Telephonic reminders for improving anti-rabies vaccination completion at a rural primary health centre: A quality improvement initiative.

Background and objectives Rabies is a fatal zoonotic viral disease preventable by prophylactic vaccination. About 60% of dog bite cases in India haven't completed vaccination schedules, and the reason among half of the defaulters was forgetfulness. This study was conducted to assess the effectiveness of telephonic reminders in vaccination completion status and explore the determinants of the intervention. Methods This is a quasi-experimental study conducted at a rural primary health centre, Puducherry, between June 2022 and November 2024. The intervention consisted of structured telephonic reminders delivered prior to scheduled anti-rabies vaccine (ARV) doses. Intervention effects were assessed using interrupted time series analysis with segmented regression, following formal assessment of autocorrelation. In addition, individual-level multivariable logistic regression with cluster-robust standard errors was used to estimate adjusted associations with ARV completion. Exploratory subgroup analyses were conducted using interaction terms and adjusted marginal effects. Results Among 695 animal bite victims, ARV completion increased from 60.2% in the pre-intervention period to 70.4% post-intervention. Interrupted time series analysis showed a statistically significant increase in post-intervention level and slope, indicating the effectiveness of the intervention. In adjusted individual-level analyses accounting for clustering by month, the post-intervention period was independently associated with higher odds of ARV completion [adjusted odds ratio 1.60, 95% Confidence interval (CI) 1.2 to 2.1]. Subgroup analyses demonstrated a significantly greater intervention effect among males, with an adjusted absolute increase in completion of 17.3% points and a significant interaction between intervention and sex of victims. Interpretation and conclusions Telephonic reminders integrated into routine primary care were associated with improved completion of the anti-rabies vaccination schedule among animal bite victims. The effect was consistent across most subgroups, with greater benefit among males. Reminder-based strategies can strengthen rabies post-exposure prophylaxis delivery in primary care.