Background
Vaccination plays a critical role in reducing childhood morbidity and mortality. Immunizing children against life-threatening and debilitating vaccine-preventable diseases remains a challenge, despite effective vaccines, particularly in low- and middle-income countries.
With the introduction of new vaccines, this is becoming increasingly difficult. Therefore, it is currently necessary to summarize the available evidence on the strategies used to reduce this gap. This is a second update of the Cochrane review first published in 2011 and updated in 2016, and focuses on interventions to improve childhood vaccination coverage in low- and middle-income countries.
What is the objective of this review?
The aim of this Cochrane review was to evaluate the effect of different strategies to increase the number of children in low- and middle-income countries who are vaccinated to prevent infection with a disease. Cochrane researchers collected and analyzed all relevant studies to answer this question and found 41 relevant studies.
Do strategies to improve childhood vaccination work?
Millions of children in low- and middle-income countries continue to die from diseases that could have been prevented by vaccines, in part because the number of children vaccinated in this context remains low. Governments and other agencies have tried different strategies to increase the number of children vaccinated.
What was studied in the review?
All interventions aimed at improving the number of children under five years of age who are vaccinated were reviewed. These include interventions aimed at caregivers (parents/guardians), health professionals, the community, the health system or a combination of any of these.
What are the main results of the review?
The review authors found 41 relevant studies from Afghanistan, China, Ivory Coast, Ethiopia, Georgia, Ghana, Guatemala, Honduras, India, Indonesia, Kenya, Mali, Mexico, Nepal, Nicaragua, Nigeria, Pakistan, Rwanda and Zimbabwe. The studies included 100,747 participants. They compared people who received these strategies with those who only received regular health services.
The studies showed the following.
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What are the limitations of the evidence?
Confidence in the evidence for the interventions studied ranged from moderate to very low, implying that the results of future research studies could differ from the results of this review.
The main reasons for low confidence in the evidence are that, in some of the studies, people were not randomly assigned to different intervention groups. This means that differences between groups could be due to differences between people and not between interventions. For some interventions, the results were very contradictory between the different studies and for others only one study was available, or the intervention had few people studied.
How current is this review?
The review authors searched for studies published up to July 2022.
