Cochrane · systematic review · CD008145
Interventions for improving coverage of childhood immunisation in low‐ and middle‐income countries
Oyo-Ita, A, Oduwole, O, Arikpo, D, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
104
current version
GRADE rated
54
No studies
50
Included studies
NR
No studies 50 · 48.1%Ungraded 0 · 0%Very low 15 · 14.4%Low 29 · 27.9%Moderate 10 · 9.6%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Show all 3 versionsHealth education compared to routine care for improving coverage of childhood immunisation in low‐ and middle‐income countries
Population: children under 5 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who received DTP3/Penta 3 by 1 year of age Health education vs routine care | RR 1.36 [1.15, 1.62] | 6 studies · 4375 participants | Low Downgraded: risk of bias, inconsistency |
Proportion of children who received all recommended vaccines by 2 years of age Health education vs routine care | no estimate extracted | NR | No studies |
Proportion of children who received the vaccine under study (BCG) Health education vs routine care | RR 0.99 [0.96, 1.01] | 2 studies · 1557 participants | Moderate Downgraded: risk of bias |
Proportion of children who received the vaccine under study (OPV3) Health education vs routine care | RR 1.08 [1.04, 1.11] | 1 study · 851 participants | Low Downgraded: risk of bias |
Proportion of children who received the vaccine under study (HBV3) Health education vs routine care | RR 1.07 [1.03, 1.1] | 1 study · 851 participants | Low Downgraded: risk of bias |
Proportion of children who received the vaccine under study (measles vaccine) Health education vs routine care | RR 1.25 [1.06, 1.47] | 4 studies · 3343 participants | Low Downgraded: risk of bias |
Proportion of children who received other vaccine under study (BCG + DTP3 + OPV) Health education vs routine care | RR 1.02 [0.96, 1.09] | 1 study · 393 participants | Low Downgraded: risk of bias |
Received at least one vaccine Health education vs routine care | RR 1.58 [1.21, 2.05] | 1 study · 228 participants | Moderate Downgraded: imprecision |
Proportion of children under 5 years of age fully immunised with all scheduled vaccines Health education vs routine care | RR 1.24 [1.06, 1.44] | 3 studies · 2387 participants | Low Downgraded: risk of bias, inconsistency |
Occurrence of vaccine‐preventable diseases Health education vs routine care | no estimate extracted | NR | No studies |
Cost of the intervention ‐ reported narratively in 2 studies Health education vs routine care | no estimate extracted | NR | No studies |
Adverse events Health education vs routine care | no estimate extracted | NR | No studies |
Monetary incentives compared to routine care for improving coverage of childhood immunisation in low‐ and middle‐income countries
Population: children under 5 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who received DTP3 or Penta 3 by 1 year of age Monetary incentives vs routine care | no estimate extracted | NR | No studies |
Proportion of children who received all recommended vaccines by 2 years of age Monetary incentives vs routine care | no estimate extracted | NR | No studies |
Proportion of children who received the vaccine under study (BCG) Monetary incentives vs routine care | RR 1 [0.99, 1.01] | 1 study · 2175 participants | Very low Downgraded: risk of bias |
Proportion of children who received the vaccine under study (measles/MMR) ‐ household monetary incentivef Monetary incentives vs routine care | RR 1.06 [0.93, 1.21] | 2 studies · 2709 participants | Very low Downgraded: risk of bias |
Proportion of children who received the vaccine under study (MMR) ‐ service‐level monetary incentiveg Monetary incentives vs routine care | RR 1.06 [0.95, 1.18] | 1 study · 615 participants | Very low Downgraded: risk of bias |
Proportion of children who received the vaccine under study (MMR) ‐ household + service‐level monetary incentive Monetary incentives vs routine care | RR 1.09 [0.96, 1.14] | 1 study · 456 participants | Very low Downgraded: risk of bias |
Proportion of children under 5 years of age fully immunised with all scheduled vaccines Monetary incentives vs routine care | RR 1.05 [0.92, 1.2] | 2 studies · 1000 participants | Very low Downgraded: risk of bias |
Occurrence of vaccine‐preventable diseases Monetary incentives vs routine care | no estimate extracted | NR | No studies |
Cost of the intervention Monetary incentives vs routine care | no estimate extracted | NR | No studies |
Adverse events Monetary incentives vs routine care | no estimate extracted | NR | No studies |
Home‐based record combined with other interventions compared to routine care for improving coverage of childhood immunisation in low‐ and middle‐income countries
Population: children aged 1 year
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who received DTP3 or Penta 3 ‐ HBRf only Home‐based record combined with other interventions vs routine care | RR 1.36 [1.06, 1.75] | 3 studies · 4019 participants | Low Downgraded: risk of bias, inconsistency |
Proportion of children who received DTP3 or Penta 3 ‐ HBR + health educationg Home‐based record combined with other interventions vs routine care | RR 1.49 [1.22, 1.82] | 2 studies · 1502 participants | Low Downgraded: risk of bias, inconsistency |
Proportion of children who received DTP3 or Penta 3 ‐ HBR + stickerh Home‐based record combined with other interventions vs routine care | RR 1.46 [1.02, 2.09] | 1 study · 2182 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received all recommended vaccines by 2 years of age Home‐based record combined with other interventions vs routine care | no estimate extracted | NR | No studies |
Proportion of children who received the vaccine under study Home‐based record combined with other interventions vs routine care | no estimate extracted | NR | No studies |
Proportion of children under 5 years of age fully immunised with all scheduled vaccines Home‐based record combined with other interventions vs routine care | no estimate extracted | NR | No studies |
Occurrence of vaccine‐preventable diseases Home‐based record combined with other interventions vs routine care | no estimate extracted | NR | No studies |
Cost of the intervention presented narratively in 2 studies Home‐based record combined with other interventions vs routine care | no estimate extracted | NR | No studies |
Adverse events Home‐based record combined with other interventions vs routine care | no estimate extracted | NR | No studies |
Digital register compared to routine care for improving coverage of childhood immunisation in low‐ and middle‐income countries
Population: children under 5 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who received DTP3 or Penta 3 by 1 year of age Digital register vs routine care | RR 0.98 [0.89, 1.09] | 2 studies · 328 participants | Moderate Downgraded: risk of bias |
Proportion of children who received all recommended vaccines by 2 years of age Digital register vs routine care | RR 1.03 [0.88, 1.2] | 1 study · 205 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study (BCG) Digital register vs routine care | RR 0.98 [0.92, 1.04] | 1 study · 205 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study (OPV3) Digital register vs routine care | RR 1.06 [0.97, 1.17] | 1 study · 205 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study (measles) Digital register vs routine care | RR 1.06 [0.97, 1.17] | 1 study · 205 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study (HBV3) Digital register vs routine care | RR 0.98 [0.89, 1.07] | 1 study · 205 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children under 5 years of age fully immunised with all scheduled vaccines Digital register vs routine care | no estimate extracted | NR | No studies |
Occurrence of vaccine‐preventable diseases Digital register vs routine care | no estimate extracted | NR | No studies |
Cost of the intervention Digital register vs routine care | no estimate extracted | NR | No studies |
Adverse events Digital register vs routine care | no estimate extracted | NR | No studies |
Phone call/SMS with/without combination with monetary incentives compared to routine care for improving coverage of childhood immunisation in low‐ and middle‐income countries
Population: children under 5 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who received DTP3 or Penta 3 by 1 year of age (phone call/SMS) Phone call/SMS with/without combination with monetary incentives vs routine care | RR 1.12 [1, 1.25] | 6 studies · 3869 participants | Low Downgraded: risk of bias, inconsistency |
Proportion of children who received DTP3 or Penta 3 by 1 year of age (SMS + monetary incentive) Phone call/SMS with/without combination with monetary incentives vs routine care | RR 1.01 [0.98, 1.03] | 1 study · 766 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received all recommended vaccines by 2 years of age (phone call/SMS only) Phone call/SMS with/without combination with monetary incentives vs routine care | RR 1.06 [0.99, 1.12] | 5 studies · 10414 participants | Low Downgraded: risk of bias, inconsistency |
Proportion of children who received all recommended vaccines by 2 years of age (SMS + monetary incentive) Phone call/SMS with/without combination with monetary incentives vs routine care | RR 1.09 [1.02, 1.16] | 1 study · 766 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study ‐ BCG (phone call/SMS only) Phone call/SMS with/without combination with monetary incentives vs routine care | RR 0.98 [0.82, 1.18] | 1 study · 748 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study ‐ BCG (SMS + monetary incentive) Phone call/SMS with/without combination with monetary incentives vs routine care | RR 1 [0.84, 1.2] | 1 study · 766 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study ‐ OPV3 (phone call/SMS only) Phone call/SMS with/without combination with monetary incentives vs routine care | RR 0.99 [0.94, 1.05] | 2 studies · 1069 participants | Moderate Downgraded: risk of bias |
Proportion of children who received the vaccine under study ‐ OPV3 (phone call/SMS + monetary incentive) Phone call/SMS with/without combination with monetary incentives vs routine care | RR 1.01 [0.99, 1.04] | 1 study · 766 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study ‐ measles/MMR (phone call/SMS + monetary incentive) Phone call/SMS with/without combination with monetary incentives vs routine care | RR 1.07 [1.01, 1.14] | 1 study · 766 participants | Low Downgraded: risk of bias, imprecision |
Occurrence of vaccine‐preventable diseases Phone call/SMS with/without combination with monetary incentives vs routine care | no estimate extracted | NR | No studies |
Cost of the intervention ‐ reported narratively for 2 studiesk Phone call/SMS with/without combination with monetary incentives vs routine care | no estimate extracted | NR | No studies |
Adverse events Phone call/SMS with/without combination with monetary incentives vs routine care | no estimate extracted | NR | No studies |
Wearable reminders compared to routine care for improving coverage of childhood immunisation in low‐ and middle‐income countries
Population: children under 5 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who received DTP3 or Penta 3 by 1 year of age Wearable reminders vs routine care | RR 1.02 [0.97, 1.07] | 2 studies · 1567 participants | Moderate Downgraded: risk of bias |
Proportion of children who received all recommended vaccines by 2 years of age Wearable reminders vs routine care | no estimate extracted | NR | No studies |
Proportion of children who received the vaccine under study ‐ BCG Wearable reminders vs routine care | RR 0.84 [0.74, 0.94] | 1 study · 1382 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study ‐ measles Wearable reminders vs routine care | RR 1.04 [0.97, 1.12] | 1 study · 1440 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children under 5 years of age fully immunised with all scheduled vaccines Wearable reminders vs routine care | no estimate extracted | NR | No studies |
Occurrence of vaccine‐preventable diseases Wearable reminders vs routine care | no estimate extracted | NR | No studies |
Cost of the intervention ‐ reported narratively for 1 study Wearable reminders vs routine care | no estimate extracted | NR | No studies |
Adverse events Wearable reminders vs routine care | no estimate extracted | NR | No studies |
Training of health providers compared with routine care for improving coverage of childhood immunisation in low‐ and middle‐income countries
Population: children under the age of 5 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who received DTP3 or Penta 3 by 1 year of age Training of health providers vs routine care | no estimate extracted | NR | No studies |
Proportion of children who received all recommended vaccines by 2 years of age Training of health providers vs routine care | RR 5.65 [3.62, 8.83] | 1 study · 420 participants | Very low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study (BCG) Training of health providers vs routine care | no estimate extracted | NR | No studies |
Proportion of children under 5 years of age fully immunised with all scheduled vaccines Training of health providers vs routine care | no estimate extracted | NR | No studies |
Occurrence of vaccine‐preventable diseases Training of health providers vs routine care | no estimate extracted | NR | No studies |
Cost of the intervention Training of health providers vs routine care | no estimate extracted | NR | No studies |
Adverse events Training of health providers vs routine care | no estimate extracted | NR | No studies |
Home visit compared to routine care for improving coverage of childhood immunisation in low‐ and middle‐income countries
Population: children under 5 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who received DTP3 or Penta 3 by 1 year of age Home visit vs routine care | no estimate extracted | NR | No studies |
Proportion of children who received all recommended vaccines by 2 years of age Home visit vs routine care | RR 1.29 [1.15, 1.45] | 1 study · 419 participants | Very low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study (OPV3) Home visit vs routine care | RR 1.22 [1.1, 1.35] | 1 study · 419 participants | Very low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study (measles) Home visit vs routine care | RR 1.26 [1.14, 1.39] | 1 study · 419 participants | Very low Downgraded: risk of bias, imprecision |
Number of children under 5 years of age fully immunised with all scheduled vaccines ‐ not reported Home visit vs routine care | no estimate extracted | NR | No studies |
Occurrence of vaccine‐preventable diseases Home visit vs routine care | no estimate extracted | NR | No studies |
Cost of the intervention Home visit vs routine care | no estimate extracted | NR | No studies |
Adverse events Home visit vs routine care | no estimate extracted | NR | No studies |
Immunisation outreach compared to routine care for improving coverage of childhood immunisation in low‐ and middle‐income countries
Population: children under 5 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who received DTP3/Penta 3 by 1 year of age Immunisation outreach vs routine care | RR 1.32 [1.11, 1.56] | 1 study · 541 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Proportion of children who received all recommended vaccines by 25 years of age Immunisation outreach vs routine care | RR 1.33 [1, 1.76] | 1 study · 309 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Proportion of children who received the vaccine under study (BCG) Immunisation outreach vs routine care | RR 1.06 [0.99, 1.13] | 1 study · 647 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Proportion of children who received the vaccine under study (HBV3) Immunisation outreach vs routine care | RR 1.36 [1.13, 1.64] | 1 study · 541 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Proportion of children who received the vaccine under study (OPV3) Immunisation outreach vs routine care | RR 1.38 [1.16, 1.65] | 1 study · 541 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Proportion of children who received measles vaccine Immunisation outreach vs routine care | RR 1.26 [0.91, 1.74] | 1 study · 647 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Proportion of children under 5 years of age fully immunised with all scheduled vaccines (outreach only) Immunisation outreach vs routine care | RR 3.09 [2.11, 4.53] | 1 study · 1239 participants | Moderate Downgraded: imprecision, indirectness |
Proportion of children under 5 years of age fully immunised with all scheduled vaccines (outreach + health education) Immunisation outreach vs routine care | RR 1.28 [1.23, 1.33] | 1 study · 49444 participants | Moderate Downgraded: risk of bias |
Proportion of children under 5 years of age fully immunised with all scheduled vaccines (outreach + non‐monetary incentive) Immunisation outreach vs routine care | RR 6.66 [4.78, 9.28] | 1 study · 1242 participants | Moderate Downgraded: imprecision, indirectness |
Occurrence of vaccine‐preventable diseases Immunisation outreach vs routine care | no estimate extracted | NR | No studies |
Cost of the intervention ‐ reported narratively in one studyc Immunisation outreach vs routine care | no estimate extracted | NR | No studies |
Adverse events Immunisation outreach vs routine care | no estimate extracted | NR | No studies |
Integration of immunisation with other health services compared to routine care for improving coverage of childhood immunisation in low‐ and middle‐income countries
Population: children under 5 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who received DTP3/Penta 3 by 1 year of age Integration of immunisation with other health services vs routine care | RR 1.27 [1.17, 1.38] | 1 study · 2192 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received all recommended vaccines by 2 years of age Integration of immunisation with other health services vs routine care | RR 1.29 [1.16, 1.44] | 1 study · 1700 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study (BCG) Integration of immunisation with other health services vs routine care | RR 0.97 [0.93, 1.01] | 1 study · 2089 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study (yellow fever) Integration of immunisation with other health services vs routine care | RR 1.13 [1.04, 1.22] | 1 study · 1383 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children who received the vaccine under study (measles) Integration of immunisation with other health services vs routine care | RR 1.13 [1.04, 1.22] | 1 study · 1370 participants | Low Downgraded: risk of bias, imprecision |
Proportion of children under 5 years of age fully immunised with all scheduled vaccines Integration of immunisation with other health services vs routine care | no estimate extracted | NR | No studies |
Occurrence of vaccine‐preventable diseases Integration of immunisation with other health services vs routine care | no estimate extracted | NR | No studies |
Cost of the intervention Integration of immunisation with other health services vs routine care | no estimate extracted | NR | No studies |
Adverse events Integration of immunisation with other health services vs routine care | no estimate extracted | NR | No studies |
Engagement of community leaders compared to routine care for improving coverage of childhood immunisation in low‐ and middle‐income countries
Population: children under 5 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children who received DTP3 or Penta 3 by 1 year of age Engagement of community leaders vs routine care | RR 1.37 [1.11, 1.69] | 1 study · 2020 participants | Moderate Downgraded: imprecision |
Proportion of children who received all recommended vaccines by 2 years of age Engagement of community leaders vs routine care | no estimate extracted | NR | No studies |
Proportion of children who received the vaccine under study (measles) Engagement of community leaders vs routine care | RR 1.96 [1.61, 2.39] | 1 study · 1227 participants | Moderate Downgraded: imprecision |
Proportion of children under 5 years of age fully immunised with all scheduled vaccines Engagement of community leaders vs routine care | no estimate extracted | NR | No studies |
Occurrence of vaccine‐preventable diseases Engagement of community leaders vs routine care | no estimate extracted | NR | No studies |
Cost of the intervention Engagement of community leaders vs routine care | no estimate extracted | NR | No studies |
Adverse events Engagement of community leaders vs routine care | no estimate extracted | NR | No studies |