Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Effect of Using Vaccine Reminder and Tracker Bracelets to Improve Routine Childhood Immunization Coverage and Timeliness in Pakistan: a Randomized Control Trial.
Brief Summary: Pakistan has one of the highest infant mortality rates in the world in part, due to the low coverage (54%) for all basic vaccinations. Low uptake, lack of awareness among parents to complete the recommended immunization schedule and inability to remember vaccine appointments are some of the key factors hindering improvement in uptake of immunization services. On the supply side, ineffective methods to track children's' vaccine doses means that there is no reliable mechanism to verify vaccine administration and estimate accurate immunization coverage.

This study proposes to develop and test two types of silicon bracelets for children to stimulate immunization demand and simultaneously address supply side verification issues. These bracelets use a combination of numbers and symbols to denote the age of the child and due vaccines and are designed for illiterate or uneducated mothers; are low-cost and adaptable to most local settings. At the time of vaccine administration, the appropriate symbol denoting the vaccine on the bracelets is punched and therefore the bracelets can serve as effective reminders for mothers for timely immunization of their child and as a tool for vaccinators to verify vaccine administration and coverage.

An individually randomized, three-arm parallel group design randomized control trial will be conducted with equal allocation in the two treatment groups and control group. Children in intervention group A will receive the simple silicon bracelets, children in intervention group B will receive the bracelets developed by Alma Sana Inc. and children in the Control group will not receive any intervention. The impact of these immunization reminder bracelets on immunization coverage and timeliness will be evaluated through a randomized control trial (RCT) across 4 immunization centers in Karachi. To evaluate the bracelets' impact, variables of interest-coverage and timeliness rates of pentavalent-3/PCV-3/polio-3 and Measles 1 vaccine will be compared between Group A and the Control Group and Group B and the Control Group.

Proposed results include increase in immunization coverage and timeliness of Pentavalent-3/Pneumococcal Conjugate Vaccine (PCV-3)/Polio-3 and Measles-1 in the intervention versus control group.

The study will provide evidence of the bracelet's effectiveness for the global health community and provide a simple tool for strengthening routine immunization efforts in Pakistan.


Options:
A: Inclusion Criteria:

* First dose of primary vaccination series
* Parents owning a mobile phone and able to decipher SMS messages
* Consent form signed

Exclusion Criteria:

* Moving away from the study site in the next 12 months
* Ineligible for primary vaccination series by the MOH
B: Inclusion Criteria:

* Child presenting for pentavalent 1- vaccine
* Caregivers who owned a cellphone or had access to one
* Caregivers permanently residing in Korangi Town, Karachi

Exclusion Criteria:

* Child presenting for a vaccine other than pentavalent -1
* Caregivers not having access to a cell phone
* Caregivers residing outside of Korangi or planning to move from the catchment area
C: Inclusion Criteria:

1. Parents of healthy infants who have a cellular phone
2. Born at Mother and Child Hospital Ondo (Akure or Ondo Town)
3. Plans to receive immunizations at Mother and Child Hospital Ondo

Exclusion Criteria:

1. Parents of infants requiring hospital admission due to illness or prematurity.
2. Parents without a cellular phone
D: Inclusion Criteria:

1. Child is visiting the center for BCG or Pentavalent-1/Polio-1/PCV-1 vaccination.
2. Child is healthy
3. Child's caregiver has been a resident of study area for more than 6 months
4. Child is accompanied by a primary caregiver (mother and/or father)

Exclusion Criteria:

1. Child's age is more than 3 months. The average age of children for Penta-1 vaccine visit in Pakistan is 2.2 months (approximately 10 weeks). Children older than 3 weeks will be excluded on account of exceeding the average age for Penta-1 administration.
2. Parents plan to go to a different center for completing the vaccination course

Answer: D