Promoting, seeking, and reaching vaccination services: A systematic review of costs to immunization programs, beneficiaries, and caregivers

Yemeke, Tatenda T.; Mitgang, Elizabeth; Wedlock, Patrick T.; Higgins, Colleen R.; Chen, Hui-Han; Pallas, Sarah Wood; Abimbola, Taiwo; Wallace, Aaron S.; Bartsch, Sarah M.; Lee, Bruce Y.; Ozawa, Sachiko

doi:10.1016/j.vaccine.2021.05.075

Cited by 3 publications

(2 citation statements)

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Section: Discussionmentioning

confidence: 99%

“…Results showed challenges related to the growth of private sector services and costs to caregivers, including the loss of income [ 22 ]. While these challenges were present in the majority of the cities covered by this research, there is little documented evidence on this issue in the literature, despite costs for private service and transport and loss of income, representing potentially significant barriers for poor urban populations [ 22 ]. The evidence shows caregivers may face loss of income or costs to attend an immunization session while the same caregivers receive little social mobilization and information on the benefits of the service to motivate attendance.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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Introduction: As the world continues to urbanize, particularly in low- and middle-income countries, understanding the barriers and effective interventions to improve urban immunization equity is critical to achieving both Immunization Agenda 2030 targets and the Sustainable Development Goals. Approximately 25 million children missed one or more doses of the diphtheria, tetanus and pertussis (DTP3) vaccine in 2021 and it is estimated that close to 30% of the world’s children missing the first dose of DTP, known as zero-dose, live in urban and peri-urban settings. Methods: The aim of this research is to improve understanding of urban immunization equity through a qualitative review of mixed method studies, urban immunization strategies and funding proposals across more than 70 urban areas developed between 2016 and 2020, supported by Gavi, the Vaccine Alliance. These research studies and strategies created a body of evidence regarding the barriers to vaccination in urban settings and potential interventions relevant to low- and middle-income countries (LMICs) with a focus on the vaccination of urban poor, populations of concern and residents of informal settlements. Through the document review we identified common challenges to achieving equitable coverage in urban areas and mapped proposed interventions. Results: We identified 70 documents as part of the review and categorized results across (1) social determinants of health, (2) immunization service-delivery barriers and (3) quality of services. Barriers and solutions identified in the documents were categorized in these thematic areas, drawing information from results in more than 21 countries. Conclusion: Populations of concern such as migrants, refugees, residents of informal settlements and the urban poor face barriers to accessing care which include poor availability and quality of service. Example solutions proposed to these challenges include tailored delivery strategies, improved use of digital data collection and child-friendly services. More research is required on the efficacy of the proposed interventions identified and on gender-specific dynamics in urban poor areas affecting equitable immunization coverage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%