Innovations in Communication Technologies for Measles Supplemental Immunization Activities: Lessons from Kenya Measles Vaccination Campaign, November 2012

"Using mobile phone-based technologies can create platforms for real-time evidence-based innovations in immunizations service communication and service delivery."

This paper documents an effort to eliminate measles in Kenya via an approach of using house visits supported by a web-enabled mobile phone application to create a real-time platform for adaptive management of supplemental measles immunisation days in Kenya. The project was based on the belief that, in order to achieve a measles-free world, "effective communication must be part of all elimination plans. The choice of communication approaches must be evidence based, locally appropriate, interactive and community owned." Meanwhile, "Africa in general and Kenya in particular, has witnessed unprecedented expansion in the numbers and coverage of mobile phones, thus connecting millions of people that previously were unconnected." This trend ushers in new possibilities for disease prevention programmes.

In that context, in November 2012, 1,952 Red Cross volunteers selected from their respective communities were recruited, trained, and deployed to conduct house-to-house canvassing in 11 urban districts of Kenya. Three days before the campaigns, volunteers conducted house visits with a uniform approach and package of messages, including: (i) the rationale of the campaigns, (ii) the intended age group, (iii) location of the nearest vaccination point, (iv) what interventions the children would receive, and (v) expected reactions after the vaccinations. The volunteer would then open up an interpersonal communication session in which the household head/caregiver would seek clarifications or ask questions in the comfort of their compound/home. The dialogue would end with a volunteer seeking the consent of the family to bring the children in for a supplemental measles dose. Basic contacts (mobile phone number), number of children in the target age range, sources of information on the supplemental measles immunisation days, and consent to bring the eligible children for vaccination were captured on a web-enabled mobile phone application (episurveyor©) real-time entry screen installed on the volunteers' mobile phone handset. During the campaigns, volunteers reported daily immunisations to their co-ordinators. Post-campaign house visits were also conducted within 4 days in order to verify immunisation of eligible children, assess information sources, and detect adverse events following immunisation (AEFI).

Fifty-six per cent of the 164,643 households visited said that they had heard about the planned 2012 measles vaccination campaign 1-3 days before start dates. Twenty-five per cent of households were likely to miss the measles supplemental dose if they had not been reassured by the house visit. Pre- and post-campaign reasons for refusal showed that targeted communication reduced misconceptions, fear of injections, and trust in herbal remedies. Daily reporting of immunisations using mobile phones informed changes in service delivery plans for better immunisation coverage. House visits were more remembered (70%) as sources of information, compared with traditional mass awareness channels like megaphones (41%) and radio (37%).

Reflecting on this experience, the researchers connect lessons learned from the Polio Eradication Initiative (PEI): "As Red Cross Volunteers spread information by word-of-mouth and held dialogue sessions on immunization at household level, they also collected data on sources of information, education and awareness. This data would then trigger the shifting of communication strategies from information, education and awareness to wider but yet specific ecological complexities that influence household choices and capacity to choose. This shift in social mobilization was informed by the documented experiences from the Polio Eradication Initiative that emphasizes use of data to guide actions in behaviour change communication."

They conclude that, in high-density settlements, "house-to-house visits are easy and more penetrative compared with traditional media approaches. Using mobile phones to document campaign processes and outputs provides real time evidence for service delivery planning to improve immunization coverage."