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Improving immunisation coverage in rural India: clustered randomised controlled evaluation of immunisation campaigns with and without incentives.

Banerjee AV, Duflo E, Glennerster R, Kothari D - BMJ (2010)

Bottom Line: Proportion of children aged 1-3 at the end point who were partially or fully immunised.Children in areas neighbouring intervention B villages were also more likely to be fully immunised than those from areas neighbouring intervention A villages (1.9, 1.1 to 2.8).IRSCTN87759937.

View Article: PubMed Central - PubMed

Affiliation: Department of Economics, Massachusetts Institute of Technology, 50 Memorial Drive, E52-391, Cambridge, MA 02142, USA.

ABSTRACT

Objective: To assess the efficacy of modest non-financial incentives on immunisation rates in children aged 1-3 and to compare it with the effect of only improving the reliability of the supply of services.

Design: Clustered randomised controlled study.

Setting: Rural Rajasthan, India.

Participants: 1640 children aged 1-3 at end point.

Interventions: 134 villages were randomised to one of three groups: a once monthly reliable immunisation camp (intervention A; 379 children from 30 villages); a once monthly reliable immunisation camp with small incentives (raw lentils and metal plates for completed immunisation; intervention B; 382 children from 30 villages), or control (no intervention, 860 children in 74 villages). Surveys were undertaken in randomly selected households at baseline and about 18 months after the interventions started (end point).

Main outcome measures: Proportion of children aged 1-3 at the end point who were partially or fully immunised.

Results: Among children aged 1-3 in the end point survey, rates of full immunisation were 39% (148/382, 95% confidence interval 30% to 47%) for intervention B villages (reliable immunisation with incentives), 18% (68/379, 11% to 23%) for intervention A villages (reliable immunisation without incentives), and 6% (50/860, 3% to 9%) for control villages. The relative risk of complete immunisation for intervention B versus control was 6.7 (4.5 to 8.8) and for intervention B versus intervention A was 2.2 (1.5 to 2.8). Children in areas neighbouring intervention B villages were also more likely to be fully immunised than those from areas neighbouring intervention A villages (1.9, 1.1 to 2.8). The average cost per immunisation was $28 (1102 rupees, about pound16 or euro19) in intervention A and $56 (2202 rupees) in intervention B.

Conclusions: Improving reliability of services improves immunisation rates, but the effect remains modest. Small incentives have large positive impacts on the uptake of immunisation services in resource poor areas and are more cost effective than purely improving supply.

Trial registration: IRSCTN87759937.

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Fig 3 Number of immunisations received by children aged 1-3 years
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fig3: Fig 3 Number of immunisations received by children aged 1-3 years

Mentions: The difference between intervention B and intervention A was more marked for full immunisation than for the number of immunisations received and disappeared for the probability of receiving at least one injection. Specifically, 78% (70% to 85%) of children in intervention A villages received at least one injection compared with 74% (67% to 82%) of children in intervention B villages. Similarly, 50% (41% to 59%) of children in intervention A villages and 50% (41% to 59%) of children in intervention B villages had a BCG scar (v 28% (21% to 36%) in control villages) (fig 3), showing that the impact of the incentive was mainly to reduce the number of children dropping out after three injections. Over half (52%, 43% to 62%) of children who were reported as receiving at least one injection in intervention B villages were completely immunised compared with 23% (15% to 32%) in intervention A.


Improving immunisation coverage in rural India: clustered randomised controlled evaluation of immunisation campaigns with and without incentives.

Banerjee AV, Duflo E, Glennerster R, Kothari D - BMJ (2010)

Fig 3 Number of immunisations received by children aged 1-3 years
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2871989&req=5

fig3: Fig 3 Number of immunisations received by children aged 1-3 years
Mentions: The difference between intervention B and intervention A was more marked for full immunisation than for the number of immunisations received and disappeared for the probability of receiving at least one injection. Specifically, 78% (70% to 85%) of children in intervention A villages received at least one injection compared with 74% (67% to 82%) of children in intervention B villages. Similarly, 50% (41% to 59%) of children in intervention A villages and 50% (41% to 59%) of children in intervention B villages had a BCG scar (v 28% (21% to 36%) in control villages) (fig 3), showing that the impact of the incentive was mainly to reduce the number of children dropping out after three injections. Over half (52%, 43% to 62%) of children who were reported as receiving at least one injection in intervention B villages were completely immunised compared with 23% (15% to 32%) in intervention A.

Bottom Line: Proportion of children aged 1-3 at the end point who were partially or fully immunised.Children in areas neighbouring intervention B villages were also more likely to be fully immunised than those from areas neighbouring intervention A villages (1.9, 1.1 to 2.8).IRSCTN87759937.

View Article: PubMed Central - PubMed

Affiliation: Department of Economics, Massachusetts Institute of Technology, 50 Memorial Drive, E52-391, Cambridge, MA 02142, USA.

ABSTRACT

Objective: To assess the efficacy of modest non-financial incentives on immunisation rates in children aged 1-3 and to compare it with the effect of only improving the reliability of the supply of services.

Design: Clustered randomised controlled study.

Setting: Rural Rajasthan, India.

Participants: 1640 children aged 1-3 at end point.

Interventions: 134 villages were randomised to one of three groups: a once monthly reliable immunisation camp (intervention A; 379 children from 30 villages); a once monthly reliable immunisation camp with small incentives (raw lentils and metal plates for completed immunisation; intervention B; 382 children from 30 villages), or control (no intervention, 860 children in 74 villages). Surveys were undertaken in randomly selected households at baseline and about 18 months after the interventions started (end point).

Main outcome measures: Proportion of children aged 1-3 at the end point who were partially or fully immunised.

Results: Among children aged 1-3 in the end point survey, rates of full immunisation were 39% (148/382, 95% confidence interval 30% to 47%) for intervention B villages (reliable immunisation with incentives), 18% (68/379, 11% to 23%) for intervention A villages (reliable immunisation without incentives), and 6% (50/860, 3% to 9%) for control villages. The relative risk of complete immunisation for intervention B versus control was 6.7 (4.5 to 8.8) and for intervention B versus intervention A was 2.2 (1.5 to 2.8). Children in areas neighbouring intervention B villages were also more likely to be fully immunised than those from areas neighbouring intervention A villages (1.9, 1.1 to 2.8). The average cost per immunisation was $28 (1102 rupees, about pound16 or euro19) in intervention A and $56 (2202 rupees) in intervention B.

Conclusions: Improving reliability of services improves immunisation rates, but the effect remains modest. Small incentives have large positive impacts on the uptake of immunisation services in resource poor areas and are more cost effective than purely improving supply.

Trial registration: IRSCTN87759937.

Show MeSH