Department of Economics, Massachusetts Institute of Technology, 50 Memorial Drive, E52-391, Cambridge, MA 02142, USA.
BMJ. 2010 May 17;340:c2220. doi: 10.1136/bmj.c2220.
To assess the efficacy of modest non-financial incentives on immunisation rates in children aged 1-3 and to compare it with the effect of only improving the reliability of the supply of services.
Clustered randomised controlled study.
Rural Rajasthan, India.
1640 children aged 1-3 at end point.
134 villages were randomised to one of three groups: a once monthly reliable immunisation camp (intervention A; 379 children from 30 villages); a once monthly reliable immunisation camp with small incentives (raw lentils and metal plates for completed immunisation; intervention B; 382 children from 30 villages), or control (no intervention, 860 children in 74 villages). Surveys were undertaken in randomly selected households at baseline and about 18 months after the interventions started (end point).
Proportion of children aged 1-3 at the end point who were partially or fully immunised.
Among children aged 1-3 in the end point survey, rates of full immunisation were 39% (148/382, 95% confidence interval 30% to 47%) for intervention B villages (reliable immunisation with incentives), 18% (68/379, 11% to 23%) for intervention A villages (reliable immunisation without incentives), and 6% (50/860, 3% to 9%) for control villages. The relative risk of complete immunisation for intervention B versus control was 6.7 (4.5 to 8.8) and for intervention B versus intervention A was 2.2 (1.5 to 2.8). Children in areas neighbouring intervention B villages were also more likely to be fully immunised than those from areas neighbouring intervention A villages (1.9, 1.1 to 2.8). The average cost per immunisation was $56 (2202 rupees) in intervention A and $28 (1102 rupees, about pound16 or euro19) in intervention B.
Improving reliability of services improves immunisation rates, but the effect remains modest. Small incentives have large positive impacts on the uptake of immunisation services in resource poor areas and are more cost effective than purely improving supply.
IRSCTN87759937.
评估适度非财务激励对 1-3 岁儿童免疫率的效果，并将其与仅提高服务供应可靠性的效果进行比较。
集群随机对照研究。
印度拉贾斯坦邦农村。
1640 名 1-3 岁终点儿童。
134 个村庄被随机分为三组：每月一次可靠的免疫营地（干预 A；来自 30 个村庄的 379 名儿童）；每月一次可靠的免疫营地，辅以小奖励（用于完成免疫的生 lentils 和金属板；干预 B；来自 30 个村庄的 382 名儿童），或对照组（无干预，74 个村庄的 860 名儿童）。在基线和干预开始后约 18 个月（终点），在随机选择的家庭中进行调查。
终点调查中 1-3 岁儿童部分或完全免疫的比例。
在终点调查中，1-3 岁儿童完全免疫率为 39%（148/382，95%置信区间 30%至 47%），干预 B 组（有激励的可靠免疫）为 18%（68/379，11%至 23%），干预 A 组（无激励的可靠免疫）为 6%（50/860，3%至 9%）。与对照组相比，干预 B 组完全免疫的相对风险为 6.7（4.5 至 8.8），干预 B 组与干预 A 组相比为 2.2（1.5 至 2.8）。与来自干预 A 组所在地区的儿童相比，来自干预 B 组所在地区的儿童更有可能完全免疫（1.9，1.1 至 2.8）。
提高服务可靠性可提高免疫率，但效果仍然有限。在资源匮乏地区，小奖励对疫苗接种服务的利用率有很大的积极影响，而且比单纯提高供应更具成本效益。
IRSNCTN87759937。
