Improving hepatitis B birth dose in rural Lao People's Democratic Republic through the use of mobile phones to facilitate communication

Vaccine. 2016 Nov 11;34(47):5777-5784. doi: 10.1016/j.vaccine.2016.09.056. Epub 2016 Oct 11.


Background: Hepatitis B vaccine birth dose (HepB-BD) was introduced in Lao People's Democratic Republic to prevent perinatal hepatitis B virus transmission in 2008; high coverage is challenging since only 38% of births occur in a health facility. Healthcare workers report being unaware of home births and thus unable to conduct timely postnatal care (PNC) home visits. A quasi-experimental pilot study was conducted wherein mobile phones and phone credits were provided to village health volunteers (VHV) and healthcare workers (HCWs) to assess whether this could improve HepB-BD administration, as well as birth notification and increase home visits.

Methods: From April to September 2014, VHVs and HCWs in four selected intervention districts were trained, supervised, received outreach per diem for conducting home visits, and received mobile phones and phone credits. In three comparison districts, VHVs and HCWs were trained, supervised, and received outreach per diem for conducting home visits. A post-study survey compared HepB-BD coverage among children born during the study and children born one year before. HCWs and VHVs were interviewed about the study.

Findings: Among intervention districts, 463 study children and 406 pre-study children were enrolled in the survey; in comparison districts, 347 study children and 309 pre-study children were enrolled. In both arms, there was a significant improvement in the proportion of children reportedly receiving a PNC home visit (intervention p<0.0001, comparison p=0.04). The median difference in village level HepB-BD coverage (study cohort minus pre-study cohort), was 57% (interquartile range [IQR] 32-88%, p<0.0001) in intervention districts, compared with 20% (IQR 0-50%, p<0.0001) in comparison districts. The improvement in the intervention districts was greater than in the comparison districts (p=0.0009).

Conclusion: Our findings suggest that the provision of phones and phone credits might be one important factor for increasing coverage. However, reasons for improvement in both arms are multifactorial and discussed.

Keywords: Hepatitis B; Lao PDR; Lay health worker; Mobile phones; Postnatal visits.

MeSH terms

  • Cell Phone / statistics & numerical data*
  • Cohort Studies
  • Communication
  • Female
  • Health Personnel
  • Hepatitis B / economics
  • Hepatitis B / prevention & control*
  • Hepatitis B / transmission*
  • Hepatitis B Vaccines / administration & dosage*
  • Hepatitis B virus / immunology*
  • Home Childbirth
  • Humans
  • Infant
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Laos
  • Male
  • Pilot Projects
  • Pregnancy
  • Rural Health Services*
  • Rural Population
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Vaccination / economics
  • Vaccination / psychology


  • Hepatitis B Vaccines