TY  - JOUR
AU  - Siddiqi, Danya Arif
AU  - Ali, Rozina Feroz
AU  - Shah, Mubarak Taighoon
AU  - Dharma, Vijay Kumar
AU  - Khan, Anokhi Ali
AU  - Roy, Tapash
AU  - Chandir, Subhash
PY  - 2023
DA  - 2023/2/17
TI  - Evaluation of a Mobile-Based Immunization Decision Support System for Scheduling Age-Appropriate Vaccine Schedules for Children Younger Than 2 Years in Pakistan and Bangladesh: Lessons From a Multisite, Mixed Methods Study
JO  - JMIR Pediatr Parent
SP  - e40269
VL  - 6
KW  - missed opportunities for vaccination
KW  - mobile-based immunization decision support system
KW  - catch-up immunizations
AB  - Background: Missed opportunities for vaccination (MOVs), that is, when children interact with the health system but fail to receive age-eligible vaccines, pose a crucial challenge for equitable and universal immunization coverage. Inaccurate interpretations of complex catch-up schedules by health workers contribute to MOVs. Objective: We assessed the feasibility of a mobile-based immunization decision support system (iDSS) to automatically construct age-appropriate vaccination schedules for children and to prevent MOVs. Methods: A sequential exploratory mixed methods study was conducted at 6 immunization centers in Pakistan and Bangladesh. An android-based iDSS that is packaged in the form of an application programming interface constructed age-appropriate immunization schedules for eligible children. The diagnostic accuracy of the iDSS was measured by comparing the schedules constructed by the iDSS with the gold standard of evaluation (World Health Organization–recommended Expanded Programme on Immunization schedule constructed by a vaccines expert). Preliminary estimates were collected on the number of MOVs among visiting children (caused by inaccurate vaccination scheduling by vaccinators) that could be reduced through iDSS by comparing the manual schedules constructed by vaccinators with the gold standard. Finally, the vaccinators’ understanding, perceived usability, and acceptability of the iDSS were determined through interviews with key informants. Results: From July 5, 2019, to April 11, 2020, a total of 6241 immunization visits were recorded from 4613 eligible children. Data were collected for 17,961 immunization doses for all antigens. The iDSS correctly scheduled 99.8% (17,932/17,961) of all age-appropriate immunization doses compared with the gold standard. In comparison, vaccinators correctly scheduled 96.8% (17,378/17,961) of all immunization doses. A total of 3.2% (583/17,961) of all due doses (across antigens) were missed in age-eligible children by the vaccinators across both countries. Vaccinators reported positively on the usefulness of iDSS, as well as the understanding and benefits of the technology. Conclusions: This study demonstrated the feasibility of a mobile-based iDSS to accurately construct age-appropriate vaccination schedules for children aged 0 to 23 months across multicountry and low- and middle-income country settings, and underscores its potential to increase immunization coverage and timeliness by eliminating MOVs. 
SN  - 2561-6722
UR  - https://pediatrics.jmir.org/2023/1/e40269
UR  - https://doi.org/10.2196/40269
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36800221
DO  - 10.2196/40269
ID  - info:doi/10.2196/40269
ER  -