Use of community engagement interventions to improve child immunisation in low‐ and middle‐income countries: A systematic review and meta‐analysis

Jain, Monica; Shisler, Shannon; Lane, Charlotte; Bagai, Avantika; Brown, Elizabeth E.; Engelbert, Mark; Vardy, Yoav; Eyers, John; Leon, Daniela Anda; Parsekar, Shradha S

doi:10.1002/cl2.1253

Cited by 7 publications

(14 citation statements)

References 114 publications

(274 reference statements)

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“…The findings about the success of community engagement tools and approaches at obtaining buy-in among caregivers and community members at large also resonate with the literature on community engagement and its importance in designing, planning and implementing interventions so that they are more likely to be acceptable to the community, feasible, and appropriate for the context [17,21,22]. The interventions in the synthesis did so by assigning roles to community leaders in programme monitoring and leveraging on existing community platforms to facilitate shared accountability between the community and FHWs.…”

Section: Discussionmentioning

confidence: 54%

“…However, from a provider perspective, intervention feasibility is mediated by a few other important factors, including health worker capacity, a lack of cost data, and the limits of the overall health system. Whether local capacity is sufficient to deliver these interventions in low resource L&MIC contexts remains a concern [17,24].…”

Section: Discussionmentioning

confidence: 99%

“…The interventions varied in the tools and approaches they used to engage the community and the stage at which they involved the community. In their systematic review, Jain and colleagues [17] offer a theoretical framework (Fig 1) that captures this diversity in community engagement approaches and broadly indicates the causal links that undergird community engagement interventions, and the assumptions made along the way, to affect the behavioural, social, and practical drivers of immunisation and improve service delivery. Formative evaluations helped interrogate theory of change assumptions by unpacking how aspects such as appropriateness, acceptability, and feasibility impinged upon intervention logic.…”

Section: Community Engagement Approaches: Theory Of Change and Role O...mentioning

confidence: 99%

“…They consulted a range of stakeholders to identify potential barriers and enablers that affected the appropriateness, acceptability and feasibility of piloted tools and approaches. The last column provides information on how these interventions map onto the community engagement framework conceptualised by Jain and colleagues [17].…”

Section: Plos Onementioning

confidence: 99%

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Designing appropriate, acceptable and feasible community-engagement approaches to improve routine immunisation outcomes in low- and middle-income countries: A synthesis of 3ie-supported formative evaluations

Tripathi¹,

Jain²,

Bagai³

et al. 2022

PLoS ONE

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Introduction As global child vaccination coverage has plateaued, understanding how to increase routine child vaccination rates further is key to avoiding preventable disease and death. To analyse how community engagement strategies can increase child vaccination, we synthesise the results from formative evaluations of interventions that aimed to increase vaccination coverage in Ethiopia, Myanmar, Nigeria, and Pakistan Methods This paper uses an inductive qualitative approach to synthesise the results from the six evaluations, gathering lessons for designing context appropriate interventions that are feasible to implement and acceptable to providers, communities, and caregivers. Results Assessing contextual, caregiver-level and provider-level barriers to vaccination is key to identifying appropriate engagement strategies. Across all contexts, low knowledge about the schedule of vaccines and the importance of timeliness represented a barrier to child immunisation. Despite the variability in how studies measured and reported caregiver attitudes, vaccine hesitancy was not found to represent an important barrier to immunisation. Frontline health workers played a critical role in community engagement approaches to increase vaccination. Interventions successfully obtained community buy-in by centre-staging community members, especially leaders, ensuring their participation in monitoring, and making immunisation an agenda item on community platforms. Interventions were implemented through existing health systems with substantial assistance from research teams. Limited data was available about intervention costs. Conclusions Interventions designed around community engagement strategies can be appropriate, acceptable, and feasible approaches to overcome barriers to vaccination in a variety of low- and middle-income country contexts. However, questions remain about the ability of health systems to implement interventions at scale, both from a cost perspective and a capacity perspective.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Community Engagement Approaches: Theory Of Change and Role O...mentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

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Designing appropriate, acceptable and feasible community-engagement approaches to improve routine immunisation outcomes in low- and middle-income countries: A synthesis of 3ie-supported formative evaluations

Tripathi¹,

Jain²,

Bagai³

et al. 2022

PLoS ONE

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“…Community engagement has been found to increase child vaccine uptake in LMICs [12]. In Ethiopia, community engagement interventions on childhood vaccination have included community health workers in their delivery [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

A 10+10+30 radio campaign is associated with increased infant vaccination and decreased morbidity in Jimma Zone, Ethiopia: A prospective, quasi-experimental trial

Appiah

Gebretsadik²,

Mamo³

et al. 2022

PLOS Glob Public Health

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Mass media interventions have the potential to reach large audiences and influence health behaviours and outcomes. To date, no study has evaluated the effect of a radio-only campaign on infant vaccination coverage, timeliness, and related morbidity in a low-income country. We implemented the “10+10+30” radio campaign involving broadcasting a weekly 10-minute radio drama series on vaccination, followed by a 10-minute discussion by community health workers, and then a 30-minute listener phone-in segment in Jimma Zone, Ethiopia for three months. To assess the impact of 10+10+30, which was aired on a community radio station, we recruited mothers of infants up to 5 weeks old in intervention district clusters that were inside the radio station’s reception range (n = 328 dyads) and control district clusters that were outside of the range (n = 332 dyads). Intention-to-treat and per-protocol analyses, adjusted for pre-intervention differences between the districts, were conducted to examine the co-primary outcome of Penta-3 vaccination coverage and timeliness as well as those of other vaccines and outcomes related to infant morbidity. Both intention-to-treat and per-protocol analyses revealed higher vaccine coverage (p<0.001) and more timely vaccine administration (p<0.001) in the intervention district relative to the control district, with infants in the intervention district being 39% more likely to receive a Penta 3 vaccination (adjusted RR: 1.39, p<0.001). In addition, adjusted regression analyses of maternal retrospective reports over a two-week period revealed 80% less infant diarrhoea (RR: 0.20, p<0.001), 40% less fever (RR: 0.60, p<0.001) and 58% less cough (RR: 0.42, p<0.001) in the intervention district relative to the control district. This study provides compelling initial evidence that a radio drama integrated with discussion and phone-in components may improve infant vaccination coverage and timeliness, and may reduce infant morbidity. Randomized controlled trials are needed to confirm and extend these findings with other samples.

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Effective interventions for improving routine childhood immunisation in low and middle-income countries: a systematic review of systematic reviews

Jain,

Duvendack,

Shisler

et al. 2024

BMJ Open

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ObjectiveAn umbrella review providing a comprehensive synthesis of the interventions that are effective in providing routine immunisation outcomes for children in low and middle-income countries (L&MICs).DesignA systematic review of systematic reviews, or an umbrella review.Data sourcesWe comprehensively searched 11 academic databases and 23 grey literature sources. The search was adopted from an evidence gap map on routine child immunisation sector in L&MICs, which was done on 5 May 2020. We updated the search in October 2021.Eligibility criteriaWe included systematic reviews assessing the effectiveness of any intervention on routine childhood immunisation outcomes in L&MICs.Data extraction and synthesisSearch results were screened by two reviewers independently applying predefined inclusion and exclusion criteria. Data were extracted by two researchers independently. The Specialist Unit for Review Evidence checklist was used to assess review quality. A mixed-methods synthesis was employed focusing on meta-analytical and narrative elements to accommodate both the quantitative and qualitative information available from the included reviews.Results62 systematic reviews are included in this umbrella review. We find caregiver-oriented interventions have large positive and statistically significant effects, especially those focusing on short-term sensitisation and education campaigns as well as written messages to caregivers. For health system-oriented interventions the evidence base is thin and derived from narrative synthesis suggesting positive effects for home visits, mixed effects for pay-for-performance schemes and inconclusive effects for contracting out services to non-governmental providers. For all other interventions under this category, the evidence is either limited or not available. For community-oriented interventions, a recent high-quality mixed-methods review suggests positive but small effects. Overall, the evidence base is highly heterogenous in terms of scope, intervention types and outcomes.ConclusionInterventions oriented towards caregivers and communities are effective in improving routine child immunisation outcomes. The evidence base on health system-oriented interventions is scant not allowing us to reach firm conclusions, except for home visits. Large evidence gaps exist and need to be addressed. For example, more high-quality evidence is needed for specific caregiver-oriented interventions (eg, monetary incentives) as well as health system-oriented (eg, health workers and data systems) and community-oriented interventions. We also need to better understand complementarity of different intervention types.

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Use of community engagement interventions to improve child immunisation in low‐ and middle‐income countries: A systematic review and meta‐analysis

Cited by 7 publications

References 114 publications

Designing appropriate, acceptable and feasible community-engagement approaches to improve routine immunisation outcomes in low- and middle-income countries: A synthesis of 3ie-supported formative evaluations

Designing appropriate, acceptable and feasible community-engagement approaches to improve routine immunisation outcomes in low- and middle-income countries: A synthesis of 3ie-supported formative evaluations

A 10+10+30 radio campaign is associated with increased infant vaccination and decreased morbidity in Jimma Zone, Ethiopia: A prospective, quasi-experimental trial

Effective interventions for improving routine childhood immunisation in low and middle-income countries: a systematic review of systematic reviews

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