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The effect of mass vaccination campaigns against polio on the utilization of routine immunization services: A regression discontinuity design

Monday, 18th of July 2016

Vaccine, Volume 34, Issue 33, 19 July 2016, Pages 3817–3822

The effect of mass vaccination campaigns against polio on the utilization of routine immunization services: A regression discontinuity design

• Stephane Helleringer^{a, ,} ,
• Patrick O. Asuming^b,
• Jalaa Abdelwahab^c
• ^a Johns Hopkins University, Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
• ^b University of Ghana Business School, Ghana
• ^c United Nations´ Children Fund (UNICEF), USA

Received 31 January 2016, Revised 13 May 2016, Accepted 25 May 2016, Available online 15 June 2016

Highlights

•Mass vaccination campaigns may affect the use of routine immunization services.

 

•Unobserved confounders and reverse causality affect evaluations of mass vaccination campaigns.

 

•We proposed a framework that emulates a randomized trial of exposure to a mass vaccination campaign.

 

•In Bangladesh, we found that exposure to a polio campaign increased the use of routine immunization.

 

•This framework could help evaluate other vaccination campaigns and disease-specific programs.

Abstract below; full text is available to journal subscribers.

Background

In most low and middle-income countries (LMIC), vaccines are primarily distributed by routine immunization services (RI) at health facilities. Additional opportunities for vaccination are also provided through mass vaccination campaigns, conducted periodically as part of disease-specific initiatives. It is unclear whether these campaigns are detrimental to RI services, or wether they may stimulate the utilization of RI.

Methods

Unobserved confounders and reverse causality have limited existing evaluations of the effects of mass vaccination campaigns on RI services. We explored the use of a regression discontinuity design (RDD) to measure these effects more precisely. This is a quasi-experimental method, which exploits random variations in birth dates to identify the causal effects of vaccination campaigns. We applied RDD to survey data on a nationwide vaccination campaign against Polio conducted in Bangladesh.

Results

We compared systematically the children born immediately before vs. after the vaccination campaign. These two groups had similar background characteristics, but differed by their exposure to the vaccination campaign. Contrary to previous studies, exposure to the campaign had positive effects on RI utilization. Children exposed to the campaign received between 0.296 and 0.469 additional doses of DPT vaccine by age 4 months than unexposed children.

Conclusions

RDD constitutes a promising tool to assess the effects of mass vaccination campaigns on RI services. It could be tested in additional settings, using larger and more precise datasets. It could also be extended to measure the effects of other disease-specific interventions on the functioning of health systems, in particular those that occur at a discrete point in time and/or include age-related eligibility criteria.

© 2016 Elsevier Ltd. All rights reserved.