the effect of SMS health education, results show SMS delivered health education intervention improved immunisation coverage for the 10th and 14th week (p-value = 0.009; 95% CI [3.4 – 23.3]) and (p-value =0.001, 95% CI [14.2 – 30.9]) and not for the 6th week (p-value = 0.684; 95% CI [-10.2 – 15.5]). On timeliness, intervention shows significant effect (p-value = 0.002, 95% CI [4.7 – 22.0]), (p-value = 0.001, 95% CI [7.4 – 23.1]) and (p-value = 0.001, 95% CI [6.4 – 18.8]) across the schedules. Furthermore, results revealed that when compared to the mothers, involving the fathers led to a statistically significant result on timeliness of immunisation (p-value= 0.014, 95% CI [0.081 - 0.729]). Lastly, intervention also significantly (p-value=0.001) reduced barriers to immunisation. This study affirms the role of mHealth in improving immunisation outcomes in Nigeria and further demonstrates the superiority of reminder SMS over SMS-delivered health education. There is a need for policymakers to design a policy that would mandate the use of a parental reminder system for improved immunisation outcomes in Nigeria.