Abstract:
The World Health Organization estimates that 29% of under-five mortality could be prevented with
existing vaccines. However, non-consistent attendance for immunization appointments remains a global challenge
to healthcare providers. Thus, innovative strategies are required to reach the last mile where technology could be
effectively utilized to achieve better compliance with children immunization schedules. Therefore, the aim of the
review was to systematically collect and summarize the available evidence on the effectiveness of text message
reminders on childhood vaccination.
Methods: This review was conducted according to a priori published protocol on PROSPERO. A systematic literature
search of databases (PubMed/MEDLINE, EMBASE, Cochrane/Wiley library, and Science direct) was conducted. Eligibility
and risk of bias assessments were performed independently by two reviewers. PRISMA flow diagrams were used to
summarize the study selection process. Taking into account the level of heterogeneity, a random effects model was
used and risk ratios with their 95% CI were used to present the pooled estimates. To investigate the sources of
heterogeneity, subgroup analysis and meta-regression analysis were also considered. In this review, publication bias
was assessed statistically using Harbord test.
Results: A total of 1771 articles were searched. Out of those 1771 articles, 558 duplicated articles were removed. About
1213 articles were further screened, and finally, ten articles met the inclusion criteria. The meta-analysis showed that
there is a significant effect of text message reminders on childhood vaccination coverage (RR = 1.11; 95% CI 1.05–1.17)
with a moderate level of heterogeneity (I2 = 64.3%, P = 0.003). The results from the Harbord test suggested that there is
no evidence for publication bias (P = 0.340).
Conclusion: This review highlights the potential benefits of incorporating mobile text message reminders into the
standard management of childhood immunizations, especially in low- and middle-income countries. The frequency
and timing of the text message reminders are also crucial in determining the effectiveness of text message reminders.
Hence, mHealth interventions deserve more attention as a potential innovation to improve healthcare programs.
Systematic review registration: PROSPERO CRD42017074230
