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...

Improving Equity in Urban Immunization in Low- and Middle-Income Countries: A Qualitative Document Review

“…The recommendations for improvements in these areas include investment and prioritization, bringing children to already existing services in under-resourced areas, improving healthworker interaction and rebuilding the reputation of the immunization programs. These are consistent with the review by Oyo and Nelson et al [ 29 , 30 ].…”

Improving Equity in Urban Immunization in Low- and Middle-Income Countries: A Qualitative Document Review

“…The recommendations for improvements in these areas include investment and prioritization, bringing children to already existing services in under-resourced areas, improving healthworker interaction and rebuilding the reputation of the immunization programs. These are consistent with the review by Oyo and Nelson et al [ 29 , 30 ].…”

Strategies for expanding vaccination coverage in children in Brazil: systematic literature review

“…( 29 ) differed from the other studies in this systematic review by addressing a micro-policy strategy, carried out at the local level. The sending of reminders and educational leaflets to families allowed the increase in the vaccination completeness of the children’s calendar, corroborating previous studies ( 15 , 28 , 47 , 48 ) that implemented interventions with the objective of sharing knowledge about the importance of vaccination and helping parents remember the dates to vaccinate their children. The findings suggest that a simple and low-cost intervention can be implemented by nurses who invest in intersectoral actions, recommended by the Health at School Program ( 28 ) .…”

Community-Led Defaulter Tracking for Catch-Up Vaccination: Implementation Experience in Uganda, 2022 and 2024

“…This compares favorably with findings from another Ugandan study that tracked and linked 68% of defaulters to immunization services [ 24 ], as well as outcomes from Uganda’s Big Catch Up (BCU) in October 2024 which led to catch-up of 89% of DTP1 defaulters, 70% of DTP3 defaulters and 50% of MR1 defaulters [ 30 ]. While direct comparison should be interpreted cautiously due to differences in implementation context and design, these findings are broadly consistent with published evidence suggesting that coordinated community–facility collaboration may support improved vaccination uptake in low- and middle-income countries (LMICs) [ 31 ]. Evidence from systematic reviews [ 32 , 33 ], further show that combined community engagement and health provider interventions are more effective than isolated strategies in improving vaccination uptake in LMICs.…”

Improving Equity in Urban Immunization in Low- and Middle-Income Countries: A Qualitative Document Review

“…The recommendations for improvements in these areas include investment and prioritization, bringing children to already existing services in under-resourced areas, improving healthworker interaction and rebuilding the reputation of the immunization programs. These are consistent with the review by Oyo and Nelson et al [ 29 , 30 ].…”

Strategies for expanding vaccination coverage in children in Brazil: systematic literature review

“…( 29 ) differed from the other studies in this systematic review by addressing a micro-policy strategy, carried out at the local level. The sending of reminders and educational leaflets to families allowed the increase in the vaccination completeness of the children’s calendar, corroborating previous studies ( 15 , 28 , 47 , 48 ) that implemented interventions with the objective of sharing knowledge about the importance of vaccination and helping parents remember the dates to vaccinate their children. The findings suggest that a simple and low-cost intervention can be implemented by nurses who invest in intersectoral actions, recommended by the Health at School Program ( 28 ) .…”

Community-Led Defaulter Tracking for Catch-Up Vaccination: Implementation Experience in Uganda, 2022 and 2024

“…This compares favorably with findings from another Ugandan study that tracked and linked 68% of defaulters to immunization services [ 24 ], as well as outcomes from Uganda’s Big Catch Up (BCU) in October 2024 which led to catch-up of 89% of DTP1 defaulters, 70% of DTP3 defaulters and 50% of MR1 defaulters [ 30 ]. While direct comparison should be interpreted cautiously due to differences in implementation context and design, these findings are broadly consistent with published evidence suggesting that coordinated community–facility collaboration may support improved vaccination uptake in low- and middle-income countries (LMICs) [ 31 ]. Evidence from systematic reviews [ 32 , 33 ], further show that combined community engagement and health provider interventions are more effective than isolated strategies in improving vaccination uptake in LMICs.…”

Improving Equity in Urban Immunization in Low- and Middle-Income Countries: A Qualitative Document Review

“…The recommendations for improvements in these areas include investment and prioritization, bringing children to already existing services in under-resourced areas, improving healthworker interaction and rebuilding the reputation of the immunization programs. These are consistent with the review by Oyo and Nelson et al [ 29 , 30 ].…”

Strategies for expanding vaccination coverage in children in Brazil: systematic literature review

“…( 29 ) differed from the other studies in this systematic review by addressing a micro-policy strategy, carried out at the local level. The sending of reminders and educational leaflets to families allowed the increase in the vaccination completeness of the children’s calendar, corroborating previous studies ( 15 , 28 , 47 , 48 ) that implemented interventions with the objective of sharing knowledge about the importance of vaccination and helping parents remember the dates to vaccinate their children. The findings suggest that a simple and low-cost intervention can be implemented by nurses who invest in intersectoral actions, recommended by the Health at School Program ( 28 ) .…”

Community-Led Defaulter Tracking for Catch-Up Vaccination: Implementation Experience in Uganda, 2022 and 2024

“…This compares favorably with findings from another Ugandan study that tracked and linked 68% of defaulters to immunization services [ 24 ], as well as outcomes from Uganda’s Big Catch Up (BCU) in October 2024 which led to catch-up of 89% of DTP1 defaulters, 70% of DTP3 defaulters and 50% of MR1 defaulters [ 30 ]. While direct comparison should be interpreted cautiously due to differences in implementation context and design, these findings are broadly consistent with published evidence suggesting that coordinated community–facility collaboration may support improved vaccination uptake in low- and middle-income countries (LMICs) [ 31 ]. Evidence from systematic reviews [ 32 , 33 ], further show that combined community engagement and health provider interventions are more effective than isolated strategies in improving vaccination uptake in LMICs.…”