Impact positif sur le Programme élargi de vaccinations de l’envoi de SMS de rappel à partir d’un registre informatisé, Bobo-Dioulasso (Burkina Faso)

Résumé

L’impact dans le Programme élargi de vaccination (PEV) d’un registre informatisé de vaccination (RIV), avec l’envoi de SMS aux parents avant les sessions vaccinales, n’a jamais été estimé en Afrique sub-saharienne. Un Centre de santé et de promotion sociale (CSPS) urbain prodiguant le PEV a été tiré au sort (Colma 1, district de Do) à Bobo- Dioulasso (Burkina Faso), puis a été doté d’un RIV. Les mères des enfants ont été randomisées, au premier contact vaccinal, pour recevoir, ou non un SMS de rappel avant chaque session vaccinale fixée par la date de naissance de l’enfant. En fin d’étude, par téléphone, on a voulu savoir pourquoi un enfant, malgré les SMS envoyés, n’avait pas été enregistré comme correctement vacciné dans le RIV. Il existait une différence significative entre l’envoi ou non de SMS et la présence de l’enfant à la deuxième (p<0,001), troisième (p<0,001), et quatrième session PEV (p<0,001). Il existait aussi une relation significative pour la promptitude (rapidité) à venir faire vacciner l’enfant à la deuxième (p=0,03), troisième (p =0,02), mais pas à la quatrième session PEV (p=0,45). Sur les 523 enfants enregistrés dans le RIV, 77 enfants (14,8 %) n’ont pas été retrouvés dans les registres papier PEV de Colma 1. La principale cause de non complétude des vaccinations des enfants dans le RIV était la poursuite des vaccinations au CSPS voisin de Colma 2 (38 % des cas défaillants). L’entretien téléphonique a permis de rattraper 55 % des enfants de Colma 1, en retard pour le PEV malgré les SMS. Un RIV facilite l’envoi de SMS et augmente la complétude et la promptitude vaccinales. Un RIV, consultable par internet, permettrait de mieux connaître l’état vaccinal des enfants admis en urgence dans une structure de santé, et de faire un rattrapage vaccinal. L’abandon des registres papier et la synthèse des données RIV, envoyées aux niveaux supérieurs par internet, sont à recommander pour augmenter la promptitude et l’exactitude des données PEV. Les femmes enceintes, suivies en consultations prénatales et vaccinées par l’anatoxine tétanique, devraient être aussi inclues dans le RIV.

Abstract

The impact of a Computerized Immunization Register (CIR) on Expanded Program on Immunization (EPI), with sending SMS to parents before immunization sessions, has never been studied in sub-Saharan Africa. The objective of this study is to measure EPI quickness and completeness of vaccinations after sending call-back SMS to parents through CIR put in place in a health center. In a health center, chosen at random (Colma 1) in the city of Bobo Dioulasso, Burkina Faso, West Africa, mothers, at first EPI session, if they had a mobile phone available at hand or in her surrounding, were randomized for receiving, or not, a call-back SMS before following EPI sessions, after child registration on a Francophone CIR (Siloxane’s Intervax ©). Mothers, which were sent SMS and did not correctly followed sessions were asked through mobile phone why their child was late for EPI. 523 newborns were included in the study, with 253 whose parents were sent SMS, and 268 being informed of sessions only by ordinary methods. At second EPI session at 2 months of age, there was a statistical significant increase of coverage for children whose parents received SMS (p<0.001). Quickness to come also to this session was significantly shorter when parents received SMS (p=0.03). At third EPI session at 3 months of age, attendance to EPI for children whose parents were sent SMS was significantly better (p<0.001). Quickness to come to this session was shorter for children with SMS (p=0.02). At fourth EPI session at 4 months of age, attendance for children with SMS was significantly better for children whose parents were sent SMS (p<0.001). Quickness to come to this session was better but not significantly different (p=0.49). Out of 101 children registered as late for EPI sessions in Colma 1 CIR, even with call-back SMS, 19 (19%) parents could not be reached on the telephone. 31/82 (38%) mothers had shifted for EPI to a more proximate vaccination center (Colma 2), and 5 (6%) to private or civil servants clinic. 14/82 (17%) mothers had been travelling far from health center. Ten (12%) admitted neglect of EPI sessions. Two (2%) children had deceased, and one mother did not come back to Colma 1 after her child’s AEFI. One child has been dismissed two times of vaccination following recommendation not to open a measles multi-dose vial for a single child, and did not come back. Of 523 children registered in CIR, 77 (14.7%) could not be found in the paper registers of Colma 1. Quickness and completeness for EPI is increased by sending SMS with help of CIR. An official number should be given for each child registered in CIR, consulted by health staff admitting children in urgency, allowing EPI vaccinations completion. With CIR safeguards, CIR should replace paper registers and should be used to send EPI reports by internet at central levels, helping MOH coverage determination and MAPI surveillance. The fall of coverage due to restriction policy not to open a multidose vial for a single child is low. Health staff should institute telephone call-back for badly immunized children registered on CIR and incorporate in it, with SMS call-back, pregnant women, to better complete prenatal sessions and tetanus vaccination.