Strategies to increase the demand for childhood vaccination in low- and middle-income countries: a systematic review and meta-analysis

Abstract

ObjectiveTo investigate which strategies to increase demand for vaccination are effective in increasing child vaccine coverage in low- and middle-income countries.MethodsWe searched MEDLINE, EMBASE, Cochrane library, POPLINE, ECONLIT, CINAHL, LILACS, BDSP, Web of Science and Scopus databases for relevant studies, published in English, French, German, Hindi, Portuguese and Spanish up to 25 March 2014. We included studies of interventions intended to increase demand for routine childhood vaccination. Studies were eligible if conducted in low- and middle-income countries and employing a randomized controlled trial, non-randomized controlled trial, controlled before-and-after or interrupted time series design. We estimated risk of bias using Cochrane collaboration guidelines and performed random-effects meta-analysis.FindingsWe identified 11 studies comprising four randomized controlled trials, six cluster randomized controlled trials and one controlled before-and-after study published in English between 1996 and 2013. Participants were generally parents of young children exposed to an eligible intervention. Six studies demonstrated low risk of bias and five studies had moderate to high risk of bias. We conducted a pooled analysis considering all 11 studies, with data from 11 512 participants. Demand-side interventions were associated with significantly higher receipt of vaccines, relative risk (RR): 1.30, (95% confidence interval, CI: 1.17–1.44). Subgroup analyses also demonstrated significant effects of seven education and knowledge translation studies, RR: 1.40 (95% CI: 1.20–1.63) and of four studies which used incentives, RR: 1.28 (95% CI: 1.12–1.45).ConclusionDemand-side interventions lead to significant gains in child vaccination coverage in low- and middle-income countries. Educational approaches and use of incentives were both effective strategies.

A Systematic Review on Health Interventions Used in Enhancing Vaccination Uptake

“…However, a study conducted in the US reported that parents conforming to the nationally recommended vaccination schedule were more likely to rank internet as the most important source in their networks as compared with non-conformer parents [34]. Current review related to childhood vaccination uptake using internet found similar findings [35][36][37][38].…”

Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015

“…Despite varying results among LGAs, the overall survey findings point to both factors of supply and demand in contributing to low vaccination coverage in Nigeria, as seen in other weak health systems [14]. Lack of knowledge or education about vaccines and vaccination services was the most commonly reported reason for non-vaccination, and knowledge about the safety and importance of vaccines were identified as the most important types of information needed to help mothers/caretakers decide to vaccinate their children.…”

Tracing the Consequences of Child Poverty

“…While noting the central importance of vaccine supply and distribution, one review also took into account the demand side and argued that this was important to overcome obstacles that could disadvantage the poorest. The review suggests that both education and financial incentives are effective at increasing use, but places more emphasis on education, and shows that knowledge-based approaches are most important (Johri et al, 2016). Of those strategies seeking to improve vaccination rates, the success of face-to-face interventions aimed at increasing knowledge is low (the review argues for routine vaccination through existing health service activities, not new channels; Kaufman et al, 2013).…”