The feasibility of utilizing district health information system and short message services on decreasing child immunization dropout and increasing vaccination timeliness in Duhok Governorate

Objectives

To develop a customized individual-based electronic immunization registry using the DHIS-2 platform and investigate its effectiveness combined with short message service reminders to decrease the child immunization dropout rate and improve vaccination timeliness in the Duhok Governorate.

Study design

This was a quasi-experimental study.

Methods

The study included a preliminary pilot assessment examining deficiencies and requirements of the current paper-based immunization system, which informed the development of a tailored electronic immunization registry. This registry was implemented in a quasi-experimental study at four randomly selected vaccination units at primary healthcare centers with high dropout rates in Duhok Governorate, targeting 390 children under one year who were vaccinated or eligible to be vaccinated with the PENTA-1 vaccine and followed up for five months to receive successive doses of the PENTA-2 and PENTA-3 vaccines. The children were distributed into two groups: 195 children in the intervention group, whose children's information was entered into the electronic immunization registry and whose parents received vaccination appointment reminders, and 195 children in the control group, whose children received the regular vaccination service, information entered into the paper-based immunization registry, and did not receive vaccination appointment reminders.

Results

The results showed a statistically significant decrease in the PENTA-1 to PENTA-3 dropout rate among children enrolled in the intervention group (5.7 % compared to 29.7 % in the control group, p-value< 0.001).

Conclusion

This study offers compelling evidence that implementing the DHIS-2 platform tracker EIR with SMS reminders is an effective tool for significantly enhancing the child immunization program's outcomes. It also guides the implementation of an individual-based electronic immunization registry using the DHIS-2 tracker module by the national health team. Therefore, we recommend adopting its application to encompass a broader spectrum of vaccines and health facilities nationwide.