ABSTRACT
INTRODUCTION: Limited evidence is available about the effectiveness of strategies to remind caregivers when to bring children back for future vaccinations in low- and middle-income country settings. We evaluated the effectiveness of two reminder strategies based on home-based vaccination records (HBR) in Indonesia. METHODS: In this cluster-randomized controlled trial involving 3616 children <1â¯year of age, 90 health facilities were randomly assigned to either a control group or one of two intervention groups: (1) HBR-only group, where healthcare workers provided an HBR to any child without an HBR during a vaccination visit and instructed the caregiver to keep it at home between visits, or (2) HBRâ¯+â¯sticker group, where, in addition to HBR provision, healthcare workers placed vaccination appointment reminder stickers on the HBR. The primary outcome was receipt of the third dose of diphtheria-tetanus-pertussis-containing vaccine (DTPcv3) within 7â¯months and the secondary outcome was receipt of a timely DTPcv3 dose. RESULTS: Control group DTPcv3 coverage was 81%. In intention-to-treat analysis, neither intervention group had significantly different DTPcv3 coverage compared with the control group (RRâ¯=â¯0.94, 95% confidence interval [CI] 0.87; 1.02 for HBR-only group; RRâ¯=â¯0.97, 95% CI 0.90; 1.04 for HBRâ¯+â¯sticker group) by study end. However, children in the HBRâ¯+â¯sticker group were 50% more likely to have received a DTPcv3 vaccination (RRâ¯=â¯1.46, 95% CI 1.02, 2.09) within 60â¯days of DTPcv1 vaccination, compared with children in the control group; children in the HBR-only group were not more likely to have done so (RRâ¯=â¯1.05, 95% CI 0.71, 1.55). DISCUSSION: Reminder stickers had an immediate effect on coverage by improving the proportion of children who received a timely DTPcv3 dose but no effect on the proportion who received DTPcv3 after 7â¯months. Coupling reminder stickers with strategies to address other reasons why children do not return for vaccination visits should be further explored.
