Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature |
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| Institution: | 1. Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States;2. Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States;1. Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia;2. National Forum for Heart Disease and Stroke Prevention, Washington, District of Columbia;1. Bill & Melinda Gates Foundation, Seattle, Washington, United States;2. UNC Gillings School of Global Public Health, Chapel Hill, NC, United States;1. London School of Hygiene and Tropical Medicine, UK;2. World Health Organization Consultant, Lamballe, France;3. World Health Organization, Geneva, Switzerland;4. Biostat Global Consulting, OH, USA;1. Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh;2. Department of Infectious Diseases & Geographic Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA;3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;4. Johns Hopkins University Global mHealth Initiative, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;5. Duke Global Health Institute, Durham, NC 27708, USA;6. mPower Social Enterprises, House 133, Road 4, Block A, Banani, Dhaka 1213, Bangladesh;7. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada V6H 3V4;8. Centre for International Child Health, BC Children''s Hospital, Vancouver, BC, Canada V6H 3V4;9. Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;10. Centre for Population, Urbanization and Climate Change, icddr,b, Mohakhali, Dhaka 1212, Bangladesh;1. Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan;2. Departments of Global Health, Epidemiology, Paediatrics, and Emory Vaccine Center, Emory University, Atlanta, Georgia;3. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan;1. Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya;2. Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK;3. Centre for International Health, Johns Hopkins University, Baltimore, MD, United States;4. County Department of Health, Kilifi County Hospital, PO Box 491-80108, Kilifi, Kenya;5. National Vaccines and Immunisations Programme, Ministry of Health, Kenya;6. Vector Borne Diseases Control Unit, Ministry of Health, Kenya;7. Department of Medicine, Imperial College, St Mary''s Hospital, Praed Street, London, United Kingdom;8. INDEPTH Network, Accra, Ghana |
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| Abstract: | IntroductionImmunization 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.MethodsWe 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.ResultsFifteen 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.ConclusionFew 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. |
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| Keywords: | Vaccination Urban Immunization Slum |
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