Using mobile phone re-call notification as a primary care practice to improve vaccination uptake for children under five in Baghdad, Iraq, 2022
Author(s)
Type
Journal Article
Abstract
Introduction: Reminder and recall (RR) interventions are proven strategies for improving childhood immunization coverage. However, evidence on their feasibility and effectiveness in routine primary healthcare settings in Iraq is limited. This study evaluated a direct, person‑to‑person mobile phone recall intervention to improve vaccine uptake among children under five years of age in Baghdad Province in 2022.
Methods: The intervention was implemented in 50 Primary Healthcare Centers (PHCs) with the lowest routine immunization performance, including 20 centers in Karkh and 30 in Rusafa. Eligible participants were children under five years of age who were overdue for one or more vaccines in the national Expanded Programme on Immunization (EPI) schedule, excluding Bacillus Calmette–Guérin (BCG) vaccine administered at birth. Trained EPI staff contacted caregivers through direct telephone calls, with up to six biweekly attempts over a three‑month period. Standardized data collection forms were used under supervision of the Directorate of Public Health.
Results: A total of 17,241 children (47.8% female) with 48,919 overdue vaccine doses were identified, of whom 15,087 (87.4%) had valid mobile phone numbers. Among these, 28,130 call attempts resulted in 10,061 caregiver responses. Most respondents (87.5%) agreed to schedule vaccination appointments. Ultimately, 6,831 children attended PHCs and received 13,386 overdue vaccine doses, corresponding to 39.4% child‑level and 27.4% dose‑level coverage among targeted defaulters.
Conclusion: Direct cellphone‑based recall interventions are feasible and operationally effective for improving routine childhood immunization in Iraq. As a low‑cost strategy embedded within existing EPI structures, this approach has strong potential for scale‑up in similar settings.
Methods: The intervention was implemented in 50 Primary Healthcare Centers (PHCs) with the lowest routine immunization performance, including 20 centers in Karkh and 30 in Rusafa. Eligible participants were children under five years of age who were overdue for one or more vaccines in the national Expanded Programme on Immunization (EPI) schedule, excluding Bacillus Calmette–Guérin (BCG) vaccine administered at birth. Trained EPI staff contacted caregivers through direct telephone calls, with up to six biweekly attempts over a three‑month period. Standardized data collection forms were used under supervision of the Directorate of Public Health.
Results: A total of 17,241 children (47.8% female) with 48,919 overdue vaccine doses were identified, of whom 15,087 (87.4%) had valid mobile phone numbers. Among these, 28,130 call attempts resulted in 10,061 caregiver responses. Most respondents (87.5%) agreed to schedule vaccination appointments. Ultimately, 6,831 children attended PHCs and received 13,386 overdue vaccine doses, corresponding to 39.4% child‑level and 27.4% dose‑level coverage among targeted defaulters.
Conclusion: Direct cellphone‑based recall interventions are feasible and operationally effective for improving routine childhood immunization in Iraq. As a low‑cost strategy embedded within existing EPI structures, this approach has strong potential for scale‑up in similar settings.
Date Issued
2026-07-01
Date Acceptance
2026-07-03
Citation
Journal of Public Health Research, 2026, 15 (3), pp.1-11
ISSN
2279-9028
Publisher
SAGE Publishing
Start Page
1
End Page
11
Journal / Book Title
Journal of Public Health Research
Volume
15
Issue
3
Copyright Statement
© The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
License URL
Identifier
10.1177/22799036261470482
Subjects
reminder/re-call notification
immunization
vaccine
coverage
Iraq
primary care
Publication Status
Published
Date Publish Online
2026-07-17