Published in PLOS One on 2025-12-23, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Alex Bhattacharya, Chidera Mark-Uchendu, Christa Hansen, Jay Evans
Source: PLOS One • DOI 10.1371/journal.pone.0324117
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Mobile health and digital health (mHealth/DH) interventions have been shown to support immunisation programmes in Sub-Saharan Africa (SSA) and improve uptake of life-saving vaccines. As 19 SSA countries were targeted to begin rolling out the two new malaria vaccines (RTS,S/AS01 and R21/Matrix-M) in 2024, this systematic review aims to investigate which mHealth/DH interventions are most effective at increasing vaccination uptake (by assessing vaccination coverage and timeliness outcomes) in these countries. The review assessed the effectiveness of mHealth/DH interventions for increasing uptake of Diphtheria–Tetanus–Pertussis or Pentavalent vaccines (DTP/Pentavalent). As with any multi-dose vaccine, the DTP/Pentavalent vaccine requires multiple doses to ensure its maximum protective benefit, therefore maintaining schedule adherence and ensuring its timely completion is essential. Thus, identifying strategies to support adherence, such as digital appointment reminders, remains a public health priority. Eight electronic databases were searched, alongside selected grey literature sources. A narrative synthesis was conducted with studies grouped by mHealth/DH intervention-type. Included studies were assessed for risk of bias using RoB2 and ROBINS-I, and certainty of evidence was evaluated using the GRADE approach. 14 studies were included, comprising both randomised and non-randomised control trials. However, only 4 out of the 19 SSA countries were represented (Nigeria, Kenya, Burkina Faso and Cote D’Ivoire). All interventions investigated were appointment reminders. Generally, all intervention-types were positively associated with vaccination coverage and timeliness. SMS-based interventions showed modest effects, whereas interventions incorporating voice components (phone calls/voice messages) tended to yield larger effects. The certainty of evidence ranged from very low to moderate depending on the intervention-type and outcome pairing. The findings offer evidence-based insights to guide the development and implementation of mHealth/DH interventions within SSA childhood immunisation programmes. While interventions with voice-based components appear particularly promising, the limited certainty of evidence demonstrates further high-quality, context-specific research is required to draw stronger conclusions.
Introduction
2024 was a monumental year for public health and the fight against malaria. The World Health Organization (WHO) has now approved two malaria vaccines for use (RTS,S/AS01 and R21/Matrix-M), and these are beginning to be rolled out in 19 countries (Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Cote d’Ivoire, Democratic Republic of Congo, Ghana, Guinea, Kenya, Liberia, Malawi, Mozambique, Niger, Nigeria, Sierra Leone, South Sudan and Uganda) across Sub-Saharan Africa (SSA) [1]. This raises important questions about how best to support childhood vaccination uptake in this context.
There is increasing evidence to suggest that mobile health (mHealth) and digital health (DH) interventions could optimise immunisation programmes and improve uptake of lifesaving vaccines [2,3]. Whilst no studies have yet assessed mHealth or digital health (mHealth/DH) interventions for malaria vaccine uptake directly, examining interventions used to improve uptake of other multi-dose routine childhood vaccines (such as the Diphtheria–Tetanus–Pertussis or Pentavalent (DTP/Pentavalent) vaccines) can offer relevant insights that may inform future vaccination programme design in similar contexts. Therefore, this systematic review investigates mHealth/DH interventions for increasing DTP/Pentavalent vaccination uptake in these 19 SSA countries. Although this review focuses on mHealth/DH interventions for improving DTP/Pentavalent vaccine uptake, the 19 countries were selected because of their planned malaria vaccine rollouts, which provided the contextual motivation for the study.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2025 Alex Bhattacharya, Chidera Mark-Uchendu, Christa Hansen, Jay Evans. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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