Providing mothers with information on vaccination against tetanus with diphtheria pertussis tetanus immunization, regardless of whether the stressed outcome was negative or positive, is a cost-effective way to significantly increase vaccination rates in rural India.
“An estimated 5.9 million children die each year globally, of which 1.2 million are in India,” Timothy Powell-Jackson, MSc, PhD, from the department of global health and development at the London School of Hygiene, London, and colleagues wrote. “The majority of these deaths are preventable with existing low-cost health technologies, such as improved water and sanitation, zinc supplementation, oral rehydration solutions and vaccines.”
“Despite well-documented evidence on the health and developmental benefits of immunization, a huge number of children fail to get vaccinated,” the researchers continued. “In Uttar Pradesh, a state of more than 200 million people and the setting for this study, only 51% of children aged 12 to 23 months are fully vaccinated.”
To examine the result of a short-term intervention that provided face-to-face education on diphtheria pertussis tetanus (DPT) vaccination to mothers, the researchers conducted an individually randomized controlled trial. The targeted population included mothers of children who were unvaccinated or incompletely vaccinated.
Three cohorts were randomized, and all had information regarding vaccination presented as a benefit (child would be less likely to get tetanus and would be healthier), a loss (child would be more likely to get tetanus without vaccination and would be unhealthy) or no information (control group). The researchers administered surveys at baseline in September 2015 and at follow-up after the intervention was completed in April 2016 to determine how many children received three doses of DTP (DTP3) after 7 months of follow-up.
Of the 722 mothers who participated in the study, 2.2% were lost to follow-up. When comparing the control and intervention groups, 28% of the control group received DTP3 and 43% received the immunizations in the pooled information groups (risk difference, 15 percentage points; 95% CI, 7%-22%). The RR for receiving immunizations was 1.52 (95% CI, 1.2-1.9).
When information was provided to mothers, measles vaccination rates increased by 22 percentage points (risk difference, 22%; 95% CI, 14%-30%; RR, 1.53, 95% CI, 1.29-1.80). Additionally, full immunization increased by 14 percentage points (risk difference, 14%; 95% CI, 8%-21%; RR, 1.72; 95% CI, 1.29-2.29).
According to the researchers, the educational intervention amplified maternal knowledge of causes, symptoms and the prevention of tetanus; however, this education did not affect opinion of vaccine efficacy. The positive effects of the intervention occurred regardless of whether the information had a positive or negative angle (risk difference, 4%; 95% CI, –5% to 13%; RR,1.11; 95% CI, 0.90-1.36).
Powell-Jackson and colleagues also observed that providing an educational intervention was a highly cost-effective method of increasing vaccination when compared with the WHO-suggested threshold of once the gross domestic product per capita, with the cost per disability-adjusted life year averted totaling $186 U.S.
“The large effect on measles vaccination was not anticipated, given that the information intervention focused solely on tetanus,” Powell-Jackson and colleagues wrote. “We speculate that the increase in measles vaccination was generated by increased engagement with the public health system and, in turn, health workers ensuring children were up to date on all their vaccines, not just DTP3.” – by Katherine Bortz
Disclosures: Powell-Jackson reports receiving a research grant from Merck through its Merck for Mothers program. Please see the study for all other authors’ relevant financial disclosures.