Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization: Field-Based Randomized Controlled Trial.

Countries' Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries. We aim to assess whether involving community volunteers (CVs) to track children's vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children's vaccination timeliness, completeness, and coverage. This was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness. Overall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5%) and 718 (98.4%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6%) and 636 (97.7%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette-Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi +Hb) dose 3 (aOR 2.0, 95% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group. Findings support that involving CVs to track children's vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children's vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts. Pan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548.

Ateudjieu J ，Tchio-Nighie KH ，Goura AP ，Ndinakie MY ，Dieffi Tchifou M ，Amada L ，Tsafack M ，Kiadjieu Dieumo FF ，Guenou E ，Nangue C ，Kenfack B ... -  《JMIR Public Health and Surveillance》

Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization (TDM-IAI): Protocol for a Field-Based Randomized Controlled Trial.

In Cameroon, the coverage, completeness, and timeliness of the Expanded Programme on Immunization (EPI) vaccines administration in children have remained heterogeneous and below the national and districts targets in several districts. In an effort to solve this problem, many interventions have been tested but none has shown significant improvement of the situation. This trial aims to test whether involving Community Volunteers to assess children vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children vaccination timeliness, completeness and coverage. Communities of the Foumban Health district, West region of Cameroon will be selected and assigned to either intervention or control groups using a restricted randomization of 2. In the intervention group, one Community Volunteer per community will be trained to visit households and record EPI-targeted children in a register, record their demographic movements, and assess their immunization status monthly for a year. The information recorded will be snapped and sent to the competent health center immunization team through WhatsApp. These will be used to plan and implement monthly community catch up immunization sessions in collaboration with the community volunteer. In the control group, the routine immunization sessions will be conducted with health centers organizing either weekly vaccination sessions for communities situated not farther than 5 kilometers away from the health facility or monthly vaccination sessions in communities situated more than 5 kilometers away from the health center. Baseline, mid-term and end-line surveys will be conducted to assess and compare immunization coverage, timeliness, and completeness. Funded in 2018, data collection started in 2018 and has been completed. Data analysis and reporting are ongoing. This trial is expecting to test an innovative approach to improving children's immunization timeliness, completeness and coverage of immunization by tracking EPI targeted population vaccination status and denominator at household level and building collaboration between the community and health facilities vaccination teams to organize monthly community-based response vaccination sessions. This intervention is expected to improve children sustainable access to EPI vaccination as it offers assessing and responding to their immunization needs at monthly basis using low cost local human resources. Pan African Clinical Trials Registry ID PACTR201808527428720; tinyurl.com/u058qnse. DERR1-10.2196/21734.

Ateudjieu J ，Yakum NM ，Goura AP ，Guenou E ，Beyala LB ，Amada L ，Ngoche I ，Kiadjieu FF ，Nangue C ，Djosseu EBS ，Kenfack B ... -  《JMIR Research Protocols》

EPI immunization coverage, timeliness and dropout rate among children in a West Cameroon health district: a cross sectional study.

Ateudjieu J ，Yakum MN ，Goura AP ，Tembei AM ，Ingrid DK ，Bita'a Landry B ，Kenfack B ，Amada L ，Tadzong I ，Bissek AC ... -  《BMC PUBLIC HEALTH》

Factors affecting immunization coverage levels in a district of India.

Balraj V ，Mukundan S ，Samuel R ，John TJ ... -  《INTERNATIONAL JOURNAL OF EPIDEMIOLOGY》

The Mobile Solutions for Immunization (M-SIMU) Trial: A Protocol for a Cluster Randomized Controlled Trial That Assesses the Impact of Mobile Phone Delivered Reminders and Travel Subsidies to Improve Childhood Immunization Coverage Rates and Timeliness in

Gibson DG ，Kagucia EW ，Ochieng B ，Hariharan N ，Obor D ，Moulton LH ，Winch PJ ，Levine OS ，Odhiambo F ，O'Brien KL ，Feikin DR ... -  《JMIR Research Protocols》