Digital reminder systems for improving adherence to anti-rabies vaccination among animal bite victims: A systematic review

Background and objectives Digital reminder systems may improve adherence to scheduled vaccination visits. This systematic review aimed to evaluate the effectiveness of digital reminder interventions in improving adherence to and completion of anti-rabies vaccination among animal bite patients. Methods A systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Library was conducted on September 28, 2025 following a registered PROSPERO protocol (CRD420251148817). Two reviewers independently screened studies using NESTED Knowledge, extracted data, and assessed study quality using the Cochrane RoB-2 tool and the JBI critical appraisal checklist. Results Of 733 records identified, 436 remained after duplicate record removal and were screened by the title and abstract. Twelve studies underwent full-text assessment, and three that met the inclusion criteria were conducted in Tanzania, Kenya, and India. Two quasi-experimental studies evaluated SMS reminder systems, and one randomised controlled trial evaluated telephonic reminders. All studies reported improved adherence to scheduled anti-rabies vaccination compared with routine care. Vaccination completion was 70% vs 53% in the telephonic reminder trial and 93% vs 78% in the SMS reminder study. In the Tanzanian study adherence improved across four doses (62%, 50%, 29%, 13%) with SMS reminders compared with controls (48%, 41%, 22%, 7%). Differences in study design, vaccination regimens, and intervention modalities limited direct comparison across studies. Interpretation and conclusions Digital reminder interventions may improve adherence to anti-rabies vaccination schedules, but available evidence is limited and heterogeneous, resulting in low certainty of evidence. Larger randomised trials are required to determine the effectiveness and scalability of digital reminder systems.