Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, USA
Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.
BMJ Glob Health. 2021 Jul;6(7). doi: 10.1136/bmjgh-2021-005035.
Childhood vaccine delivery services in the low- and middle-income countries (LMIC) are struggling to reach every child with lifesaving vaccines. Short message service (SMS) reminders have demonstrated positive impact on a number of attrition-prone healthcare delivery services. We aimed to evaluate the effectiveness of SMS reminders in improving immunisation coverage and timeliness in LMICs.
PubMed, Embase, Scopus, Cochrane CENTRAL, CINAHL, CNKI, PsycINFO and Web of Science including grey literatures and Google Scholar were systematically searched for randomised controlled trials (RCTs) and non-RCTs that evaluated the effect of SMS reminders on childhood immunisation and timeliness in LMICs. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 assessment tool for RCTs and Cochrane Risk of Bias in Non-randomised Studies of Interventions tool for non-RCTs. Meta-analysis was conducted using random-effects models to generate pooled estimates of risk ratio (RR).
18 studies, 13 RCTs and 5 non-RCTs involving 32 712 infants (17 135 in intervention groups and 15 577 in control groups) from 11 LMICs met inclusion criteria. Pooled estimates showed that SMS reminders significantly improved childhood immunisation coverage (RR=1.16; 95% CI: 1.10 to 1.21; I=90.4%). Meta-analysis of 12 included studies involving 25 257 infants showed that SMS reminders significantly improved timely receipt of childhood vaccines (RR=1.21; 95% CI: 1.12 to 1.30; I=87.3%). Subgroup analysis showed that SMS reminders are significantly more effective in raising childhood immunisation coverage in lower middle-income and low-income countries than in upper middle-income countries (p<0.001) and sending more than two SMS reminders significantly improves timely receipt of childhood vaccines than one or two SMS reminders (p=0.040).
Current evidence from LMICs, although with significant heterogeneity, suggests that SMS reminders can contribute to achieving high and timely childhood immunisation coverage.
CRD42021225843.
在中低收入国家（LMIC），儿童疫苗接种服务难以将救生疫苗送到每一个儿童手中。短信息服务（SMS）提醒已被证明对许多易流失的医疗服务具有积极影响。我们旨在评估 SMS 提醒在提高 LMIC 中免疫接种覆盖率和及时性方面的有效性。
我们系统地检索了 PubMed、Embase、Scopus、Cochrane 中心、CINAHL、CNKI、PsycINFO 和 Web of Science，包括灰色文献和 Google Scholar，以评估 SMS 提醒对中低收入国家儿童免疫接种和及时性的影响。使用 Cochrane 偏倚风险评估工具 2.0（RCTs）和 Cochrane 干预非随机研究偏倚风险评估工具（非 RCTs）评估偏倚风险。使用随机效应模型进行荟萃分析，以生成风险比（RR）的汇总估计值。
18 项研究，包括 13 项 RCT 和 5 项非 RCT，涉及 11 个中低收入国家的 32712 名婴儿（干预组 17135 名，对照组 15577 名）符合纳入标准。汇总估计表明，SMS 提醒可显著提高儿童免疫接种覆盖率（RR=1.16；95%置信区间：1.10 至 1.21；I=90.4%）。对 12 项涉及 25257 名婴儿的研究进行的荟萃分析表明，SMS 提醒可显著提高儿童疫苗的及时接种率（RR=1.21；95%置信区间：1.12 至 1.30；I=87.3%）。亚组分析表明，与中高收入国家相比，SMS 提醒在提高中低收入和低收入国家儿童免疫接种覆盖率方面更为有效（p<0.001），发送超过两条 SMS 提醒比发送一两条 SMS 提醒更能提高儿童疫苗的及时接种率（p=0.040）。
来自 LMIC 的现有证据虽然存在很大的异质性，但表明 SMS 提醒有助于实现高且及时的儿童免疫接种覆盖率。
PROSPERO 注册号：CRD42021225843。
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