A systematic literature review of missed opportunities for immunization in low- and middle-income countries |
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| Affiliation: | 1. Florida International University, Robert Stempel College of Public Health and Social Work, Global Health Consortium, United States;2. Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences (UAMS), United States;1. Oak Ridge Institute for Science and Education, United States Department of Energy, Washington DC, United States;2. Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;3. Office of the Director, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;1. Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA;2. Immunization Division, Ministry of Health, Phnom Penh, Cambodia;3. World Health Organization, Phnom Penh, Cambodia;4. UNICEF, New York, NY, USA;1. Medical Research Council, Banjul, The Gambia;2. Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan;3. School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan;4. Unité d’Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France;5. Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;6. Ministry of Health, Banjul, The Gambia;7. Institute of Tropical Medicine, Antwerp, Belgium;1. Societat Catalana de Pediatria, Asociación Española de Vacunología, Barcelona, Spain;2. Servicio de Medicina Preventiva y Salud Pública, Hospital Vital Álvarez Buylla, Mieres, Asturias, Asociación Española de Vacunología, Oviedo, Spain;3. Servicio de Pediatría, Hospital Materno-Infantil, Universidad de Extremadura, Asociación Española de Vacunología, Badajoz, Spain;4. Servicio de Medicina Preventiva, Hospital Universitario Donostia, Asociación Española de Vacunología, San Sebastián, Spain;5. Unidad de Infectología Pediátrica, Hospital Materno-Infantil de Málaga, Grupo IBIMA, RITIP, Universidad de Málaga, Plan de Vacunaciones de Andalucía, Consejería de Salud y Familias, Málaga, Spain;6. Servicio de Salud Pública de Lorca, Consejería de Salud, Región de Murcia, Asociación Española de Vacunología, Murcia, Spain |
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| Abstract: | BackgroundMissed opportunities for immunization (MOIs) may contribute to low coverage in diverse settings, including developing countries.MethodsWe conducted a systematic literature review on MOIs among children and women of childbearing age from 1991 to the present in low- and middle-income countries. We searched multiple databases and the references of retrieved articles. Meta-analysis provided a pooled prevalence estimate and both univariate and multivariate meta-regression analysis was done to explore heterogeneity of results across studies.ResultsWe found 61 data points from 45 studies involving 41,310 participants. Of the 45 studies, 41 involved children and 10 involved women. The pooled MOI prevalence was 32.2% (95% CI: 26.8–37.7) among children – with no change during the study period – and 46.9% (95% CI: 29.7–64.0%) among women of child-bearing age. The prevalence varied by region and study methodology but these two variables together accounted for only 12% of study heterogeneity. Among 352 identified reasons for MOIs, the most common categories were health care practices, false contraindications, logistic issues related to vaccines, and organizational limitations, which did not vary by time or geographic region.ConclusionsMOI prevalence was high in low- and middle-income settings but the large number of identified reasons precludes standardized solutions. |
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| Keywords: | Immunization Missed opportunity Vaccine Vaccine hesitancy Systematic review Meta-analysis |
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