Using mobile phone Re-call notification as a primary care practice to improve vaccination uptake for children under five in baghdad, Iraq, 2022.

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.