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Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature

Monday, 24th of October 2016

 

Vaccine

Volume 34, Issue 46, 4 November 2016, Pages 5495–5503

Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature

• Kristin N. Nelson^a, , , 
• Aaron S. Wallace^a, b, 
• Samir V. Sodha^b, 
• Danni Daniels^b, 
• Vance Dietz^b
• ^a Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States
• ^b Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States

Received 19 May 2016, Revised 1 September 2016, Accepted 15 September 2016, Available online 28 September 2016

http://dx.doi.org/10.1016/j.vaccine.2016.09.038

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Highlights

•Reviewed interventions focused on improving access to and utilization of immunization services.

•Simple, strategic changes had impacts on immunization uptake.

•Reaching Every District (RED) strategies can be successfully tailored to urban settings.

•Few studies have assessed interventions designed explicitly for urban areas.

Abstract

Introduction

Immunization programs in developing countries increasingly face challenges to ensure equitable delivery of services within cities where rapid urban growth can result in informal settlements, poor living conditions, and heterogeneous populations. A number of strategies have been utilized in developing countries to ensure high community demand and equitable availability of urban immunization services; however, a synthesis of the literature on these strategies has not previously been undertaken.

Methods

We reviewed articles published in English in peer-reviewed journals between 1990 and 2013 that assessed interventions for improving routine immunization coverage in urban areas in low- and middle-income countries. We categorized the intervention in each study into one of three groups: (1) interventions aiming to increase utilization of immunization services; (2) interventions aiming to improve availability of immunization services by healthcare providers, or (3) combined availability and utilization interventions. We summarized the main quantitative outcomes from each study and effective practices from each intervention category.

Results

Fifteen studies were identified; 87% from the African, Eastern Mediterranean and Southeast Asian regions of the World Health Organization (WHO). Six studies were randomized controlled trials, eight were pre- and post-intervention evaluations, and one was a cross-sectional study. Four described interventions designed to improve availability of routine immunization services, six studies described interventions that aimed to increase utilization, and five studies aiming to improve both availability and utilization of services. All studies reported positive change in their primary outcome indicator, although seven different primary outcomes indicators were used across studies. Studies varied considerably with respect to the type of intervention assessed, study design, and length of intervention assessment.

Conclusion

Few studies have assessed interventions designed explicitly for the unique challenges facing immunization programs in urban areas. Further research on sustainability, scalability, and cost-effectiveness of interventions is needed to fill this gap.