Skip to main content

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

Download Article:

You have access to the full text article on a website external to Ingenta Connect.

Please click here to view this article on Wiley Online Library.

You may be required to register and activate access on Wiley Online Library before you can obtain the full text. If you have any queries please visit Wiley Online Library

Abstract:

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.

Language: English

Document Type: Research Article

DOI: https://doi.org/10.1111/j.1365-3156.2010.02698.x

Affiliations: 1:  Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA 2:  Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, TX, USA 3:  Vanderbilt University School of Medicine, Nashville, TN, USA 4:  Community and Family Health, University of South Florida, FL, USA 5:  Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan

Publication date: 2011-03-01

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
X
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more