Optical scanning of the 'Mother and Child Protection Card' to improve routine immunization in India: the Tika Vaani platform
| ISRCTN | ISRCTN92995640 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN92995640 |
| ClinicalTrials.gov (NCT) | Nil known |
| Clinical Trials Information System (CTIS) | Nil known |
| Protocol serial number | 20190718protocol |
| Sponsor | OnionDev Technologies Pvt Ltd (Gram Vaani) |
| Funders | Department of Biotechnology , Ministry of Science and Technology, Bill and Melinda Gates Foundation |
- Submission date
- 22/07/2019
- Registration date
- 25/07/2019
- Last edited
- 06/01/2022
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Other
Plain English summary of protocol
Current plain English summary as of 17/11/2020:
Background and study aims
Immunization is one of the most successful and cost-effective health interventions and is estimated to prevent between 2 and 3 million deaths annually worldwide. Immunization coverage in India has improved in recent years but an estimated 1 in 7 children in India do not receive immunization. Reaching these populations requires more effective immunization systems, and these in turn require improved immunization data. Immunization data in India is currently not available in high quality, at the right time and in the right place to support system decision making. Currently, the Mother and Child Protection (MCP) card immunization record is filled out by the ANMs at the point of service (usually, the local Village Health and Nutrition Day (VHND)), but entry of immunization data occurs offline, at the Primary Health Centre (PHC), with delays. New systems for data collection involving tablet computers are planned, but manual data entry poses important challenges for these health workers. Without timely and accurate data, vaccine supply and demand prediction suffer, leading to poorer coverage and follow-up of immunization.
Who can participate?
This study will take place in Uttar Pradesh, a north Indian state with poor health and development indicators. Two administrative blocks from a lagging district were identified for the study based on low immunization performance, inputs from local government authorities and sample size requirements (reflecting the number of health workers and immunization microplanning areas). A sample of immunization microplanning areas will be identified in each block. In these areas, we will recruit all frontline workers (ANM, ASHA, AWW) involved in delivery of immunization services. In the pre-intervention phase, we also recruited all families and primary caregivers (usually mothers) of children 0 to 23 months of age.
What does the study involve?
We have developed an application to help frontline workers equipped with a mobile smartphone in their tasks, which will ultimately help to strengthen immunization planning and other services for beneficiaries. This mobile phone application will change the way that immunization and health data collected by the health workers are recorded and used. The new mobile phone application will collect immunization data in real time at point-of-service using image-recognition technology (“optical scanning”). The new system will also enable direct communication with beneficiaries to offer information about immunisation services and appointment reminders. The new system is known as “Tika Vaani” [“vaccine voice” in Hindi].
We will conduct a controlled before-and-after (CBA) study in which one administrative block receives the optical scanning intervention and one administrative block serves as a control group and does not receive the intervention. Observations will be made before and after the implementation of the optical scanning intervention in intervention and control areas.
We will study outcomes related to routine immunization performance, including health worker time allocation, costs of intervention delivery, data quality, equity and timeliness of vaccination, and missed opportunities for vaccination. We will also conduct a process evaluation to identify any barriers to success and areas for improvement.
What are the possible benefits and risks of participating?
There are no disadvantages or risks to participating in the study beyond those encountered in everyday life. Participants will not gain any personal benefit from participating in this study.
Through this research, we hope to learn more about how to improve the performance of immunisation services. This will contribute to improved coverage, timeliness and completeness of immunization -- and ultimately, to improved health and well-being -- for currently left out individuals and communities.
Where is the study run from?
This study is run by OnionDev Technologies Pvt Ltd (Gram Vaani), headquartered in Gurgaon, India.
When is the study starting and how long is it expected to run for?
The study is expected to start on August 15, 2019 and run for 12 months. The anticipated end date is September 1, 2020. The study was interrupted due to the COVID-19 pandemic and lockdown in India. The new anticipated end date is June 1, 2021.
Who is funding the study?
This study is funded by the Government of India via the Department of Biotechnology (DBT) Biotechnology Industry Research Assistance Council (BIRAC) and the Bill & Melinda Gates Foundation.
Who is the main contact?
Dr. Aaditeshwar Seth
Co-Founder & Director, Onion Dev Technologies Pvt Ltd. (Gram Vaani)
Associate Professor of Computer Science, Indian Institute of Technology (IIT), Delhi
aseth@gramvaani.org
_____
Previous plain English summary:
Background and study aims
Immunization is one of the most successful and cost-effective health interventions and is estimated to prevent between 2 and 3 million deaths annually worldwide. Immunization coverage in India has improved in recent years but an estimated 1 in 7 children in India do not receive immunization. Reaching these populations requires more effective immunization systems, and these in turn require improved immunization data. Immunization data in India is currently not available in high quality, at the right time and in the right place to support system decision making. Currently, the Mother and Child Protection (MCP) card immunization record is filled out by the ANMs at the point of service (usually, the local Village Health and Nutrition Day (VHND)), but entry of immunization data occurs offline, at the Primary Health Centre (PHC), with delays. New systems for data collection involving tablet computers are planned, but manual data entry poses important challenges for these health workers. Without timely and accurate data, vaccine supply and demand prediction suffer, leading to poorer coverage and follow-up of immunization.
Who can participate?
This study will take place in Uttar Pradesh, a north Indian state with poor health and development indicators. Two administrative blocks from a lagging district were identified for the study based on low immunization performance, inputs from local government authorities and sample size requirements (reflecting the number of health workers and immunization microplanning areas). A sample of immunization microplanning areas will be identified in each block. In these areas, we will recruit all frontline workers (ANM, ASHA, AWW) involved in delivery of immunization services. We will also recruit all families and primary caregivers (usually mothers) of children 0 to 23 months of age.
What does the study involve?
We have developed an application to help frontline workers equipped with a mobile smartphone in their tasks, which will ultimately help to strengthen immunization planning and other services for beneficiaries. This mobile phone application will change the way that immunization and health data collected by the health workers are recorded and used. The new mobile phone application will collect immunization data in real time at point-of-service using image-recognition technology (“optical scanning”). The new system will also enable direct communication with beneficiaries to offer information about immunisation services and appointment reminders. The new system is known as “Tika Vaani” [“vaccine voice” in Hindi].
We will conduct a controlled before-and-after (CBA) study in which one administrative block receives the optical scanning intervention and one administrative block serves as a control group and does not receive the intervention. Observations will be made before and after the implementation of the optical scanning intervention in intervention and control areas.
We will study outcomes related to routine immunization performance, including health worker time allocation, vaccination drop-outs, data quality, equity and timeliness of vaccination, and missed opportunities for vaccination. We will also conduct a process evaluation to identify any barriers to success and areas for improvement.
What are the possible benefits and risks of participating?
There are no disadvantages or risks to participating in the study beyond those encountered in everyday life. Participants will not gain any personal benefit from participating in this study.
Through this research, we hope to learn more about how to improve the performance of immunisation services. This will contribute to improved coverage, timeliness and completeness of immunization -- and ultimately, to improved health and well-being -- for currently left out individuals and communities.
Where is the study run from?
This study is run by OnionDev Technologies Pvt Ltd (Gram Vaani), headquartered in Gurgaon, India.
When is the study starting and how long is it expected to run for?
The study is expected to start on August 15, 2019 and run for 12 months. The anticipated end date is September 1, 2020.
Who is funding the study?
This study is funded by the Government of India via the Department of Biotechnology (DBT) Biotechnology Industry Research Assistance Council (BIRAC) and the Bill & Melinda Gates Foundation.
Who is the main contact?
Dr. Aaditeshwar Seth
Co-Founder & Director, Onion Dev Technologies Pvt Ltd. (Gram Vaani)
Associate Professor of Computer Science, Indian Institute of Technology (IIT), Delhi
aseth@gramvaani.org
Contact information
Scientific
Département de gestion, d’évaluation, et de politique de santé
Université de Montréal
C.P.6128, succ. Centre-ville
Montréal
H3C 3J7
Canada
 ORCID ID |
0000-0001-5642-787X |
|---|---|
| Phone | +1 5143437318 |
| mira.johri@umontreal.ca |
Public
OnionDev Technologies Pvt. Ltd. (Gram Vaani)
Address: Building No. 346, 1st Floor
Udyog Vihar Ph-II, Near People Chowk
Gurgaon
122016
India
| Phone | +91 98993 89636 |
|---|---|
| rohit.singh@oniondev.com |
Study information
| Primary study design | Interventional |
|---|---|
| Study design | A quasi-experimental intervention study using a controlled before-and-after (CBA) design |
| Secondary study design | Non randomised study |
| Study type | Participant information sheet |
| Scientific title | Image recognition based data entry processes to ensure immunization completeness and auditing of reported data: the Tika Vaani platform |
| Study objectives | Current hypothesis as of 17/11/2020: We will study the effects on India's routine immunization system of introducing a new technology platform (Tika Vaani) for health workers to collect immunization data in real time at point-of-service using image-recognition technology via mobile phone. The image-recognition technology is linked to an interactive voice-response system for direct communication with beneficiaries and will make data immediately available to facilitate system planning and tailored interventions. We hypothesize that introduction of this new technology will contribute to improved performance of routine immunization (RI) services for children 0 to 23 months of age. _____ Previous hypothesis: We will study the effects on India's routine immunization system of introducing a new technology platform (Tika Vaani) for health workers to collect immunization data in real time at point-of-service using image-recognition technology via mobile phone. The image-recognition technology is linked to an interactive voice-response system for direct communication with beneficiaries and will make data immediately available to facilitate system planning and tailored interventions. We hypothesize that introduction of this new technology will contribute to improved performance of routine immunization (RI) services and improved coverage, timeliness and completeness of immunization among children 0 to 23 months of age. |
| Ethics approval(s) | Approved 02/08/2019, Institutional Committee for Ethics and Review of Research, OnionDev Technologies Pvt. Ltd. (Building No. 346, 1st Floor, Udyog Vihar Phase II, Near People Chowk, Gurgaon - 122016, India; contact@oniondev.com; +91 (0)124-4303248), ref: n/a |
| Health condition(s) or problem(s) studied | Child immunization |
| Intervention | Current interventions as of 17/11/2020: Frontline health workers (assistant nurse midwives, or “ANMs”) equipped with a mobile smart phone will collect immunization data in real time at immunization sessions. The easy-to-use Tika Vaani mobile phone application scans the Mother and Child Protection card immunization record using optical character recognition (OCR) methods. Its aim is to reduce burdensome paper-based documentation and increase the availability of actionable information at the point of care. Observations will be made at multiple time points before and after the implementation of the optical scanning intervention, both in a group that receives the intervention and in a control group that does not. Data will be analyzed using the differences-in-differences (DiD) method. The study will emulate a target trial in which the intervention group receives the multicomponent Tika Vaani optical scanning intervention. The intervention is designed to support the delivery of routine immunisation services in India. The control group will be defined as eligible to receive the intervention but not in receipt of it. Members of the control group will receive the usual services offered by the Government of India. The study will take place in poor-performing administrative blocks (each of approximately 200,000 population) in a rural area of Uttar Pradesh. Study blocks will be assigned to either intervention or control group by government officials. The Tika Vaani optical scanning intervention has three main components: 1. Functionalities for data collection, guidance on vaccination timing and session planning (directed to health workers (ANMs, ASHAs)) 2. Beneficiary communication (directed to caregivers of children 0 to 23 months of age)) 3. Availability of data for real-time planning & course correction (directed to health systems managers & planners – not a focus of this study phase) Data collection and follow-up: 1. ANMs in the intervention group will use the new Tika Vaani mobile phone application for data collection and work planning at all immunization sessions during the 6-month intervention period (comprising the 2-month intervention introduction and the 4-month post-intervention periods). ANMs will be followed over the entire study period (encompassing the 4-month pre-intervention period, 2-month intervention introduction period, and the 4-month post-intervention period). ASHA (community health) workers present at each immunisation session will also provide data. Each ASHA workers is expected to be observed only once during the study. 2. Beneficiaries (caregivers of children 0-23 months of age) in the intervention group will be contacted via mobile phone during the 6-month intervention period for two purposes: (1) to remind families about vaccination appointments; (2) to provide additional information post-vaccination. Each pre-immunisation and post-immunisation contact will take less than 2 minutes. _____ Previous interventions: Frontline health workers (assistant nurse midwives, or “ANMs”) equipped with a mobile smart phone will collect immunization data in real time at immunization sessions. The easy-to-use Tika Vaani mobile phone application scans the Mother and Child Protection card immunization record using optical character recognition (OCR) methods. Its aim is to reduce burdensome paper-based documentation and increase the availability of actionable information at the point of care. Observations will be made at multiple time points before and after the implementation of the optical scanning intervention, both in a group that receives the intervention and in a control group that does not. Data will be analyzed using the differences-in-differences (DiD) method. The study will emulate a target trial in which the intervention group receives the multicomponent Tika Vaani optical scanning intervention. The intervention is designed to support the delivery of routine immunisation services in India. The control group will be defined as eligible to receive the intervention but not in receipt of it. Members of the control group will receive the usual services offered by the Government of India. The study will take place in poor-performing administrative blocks (each of approximately 200,000 population) in a rural area of Uttar Pradesh. Study blocks will be assigned to either intervention or control group by government officials. The Tika Vaani optical scanning intervention has three main components: 1. Functionalities for data collection and session planning (directed to health workers (ANMs, ASHAs)) 2. Beneficiary communication (directed to caregivers of children 0 to 23 months of age)) 3. Availability of data for real-time planning & course correction (directed to health systems managers & planners – not a focus of this study phase) Data collection and follow-up: 1. ANMs in the intervention group will use the new Tika Vaani mobile phone application for data collection and work planning at all immunization sessions during the 6-month intervention period (comprising the 2-month intervention introduction and the 4-month post-intervention periods). ANMs will be followed over the entire study period (encompassing the 4-month pre-intervention period, 2-month intervention introduction period, and the 4-month post-intervention period). ASHA (community health) workers present at each immunisation session will also provide data. Each ASHA workers is expected to be observed only once during the study. 2. Beneficiaries (caregivers of children 0-23 months of age) in the intervention group will be contacted via mobile phone during the 6-month intervention period for two purposes: (1) to remind families about vaccination appointments; (2) to provide additional information post-vaccination. Each pre-immunisation and post-immunisation contact will take less than 2 minutes. |
| Intervention type | Device |
| Phase | Phase II |
| Drug / device / biological / vaccine name(s) | |
| Primary outcome measure(s) |
Current primary outcome measure as of 18/11/2020: |
| Key secondary outcome measure(s) |
Current secondary outcome measures as of 17/11/2020: |
| Completion date | 25/04/2021 |
Eligibility
| Participant type(s) | |
|---|---|
| Age group | Adult |
| Sex | All |
| Target sample size at registration | 10860 |
| Total final enrolment | 10183 |
| Key inclusion criteria | 1. Study clusters are immunisation microplan areas located in a selected block of Hardoi district, UP. Immunisation microplan areas have defined geographic boundaries and a population of approximately 1000 inhabitants; these catchment areas constitute the basis for immunisation session planning (Village Health and Nutrition Days). A sample of immunization microplanning areas will be identified in each block. 2. In selected areas, we will recruit all frontline workers (ANM, ASHA, AWW) involved in delivery of Village Health and Nutrition Days and associated immunization services. 3.In selected areas, we will recruit all families and primary caregivers (usually mothers) of children 0 to 23 months of age |
| Key exclusion criteria | 1. The study will exclude villages of more than 4000 inhabitants. 2. There are no exclusion criteria for health workers 3. We will exclude caregivers of children not able to understand and speak Hindi or Urdu |
| Date of first enrolment | 15/08/2019 |
| Date of final enrolment | 25/04/2021 |
Locations
Countries of recruitment
- India
Study participating centre
Udyog Vihar II Rd
Udyog Vihar II
Sector 20
Gurgaon
122016
India
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|---|
| IPD sharing plan summary | Data sharing statement to be made available at a later date |
| IPD sharing plan | The current data sharing plans for this study are unknown and will be available at a later date |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Participant information sheet | Participant information sheet | 11/11/2025 | 11/11/2025 | No | Yes |
| Study website | Study website | 11/11/2025 | 11/11/2025 | No | Yes |
Editorial Notes
06/01/2022: The intention to publish date was changed from 01/01/2022 to 01/09/2022.
01/10/2021: The overall trial end date has been changed from 01/10/2021 to 25/04/2021.
03/06/2021: The following changes have been made:
1. The recruitment end date has been changed from 01/06/2021 to 25/04/2021.
2. The total final enrolment number has been added.
3. Publication reference added.
18/11/2020: The following changes were made to the trial record:
1. The recruitment resumed.
2. The primary outcome measure was changed.
17/11/2020: The following changes were made to the trial record:
1. The hypothesis was changed.
2. The interventions were changed.
3. The secondary outcome measures were changed.
4. The target number of participants was changed from "360 microplan clusters; 60 Assistant Nurse Midwives (health workers); 10,800 children 0 to 23 months" to "360 microplan clusters; 60 Assistant Nurse Midwives (health workers); 5,400 children 0 to 23 months"
5. The recruitment end date was changed from 01/08/2020 to 01/06/2021.
6. The plain English summary was updated.
7. The intention to publish date was changed from 01/01/2021 to 01/01/2022.
8. The overall end date was changed from 01/09/2020 to 01/10/2021.
16/04/2020: Due to current public health guidance, recruitment for this study has been paused.
12/12/2019: The following changes were made to the trial record:
1. The ethics approval date was added.
2. The trial website was added.
25/07/2019: Trial’s existence confirmed by Biotechnology Industry Research Assistance Council
