scholarly journals Every child on the map: A theory of change framework for improving childhood immunization coverage and equity using geospatial data and technologies (Preprint)

2021 ◽  
Author(s):  
Sarah Cunard Chaney ◽  
Patricia Mechael ◽  
Nay Myo Thu ◽  
Mamadou S Diallo ◽  
Carine Gachen
Keyword(s):  
Positive Impact ◽  
Immunization Coverage ◽  
Service Planning ◽  
Geospatial Data ◽  
Health System Strengthening ◽  
Theory Of Change ◽  
Immunization Programs ◽  
Childhood Immunization ◽  
Middle Income ◽  
Effective Use

UNSTRUCTURED The effective use of geospatial data and technologies to collect, manage, analyze, model and visualize geographic data has great potential to improve data driven decision-making for immunization programs. This article presents A Theory of Change for the use of geospatial technologies for immunization programming, a framework to illustrate the ways that geospatial data and technologies can contribute to improved immunization outcomes and have a positive impact on childhood immunization coverage rates in low- and middle-income countries. The Theory of Change is the result of a review of the state of the evidence and literature, consultation with implementers, donors, immunization and geospatial technology experts and a review of country implementation experiences. The framework illustrates how the effective use of geospatial data and technologies can help immunization programs realize improvements in the number of children immunized by producing reliable estimates of target populations, identifying chronically missed settlements and locations with the highest number of zero-dose and under-immunized children and guiding immunization managers with solutions to optimize resource distribution and location of health services. Through these direct effects on service delivery, geospatial data and technologies can contribute to overall health system strengthening with equity in immunization coverage. The Theory of Change presented here may serve as a guide for country program managers, implementers, donors and other stakeholders to better understand how geospatial tools can support immunization programs and facilitate integrated service planning and equitable delivery through the unifying role of geography and geospatial data.

scholarly journals Systematic review of the costs and effectiveness of interventions to increase infant vaccination coverage in low- and middle-income countries

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Cristina Munk ◽  
Allison Portnoy ◽  
Christian Suharlim ◽  
Emma Clarke-Deelder ◽  
Logan Brenzel ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Scale Up ◽  
Immunization Coverage ◽  
Health Systems Strengthening ◽  
Cash Transfer ◽  
Immunization Programs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Objective Evidence ◽  
Low And Middle Income

Abstract Background In recent years, several large studies have assessed the costs of national infant immunization programs, and the results of these studies are used to support planning and budgeting in low- and middle-income countries. However, few studies have addressed the costs and cost-effectiveness of interventions to improve immunization coverage, despite this being a major focus of policy attention. Without this information, countries and international stakeholders have little objective evidence on the efficiency of competing interventions for improving coverage. Methods We conducted a systematic literature review on the costs and cost-effectiveness of interventions to improve immunization coverage in low- and middle-income countries, including both published and unpublished reports. We evaluated the quality of included studies and extracted data on costs and incremental coverage. Where possible, we calculated incremental cost-effectiveness ratios (ICERs) to describe the efficiency of each intervention in increasing coverage. Results A total of 14 out of 41 full text articles reviewed met criteria for inclusion in the final review. Interventions for increasing immunization coverage included demand generation, modified delivery approaches, cash transfer programs, health systems strengthening, and novel technology usage. We observed substantial heterogeneity in costing methods and incompleteness of cost and coverage reporting. Most studies reported increases in coverage following the interventions, with coverage increasing by an average of 23 percentage points post-intervention across studies. ICERs ranged from $0.66 to $161.95 per child vaccinated in 2017 USD. We did not conduct a meta-analysis given the small number of estimates and variety of interventions included. Conclusions There is little quantitative evidence on the costs and cost-effectiveness of interventions for improving immunization coverage, despite this being a major objective for national immunization programs. Efforts to improve the level of costing evidence—such as by integrating cost analysis within implementation studies and trials of immunization scale up—could allow programs to better allocate resources for coverage improvement. Greater adoption of standardized cost reporting methods would also enable the synthesis and use of cost data.

scholarly journals Effectiveness of PEHRs use to increase vaccine uptake: a systematic review

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Balzarini ◽  
A Oradini Alacreu ◽  
B Frascella ◽  
G Gaetti ◽  
C Signorelli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Positive Impact ◽  
Care Delivery ◽  
Patient Empowerment ◽  
Healthcare Providers ◽  
Pneumococcal Vaccination ◽  
Immunization Coverage ◽  
Vaccine Uptake ◽  
Diabetic Patients ◽  
Immunization Programs

Abstract Background The digital transformation provides tools to empower individuals and enable feedback and interaction between users and healthcare providers. Although Personal Electronic Health Records (PEHR) have been identified as innovative tools enabling the provision of patient-centered care and prevention, evidence on their impact is scant. Methods We conducted a systematic review following the PRISMA guidelines to retrieve, quantitatively pool and critically appraise the effectiveness of PEHR access on vaccine uptake. Analysis on effectiveness were carried out for the following comparison strata: i) PEHR access vs no intervention, ii) PEHR access vs access with additional features. Results Of identified 3125 citations, 8 studies were included, the majority published in the US before 2015. Four studies assessed differences between subjects with and without access to PEHR. Access to PEHR was reported to be an effective tool to increase vaccine uptake: when accessing PEHR, study participants were 6.7% more likely to receive influenza vaccine, parents to have children vaccinated, lifetime pneumococcal vaccination was reported to be higher in diabetic patients, a positive impact on preventive behaviors was reported. Four included studies reported on the effect of access to PEHR with or without additional communication features. In one study, the effect of electronic messages delivered through PEHRs wasn't differentially distributed in the arm receiving tailored messages on influenza, and in the arm receiving educational messages on other diseases. In other studies, active PEHR users were more likely to be vaccinated against influenza and Herpes Zoster, subjects who in addition received reminders had higher rates of influenza vaccination. Conclusions While immunization programs are struggling to achieve optimal coverage targets, our findings can partially outline the association between PEHR access and vaccine uptake and further experimental research is needed. Key messages PEHRs offer great potential to support population health and in particular immunization programs, helping to put people and patients at the center of care delivery, supporting patient empowerment. Although our findings suggest immunization coverage might benefit from people accessing PEHR, there is an urgent need to produce solid experimental evidence to quantify such effect.

scholarly journals Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

2020 ◽  
Author(s):  
Joseph Benjamin Bangura ◽  
Shui-yuan Xiao ◽  
Dan Qiu ◽  
Feiyun Ouyang ◽  
Lei Chen
Keyword(s):  
Systematic Review ◽  
Health Systems ◽  
Immunization Coverage ◽  
Case Control ◽  
Sub Saharan Africa ◽  
Immunization Programs ◽  
Childhood Immunization ◽  
Cross Sectional ◽  
National Immunization ◽  
Sub Saharan

Abstract Background Immunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa. Method This systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in Sub-Saharan Africa from January 1988 to February 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, second-hand data analysis; and case control. Results Of the 2,538 items identified, 40 met inclusion criteria. Parents/caretakers were the most common subjects. Eight articles were of moderate and 32 were of high methodological quality. Seven studies analyzed secondary data; 30 used cross-sectional designs and three employed case control method. Twenty-five studies reported national immunization coverage of key vaccines for children under one, fifteen did not. When reported, national immunization coverages of childhood vaccines were reported to be low. Parents/caretaker’s barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of off-springs, life style, migration and occupation. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines. Conclusion In this review we identified more thoroughly the parents/caretakers’ barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-economic and socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people and societies in their communities across Sub-Saharan Africa.

scholarly journals “Saint Google, now we have information!”: a qualitative study on narratives of trust and attitudes towards maternal vaccination in Mexico City and Toluca

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clarissa Simas ◽  
Heidi J. Larson ◽  
Pauline Paterson
Keyword(s):  
Qualitative Study ◽  
Pregnant Women ◽  
Digital Media ◽  
Mexico City ◽  
Immunization Coverage ◽  
Childhood Immunization ◽  
Maternal Healthcare ◽  
Middle Income ◽  
Maternal Immunization ◽  
Maternal Vaccination

Abstract Background Maternal vaccination is key to decreasing maternal and infant mortality globally. Yet perceptions about maternal vaccines and immunization among pregnant women are often understudied, particularly in low- and middle- income countries. This qualitative study explored trust, views, and attitudes towards maternal immunization among pregnant women in Mexico. A total of 54 women from Mexico City and Toluca participated in the in-depth interviews and focus groups. We explored participants’ experiences with maternal vaccination, as well as how they navigated the health system, searched for information, and made decisions around maternal immunization. Results Our findings point to issues around access and quality of maternal healthcare, including immunizations services. While healthcare professionals were recognized for their expertise, participants reported not receiving enough information to make informed decisions and used online search engines and digital media to obtain more information about maternal healthcare. Some participants held strong doubts over the benefits of vaccination and were hesitant about the safety and efficacy of maternal vaccines. These concerns were also shared by pregnant women who had been vaccinated. Some participants disclosed low levels of trust in government and vaccination campaigns. Conclusion Pregnant women, soon to be parents and making vaccination decisions for their child, constitute an important target group for policymakers seeking optimal maternal as well as childhood immunization coverage. Our findings highlight the importance of targeted communication, trust-building and engagement strategies to strengthen confidence in immunization amongst this group.

scholarly journals A missed opportunity: birth registration coverage is lagging behind Bacillus Calmette–Guérin (BCG) immunization coverage and maternal health services utilization in low- and lower middle-income countries

2019 ◽  
Vol 38 (S1) ◽  
Author(s):  
M. Hafizur Rahman ◽  
Amber Bickford Cox ◽  
Samuel L. Mills
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Immunization Coverage ◽  
Maternal Health Services ◽  
Birth Registration ◽  
Childhood Immunization ◽  
Middle Income ◽  
Middle Income Countries

Abstract Background Civil registration and vital statistics (CRVS) systems lay the foundation for good governance by increasing the effectiveness and delivery of public services, providing vital statistics for the planning and monitoring of national development, and protecting fundamental human rights. Birth registration provides legal rights and facilitates access to essential public services such as health care and education. However, more than 110 low- and middle-income countries (LMICs) have deficient CRVS systems, and national birth registration rates continue to fall behind childhood immunization rates. Using Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data in 72 LMICs, the objectives are to (a) explore the status of birth registration, routine childhood immunization, and maternal health services utilization; (b) analyze indicators of birth registration, routine childhood immunization, and maternal health services utilization; and (c) identify missed opportunities for strengthening birth registration systems in countries with strong childhood immunization and maternal health services by measuring the absolute differences between the birth registration rates and these childhood and maternal health service indicators. Methods We constructed a database using DHS and MICS data from 2000 to 2017, containing information on birth registration, immunization coverage, and maternal health service indicators. Seventy-three countries including 34 low-income countries and 38 lower middle-income countries were included in this exploratory analysis. Results Among the 14 countries with disparity between birth registration and BCG vaccination of more than 50%, nine were from sub-Saharan Africa (Tanzania, Uganda, Gambia, Mozambique, Djibouti, Eswatini, Zambia, Democratic Republic of Congo, Ghana), two were from South Asia (Bangladesh, Nepal), one from East Asia and the Pacific (Vanuatu) one from Latin America and the Caribbean (Bolivia), and one from Europe and Central Asia (Moldova). Countries with a 50% or above absolute difference between birth registration and antenatal care coverage include Democratic Republic of Congo, Gambia, Mozambique, Nepal, Tanzania, and Uganda, in low-income countries. Among lower middle-income countries, this includes Eswatini, Ghana, Moldova, Timor-Leste, Vanuatu, and Zambia. Countries with a 50% or above absolute difference between birth registration and facility delivery care coverage include Democratic Republic of Congo, Djibouti, Moldova, and Zambia. Conclusion The gap between birth registration and immunization coverage in low- and lower middle-income countries suggests the potential for leveraging immunization programs to increase birth registration rates. Engaging health providers during the antenatal, delivery, and postpartum periods to increase birth registration may be a useful strategy in countries with access to skilled providers.

scholarly journals Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

2020 ◽  
Author(s):  
Joseph Benjamin Bangura ◽  
Shui-yuan Xiao ◽  
Dan Qiu ◽  
Feiyun Ouyang ◽  
Lei Chen
Keyword(s):  
Systematic Review ◽  
Health Systems ◽  
Immunization Coverage ◽  
Case Control ◽  
Sub Saharan Africa ◽  
Immunization Programs ◽  
Childhood Immunization ◽  
Cross Sectional ◽  
National Immunization ◽  
Sub Saharan

Abstract Background Immunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa. Method This systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in Sub-Saharan Africa from January 1988 to February 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, second-hand data analysis; and case control. Results Of the 2,538 items identified, 40 met inclusion criteria. Parents/caretakers were the most common subjects. Eight articles were of moderate and 32 were of high methodological quality. Seven studies analyzed secondary data; 30 used cross-sectional designs and three employed case control method. Twenty-five studies reported national immunization coverage of key vaccines for children under one, fifteen did not. When reported, national immunization coverages of childhood vaccines were reported to be low. Parents/caretaker’s barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of off-springs, life style, migration and occupation. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines. Conclusion In this review we identified more thoroughly the parents/caretakers’ barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-economic and socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people and societies in their communities across Sub-Saharan Africa.

scholarly journals Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

2020 ◽  
Author(s):  
Joseph Benjamin Bangura ◽  
Shui-yuan Xiao ◽  
Dan Qiu ◽  
Feiyun Ouyang ◽  
Lei Chen
Keyword(s):  
Systematic Review ◽  
Health Systems ◽  
Immunization Coverage ◽  
Case Control ◽  
Sub Saharan Africa ◽  
Immunization Programs ◽  
Childhood Immunization ◽  
Cross Sectional ◽  
National Immunization ◽  
Sub Saharan

Abstract Background Immunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa. Method This systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in Sub-Saharan Africa from January 1988 to February 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, second-hand data analysis; and case control. Results Of the 2,538 items identified, 40 met inclusion criteria. Parents/caretakers were the most common subjects. Eight articles were of moderate and 32 were of high methodological quality. Seven studies analyzed secondary data; 30 used cross-sectional designs and three employed case control method. Twenty-five studies reported national immunization coverage of key vaccines for children under one, fifteen did not. When reported, national immunization coverages of childhood vaccines were reported to be low. Parents/caretaker’s barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of off-springs, life style, migration and occupation. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines. Conclusion In this review we identified more thoroughly the parents/caretakers’ barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-economic and socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people and societies in their communities across Sub-Saharan Africa.

scholarly journals Childhood Immunization in Ethiopia: Accuracy of Maternal Recall Compared to Vaccination Cards

Vaccines ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 48 ◽  
Author(s):  
Julia M. Porth ◽  
Abram L. Wagner ◽  
Yemesrach A. Tefera ◽  
Matthew L. Boulton
Keyword(s):  
Predictive Value ◽  
Immunization Coverage ◽  
Cross Sectional Study ◽  
Vaccination Status ◽  
Childhood Vaccination ◽  
Childhood Immunization ◽  
Cross Sectional ◽  
Middle Income ◽  
Vaccination Card ◽  
Maternal Recall

Health surveys conducted in low- and middle-income countries typically estimate childhood vaccination status based on written vaccination cards, maternal recall (when cards are not available), or a combination of both. This analysis aimed to assess the accuracy of maternal recall of a child’s vaccination status in Ethiopia. Data came from a 2016 cross-sectional study conducted in the Southern Nations, Nationalities, and Peoples’ (SNNP) Region of Ethiopia. Vaccine doses received by a given 12–23-month-old child were recorded from both a vaccination card and based on maternal recall and then compared. Concordance, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen’s Kappa were calculated. Estimates of full immunization coverage were similar when collected via vaccination card (75%) and maternal recall (74%). For fully vaccinated children, comparison of maternal recall versus vaccination card showed high concordance (96%), sensitivity (97%), specificity (93%), PPV (98%), NPV (92%), and Kappa (90%). Accuracy of maternal recall of a child’s vaccination status is high in the SNNP region of Ethiopia. Although determination of vaccination status via vaccination card is preferred since it constitutes a written record, maternal recall can also be used with confidence when vaccination cards are not available.

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