2011 Grant Recipient 
Kenya
PhD, Department of International Health, JHSPH
Conduct a pilot study of 100 mothers in rural western Kenya to work through the logistical and operational hurdles to using mobile phone based strategies to improve immunization. This will include sending SMS reminders to mothers when it is time to vaccinate their children and paying mothers who bring in their children for vaccination using airtime (or MPESA, a mobile money transfer system widespread in Kenya.) The amount will be approximately equivalent to the opportunity cost of transportation. This pilot will take place in the CDC demographic surveillance system area in rural Rarieda (Asembo) and Siaya Districts (Gem, Karemo) of western Kenya. Success of the pilot study will lead into a randomized controlled trial of this strategy to improve coverage and timeliness of vaccination in rural Western Kenya and Northern Nigeria. Personal Narrative:
I was excited to travel to Kenya as it was my first trip to Africa. I was based in Kisumu town which is the 3rd largest city in Kenya located in the shores of Lake Victoria. Finding accommodation could be hard but the expatriate community living there was well connected and very helpful. I worked at CDC field station and was surprised to find out that, as compared to South Asia, most of the field management staff had a Bachelors degree. I was initially worried that IT aspect of our project may require assistance from international collaborators however after meeting with IT team I realized their skills were better than I had expected. All they needed was a direction and they surprised me with their hard work and results. Another thing that changed my perspective was the infiltration of mobile technology deep into remote areas of country. Cellular phone services were introduced in 1993 in the country, since then it has expanded a lot. You may not find a grocery store in a small village, but you will certainly see a small cabin stall providing mobile phone services like money transfer and much more. As expected the internet connection was frequently interrupted while the speed was only 20-50 Kbps which is sometimes troublesome. The frustrating experience was sharing the office vehicle with other teams from office as punctuality was not a norm which leaves you waiting on street for quite some time. Other than these, it was a pleasant experience. The people were very friendly and since English language was common, communication was never a problem. It was good to mingle with local people and learn their social norms and off course meeting aboriginal Masai people was a unique experience. The Expanded Program on Immunization (EPI) provides wide?access to vaccines in developing countries, but low vaccine uptake and delayed immunizations make infants and children more vulnerable to vaccine preventable diseases. The result of suboptimal immunization rates is persistent existence of several vaccine preventable diseases. Like many other developing countries Kenya is also facing the challenge of loss to follow-up and delayed immunizations. According to Government estimates, the immunization coverage in Kenya is less than 85% for all the vaccines while proportion of fully immunized children is less than 70%. Since mobile phone use is common in Kenya, it provides an excellent opportunity to test cell phone based interventions to improve timely immunization coverage. The use of Conditional cash transfers or incentives to raise immunization coverage have been previously used in few other countries but there is no evidence of programs using mobile cash transfers targeted at improving EPI immunization coverage rates. If successful, this low?cost simple tech intervention can significantly raise immunization coverage and timeliness. For those fellow students who are traveling there for first time, I would suggest they should plan extra time for themselves to discover Kenya and adjacent countries as there is lot to explore. And a caution, please do not take US dollar bills issued prior to 1999 as they would either be not accepted in Kenyan banks or exchanged at significantly lower rate than face value. Moreover, if travelling during Jun-Aug, the trip will be costly due to peak tourism season and may require additional funds. I am thankful to Johns Hopkins Center for Global Health for providing an opportunity to work in an international setting and off course with a long list of projects to choose from, I was able to work in my area of interest. Although my trip to Kenya is over, my learning experience is still on as I am involved with study team through weekly conference calls and would stay on board until the project completion. I have realized that in terms of immunization coverage, we have similar challenges in many parts of the world. Cell phones have shown the potential to provide global health & research solutions and they could also empower healthcare systems to ensure each child completes the immunization schedule in timely manner. Photo Album:  | Group photo with study team we trained for enrollment and data collection |  | During training session for data collectors |  | Enjoying the dance show with Masai women at a village near Masai mara |  | A photo with wife of Masai village chief |  | Follow-up immunization visit of first enrolled infant at Tingwangi Health Center |
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