Interventions for improving coverage of childhood immunisation in low- and middle-income countries

Abstract

Background Immunisation is a powerful public health strategy for improving child survival, not only by directly combating key diseases that kill children but also by providing a platform for other health services. However, each year millions of children worldwide, mostly from low- and middle-income countries (LMICs), do not receive the full series of vaccines on their national routine immunisation schedule. This is an update of the Cochrane review published in 2011 and focuses on interventions for improving childhood immunisation coverage in LMICs. Objectives To evaluate the effectiveness of intervention strategies to boost and sustain high childhood immunisation coverage in LMICs. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2016, Issue 4, part of The Cochrane Library . www.cochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 12 May 2016); MEDLINE In-Process and Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 12 May 2016); CINAHL 1981 to present, EbscoHost (searched 12 May 2016); Embase 1980 to 2014 Week 34, OvidSP (searched 2 September 2014); LILACS, VHL (searched 2 September 2014); Sociological Abstracts 1952 - current, ProQuest (searched 2 September 2014). We did a citation search for all included studies in Science Citation Index and Social Sciences Citation Index, 1975 to present; Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 2 July 2016). We also searched the two Trials Registries: ICTRP and ClinicalTrials.gov (searched 5 July 2016) Selection criteria Eligible studies were randomised controlled trials (RCT), non-RCTs, controlled before-after studies, and interrupted time series conducted in LMICs involving children aged from birth to four years, caregivers, and healthcare providers. Data collection and analysis We independently screened the search output, reviewed full texts of potentially eligible articles, assessed risk of bias, and extracted data in duplicate; resolving discrepancies by consensus. We then conducted random-effects meta-analyses and used GRADE to assess the certainty of evidence. Main results Fourteen studies (10 cluster RCTs and four individual RCTs) met our inclusion criteria. These were conducted in Georgia (one study), Ghana (one study), Honduras (one study), India (two studies), Mali (one study), Mexico (one study), Nicaragua (one study), Nepal (one study), Pakistan (four studies), and Zimbabwe (one study). One study had an unclear risk of bias, and 13 had high risk of bias. The interventions evaluated in the studies included community-based health education (three studies), facility-based health education (three studies), household incentives (three studies), regular immunisation outreach sessions (one stud...

Parents' and informal caregivers' views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence

“…Using guidelines developed by the Cochrane Qualitative Research Methods Group for searching for qualitative evidence (Noyes 2011), as well as modified versions of the search developed for the three COMMVAC intervention reviews (Kaufman 2013; Saeterdal 2014; Oyo-Ita 2016), we developed search strategies for each database. We chose these databases as we anticipated that they would provide the highest yield of results based on preliminary, exploratory searches.…”

“…As part of data synthesis, we explored how we could integrate the findings from our review with those of related Cochrane intervention reviews (Kaufman 2013; Saeterdal 2014; Oyo-Ita 2016). Currently, these three effectiveness reviews are characterised by few studies and mostly low certainty evidence.…”

“…Project staff have previously published three Cochrane reviews on the effects of different communication approaches for childhood vaccination and of strategies to improve vaccination coverage in LMICs (Kaufman 2013; Saeterdal 2014; Oyo-Ita 2016). Kaufman 2013 assessed the effect of face-to-face strategies to inform or educate about childhood vaccination, finding low or very low certainty evidence that face-to-face strategies may not have an effect on immunisation rates or parent knowledge and understanding of vaccination.…”

“…Saeterdal 2014 examined community interventions to promote childhood vaccination and found that these interventions may improve attitudes and probably increase vaccination uptake under some circumstances. Oyo-Ita 2016 looked at interventions to improve the coverage of child immunisation in LMICs and found that home visits and health education may improve immunisation coverage.…”

Non-uptake of childhood vaccination among the children of HIV-infected mothers in sub-Saharan Africa: A multilevel analysis

“…30 Interventions that provide parents, caregivers and other community members with information on the benefit of immunization may improve childhood vaccination coverage in the communities and the countries. 31,32 There should be renewed efforts to educate the girl child in Africa as it has been proven that been educated improves vaccination uptake. Special attention is needed in countries with high rate of illiteracy since this factor also impact negatively on vaccines uptake.…”