Interventions to Improve Immunization Coverage Among Children and Adolescents: A Meta-analysis

Siddiqui, Faareha; Padhani, Zahra Ali; Salam, Rehana A; Aliani, Razia; Lassi, Zohra S; Das, Jai K; Bhutta, Zulfiqar Ahmed

doi:10.1542/peds.2021-053852d

Cited by 22 publications

(10 citation statements)

References 124 publications

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“…Our review also shows that caregivers who attained some level of education have higher odds of acceptance compared to those who never attended school. This finding echoes the results of previous studies, which showed that attainment of a higher level of education among mothers is a leading predictor of full immunization coverage [ 4 , 37 ] and that health education interventions targeting caregivers significantly increased parental attitudes toward vaccines [ 38 , 39 ] and immunization coverage [ 40 , 41 ]. Therefore, vaccine education campaigns targeting caregivers with a lower level of education may go a long way in improving the acceptance of the RTS,S malaria vaccines among caregivers.…”

Section: Discussionsupporting

confidence: 87%

A systematic review and meta-analysis of the prevalence of caregiver acceptance of malaria vaccine for under-five children in low-income and middle-income countries (LMICs)

et al. 2022

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Introduction Malaria is the second leading cause of death in children after diarrheal disease, with low- and middle-income countries (LMICs) accounting for over 9 in 10 incidence and deaths. Widespread acceptance and uptake of the RTS,S vaccine, recently approved by the world health organization (WHO), is projected to significantly reduce malaria incidence and deaths. Therefore, we conducted this systematic review and meta-analysis with the aim to determine the malaria vaccine acceptance rate and the factors associated with acceptance. Methods We searched six databases including Google Scholar, PubMed, Cochrane, African Index Medicus, The Regional Office for Africa Library, and WHO Institutional Repository for Information Sharing (IRIS) to identify studies evaluating the malaria vaccine acceptance rate. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Studies were included if they were original articles published in the English language in peer-reviewed journals and assessed the prevalence of willingness to accept a free malaria vaccine, and not qualitative. The risk of publication bias was checked using both Beggar’s funnel plot and Egger’s test, while the I2 statistic was used to assess the heterogeneity of the included studies. Study quality was determined using the Newcastle-Ottawa scale. A meta-analysis was performed using a random effects model to evaluate the pooled prevalence of malaria vaccine acceptance. The protocol for this article was registered prospectively on the International Prospective Register for Systematic Reviews (PROSPERO), with ID number CRD42022334282). Results Our analysis included 11 studies with a total sample size of 14, 666 participants. The aggregate malaria vaccine acceptance rate was 95.3% (95% CI:93.0%–97.2%). Among the general population, the acceptance rate was 96.3% (95% CI:92.0%–99.0%) and among mothers, it was 94.4% (95% CI:90.8%–97.2%). By country, Nigeria had the highest acceptance rate (97.6%, 95% CI:96.0%-98.8%), followed by Ghana (94.6%, 95% CI:93.8%-95.3%) and Tanzania (92.5%, 95% CI:84.4%-97.8%). Sociodemographic determinants of vaccine acceptance included place of residence, tribe, age, sex, occupation, and religion. Reasons for low acceptance included safety concerns, efficacy profile, vaccine’s requirement for multiple injections, and poor level of awareness. Conclusion Future efforts should be focused on identifying factors that may improve the actual uptake of the RTS,S vaccine in malaria-endemic communities.

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Section: Discussionsupporting

confidence: 87%

A systematic review and meta-analysis of the prevalence of caregiver acceptance of malaria vaccine for under-five children in low-income and middle-income countries (LMICs)

et al. 2022

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“…Maternal education has been shown to positively contribute to child health and associated immunization service uptake [ 28 , 29 ]. A meta-analysis found that education about vaccinations through counseling sessions and printable information materials increased overall vaccination coverage by 19% [ 30 ]. In the same meta-analysis, interventions for providers, such as training for health staff and reminders for end-users, were shown to improve vaccine coverage by 13% [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Using intervention mapping to develop an implementation strategy to improve timely uptake of streamlined birth-dose vaccines in the Democratic Republic of the Congo

Boisson-Walsh,

Fried,

Shea

et al. 2024

PLOS Glob Public Health

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Despite the policy recommendation and effectiveness of administering the hepatitis B birth-dose vaccine (HepB-BD) to newborns to prevent mother-to-child hepatitis B transmission, timely uptake remains an issue. Countries adopting the HepB-BD to their national immunization schedule report programmatic challenges to administering the vaccine within the recommended 24-hour window after delivery. Further, while the World Health Organization recommends streamlining three birth-dose vaccines (HepB-BD, BCG, and OPV0), scarce Sub-Saharan(SSA)-based literature reports on a streamlined and timely approach to birth-dose vaccines. As more SSA countries adopt the new birth-dose vaccine to their immunization schedules, a systematically developed implementation strategy—Vaccination of Newborns–Innovative Strategies to Hasten Birth-Dose vaccines’ delivery (VANISH-BD)—will facilitate the adoption and implementation of timely birth-dose vaccine uptake. In this paper, we describe the development of the implementation strategy using intervention mapping, an evidence-based and theory-driven approach. We report on the development of our intervention, beginning with the needs assessment based in Kinshasa Province, Democratic Republic of the Congo (DRC), informing step 1 of intervention mapping. The intervention is contextually relevant, locally produced, sustainable, and designed to improve timely birth-dose vaccine uptake in the DRC. We intend to inform future implementers about improving timely and streamlined birth-dose vaccine uptake and for VANISH-BD to be adapted for similar contexts.

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“…Contextualized pro-equity urban immunization interventions will result in faster advances toward the IA2030 targets, and work to halt and slow down current backsliding and fragility in immunization systems. Additionally, many of the results point to the room for multisectoral and integrated interventions, as many of the determinants related to low immunization coverage point to potential interventions on gender barriers, education barriers, and systems strengthening [32,34,35]. Tools such as the urban immunization toolkit are being used by several countries to complement existing immunization guidelines by tailoring immunization planning, implementing, and monitoring approaches to meet challenging contexts in urban areas, especially in slum environments; many such tools are available to support these efforts globally [35].…”

Section: Discussionmentioning

confidence: 99%

Achieving the IA2030 Coverage and Equity Goals through a Renewed Focus on Urban Immunization

et al. 2023

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The 2021 WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) reported approximately 25 million under-vaccinated children in 2021, out of which 18 million were zero-dose children who did not receive even the first dose of a diphtheria-tetanus-pertussis-(DPT) containing vaccine. The number of zero-dose children increased by six million between 2019, the pre-pandemic year, and 2021. A total of 20 countries with the highest number of zero-dose children and home to over 75% of these children in 2021 were prioritized for this review. Several of these countries have substantial urbanization with accompanying challenges. This review paper summarizes routine immunization backsliding following the COVID-19 pandemic and predictors of coverage and identifies pro-equity strategies in urban and peri-urban settings through a systematic search of the published literature. Two databases, PubMed and Web of Science, were exhaustively searched using search terms and synonyms, resulting in 608 identified peer-reviewed papers. Based on the inclusion criteria, 15 papers were included in the final review. The inclusion criteria included papers published between March 2020 and January 2023 and references to urban settings and COVID-19 in the papers. Several studies clearly documented a backsliding of coverage in urban and peri-urban settings, with some predictors or challenges to optimum coverage as well as some pro-equity strategies deployed or recommended in these studies. This emphasizes the need to focus on context-specific routine immunization catch-up and recovery strategies to suit the peculiarities of urban areas to get countries back on track toward achieving the targets of the IA2030. While more evidence is needed around the impact of the pandemic in urban areas, utilizing tools and platforms created to support advancing the equity agenda is pivotal. We posit that a renewed focus on urban immunization is critical if we are to achieve the IA2030 targets.

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Interventions to Improve Immunization Coverage Among Children and Adolescents: A Meta-analysis

Cited by 22 publications

References 124 publications

A systematic review and meta-analysis of the prevalence of caregiver acceptance of malaria vaccine for under-five children in low-income and middle-income countries (LMICs)

A systematic review and meta-analysis of the prevalence of caregiver acceptance of malaria vaccine for under-five children in low-income and middle-income countries (LMICs)

Using intervention mapping to develop an implementation strategy to improve timely uptake of streamlined birth-dose vaccines in the Democratic Republic of the Congo

Achieving the IA2030 Coverage and Equity Goals through a Renewed Focus on Urban Immunization

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