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Evaluation of Conditional Cash Transfers (CCTs) for Immunizations
Last registered on November 21, 2017

Pre-Trial

Trial Information
General Information
Title
Evaluation of Conditional Cash Transfers (CCTs) for Immunizations
RCT ID
AEARCTR-0001953
Initial registration date
November 05, 2017
Last updated
November 21, 2017 11:57 PM EST
Location(s)

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Primary Investigator
Affiliation
JPAL
Other Primary Investigator(s)
PI Affiliation
Interactive Research and Development (IRD)
PI Affiliation
Interactive Research and Development (IRD)
PI Affiliation
Interactive Research and Development (IRD)
PI Affiliation
Massachusetts Institute of Technology (MIT)
Additional Trial Information
Status
On going
Start date
2017-11-06
End date
2021-10-06
Secondary IDs
Abstract
Immunization rates in developing countries are low and while incentive-based approaches have been demonstrated to effectively increase take-up and completion rates of immunization, research and policy attention on the optimal design and delivery of small incentives is sparse. We propose to conduct a randomized control trial involving small conditional cash transfers (mCCTs) to determine the optimal CCT amount (high versus low), schedule (flat versus increasing) and design (lottery versus sure payment) that would lead to the highest increase in immunization rates. Interactive Research and Development's digital immunization registry will be used to enroll and randomize the study participants and generate CCTs disbursed through a mobile money transfer platform and mobile credit top- ups. The three year study will be conducted in Karachi, Pakistan enrolling a sample of 11,200 children, 0-2 years of age. The study aims to provide evidence regarding the most cost-effective way to structure incentives in terms of size, schedule, and design; and address the challenge of delivering small incentives in a way that is inexpensive, logistically simple, and not subject to leakage.

External Link(s)
Registration Citation
Citation
Arif, Danya et al. 2017. "Evaluation of Conditional Cash Transfers (CCTs) for Immunizations." AEA RCT Registry. November 21. https://doi.org/10.1257/rct.1953-2.0.
Former Citation
Arif, Danya et al. 2017. "Evaluation of Conditional Cash Transfers (CCTs) for Immunizations." AEA RCT Registry. November 21. http://www.socialscienceregistry.org/trials/1953/history/23372.
Sponsors & Partners

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Experimental Details
Interventions
Intervention(s)
The study has twelve arms. The ten treatment arms include low (USO 5/child) and high incentives (USO 15/child). Additionally, each arm is further subdivided into flat and sharp increase in amount for the six routine immunization visits recommended by EPI. Furthermore, each sub-arm has further subdivision of lottery and non-lottery. The first eight treatment arms use a mobile money money transfer system while the latter two use mobile top - ups to disburse incentives. The eleventh treatment arm provides SMS reminders for immunization. A total of 3 reminders will be sent for each immunization due: on the evening before the due date, on the morning of the due date, and 5 days after the due date if the child has not been vaccinated. The control arm (arm 12) will neither receive CCT nor SMS.
The direct beneficiaries include: 1) A total of 11,200 children age 0 - 23 months visiting an EPI center or contacted during outreach
activities for any one of the routine immunizations will be enrolled into the registry; and 2) A total of 18 Vaccinators working at 12 clinics will directly benefit through the program through reduced administrative burden and improved performance.
Intervention Start Date
2017-11-06
Intervention End Date
2020-11-06
Primary Outcomes
Primary Outcomes (end points)
Primary endpoints: Fully Immunized Child (FIC; BCG+Pentavlent1-3+Measles1) coverage in children 12-23 months old. Secondary Prevalent 3 coverage in children 12-23 months old. Prevalent 3 timeliness in children 12-23 months old. Measles 1 coverage in children 12-23 months old. Measles 1 timeliness in children 12-23 months old. Measles 2 coverage in 2 year old children . Measles 2 timeliness in children 2 year old children.
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
The study will measure the impact of our intervention on the immunization rate of eligible children (those aged between 0- 2 years) using an experimental design. The study participants will comprise of 11,200 children under 2 years of age visiting any one of the 12 EPI centers that have been recruited for the project. The experiment will be a randomized controlled trial with a cross-cutting design. It is structured to answer the most critical design questions for cost-effectiveness. The study has a cross-cutting design as follows: one experiment (1) will have the following design elements: (1a) sharply increasing vs slowly increasing payouts; (1b) high incentive vs low incentive; (1c) a simple SMS reminder vs no reminder. A second experiment (2), orthogonal to the first, will test lotteried payouts vs non-lotteried payouts. We will cross-cut (1a), (1b) and (1c) with (2).
Experimental Design Details
Not available
Randomization Method
Randomization will be done by a computer. The stratified randomization sequence will be created using statistical software through random block sizes. The allocation sequence will be concealed from the study staff responsible for screening and enrolling participants through real time phone based randomization sequence. For this study, a block randomization procedure has been put in place with a block size of 48 and six different strata based on enrollment vaccine and gender. These strata are: BCG-Male and BCG-Female, Penta1-Male and Penta1-Female and Penta2-Male and Penta2-Female.
Randomization Unit
Individuals
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
11,200 children presenting for BCG/Penta-1/Penta 2 vaccinations
Sample size: planned number of observations
11,200 children presenting for BCG/Penta-1/Penta 2 vaccinations
Sample size (or number of clusters) by treatment arms
8000 children will receive incentives, 1600 will only receive SMS while another 1600 will be in control arm.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
A sample of 11,200 participants (1600 in each arm) would give 80% power (alpha= 0.05, 2-tailed) to detect a difference of 5% in fully immunized child vaccine coverage rate over the baseline expected coverage rate of 51.5%. We assume that an increase of at least 5 percentage points in full immunization is required to generate sufficient policy interest to scale up the program. We also use 5 percentage points as the minimal detectable effect size between arms: i.e. the assumption is that there would need to be at least a 5 percentage point difference between immunization rates to justify the incentive above a simple SMS reminder program, or to justify a higher incentive payment to the lower incentive payment.
Supporting Documents and Materials

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IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Committee on the Use of Humans as Experimental Subjects
IRB Approval Date
2017-01-19
IRB Approval Number
1612798252