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A systematic review of the effects of interventions to inform or educate caregivers about childhood vaccination in low and middle-income countries

Lukusa, Lungeni (2016-03)

Thesis (MSc)--Stellenbosch University, 2016.


ENGLISH ABSTRACT: Background: Despite their proven effectiveness in reducing childhood infectious diseases, the uptake of vaccines remains suboptimal in low and middle-income countries. Identifying strategies for transmitting accurate vaccine information to caregivers would boost childhood vaccination coverage in these countries. The aim of this review was to assess the effects on vaccination coverage of interventions to inform or educate caregivers about childhood vaccination in low and middle-income countries, compared to standard immunisation practices. We chose only information and education because doing a review of all possible interventions for increasing coverage would take more time and resources. Methods: In May 2015 we conducted a comprehensive search of both peer-reviewed and grey literature. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Cumulative Index of Nursing and Allied Health, prospective trial registries, and reference lists of relevant publications. We included only individual randomised controlled trials (RCTs). The systematic review is registered in the PROSPERO International Prospective Register of systematic reviews, registration number CRD42014010141 Results: Our search identified 963 records from which eight studies were considered potentially eligible. After assessment of eligibility, we included six studies and two studies were excluded. Four included studies were conducted in Pakistan, one in India, and one in Nepal. The six studies reported immunisation status after community-based information or face-toface education. Five studies reported coverage with three doses of the combined diphtheriatetanus- pertussis vaccine (DTP3) and one reported coverage with at least one vaccine. Combining the data shows that information or education significantly improves vaccination coverage: risk ratio (RR) 1.36, 95 % Confidence interval (CI) 1.14 to 1.62. However, there was significant statistical heterogeneity: χ2 (df=5) = 14.26; P=0.01, I2=65 %. The heterogeneity could be explained, at least in part, by the type of intervention. Three studies used community-based information. Two reported DTP3 coverage and one reported coverage with at least one vaccine. Combining data for the three studies shows that community-based information improves vaccination coverage (RR 1.61, 95%CI 1.19 to 2.18), with no significant statistical heterogeneity: χ2 (df = 2) =3.18, P =.0.20, I2=37%. Three studies used face-to-face education and reported DTP3 coverage. Combining data for the three studies shows that face-to-face education improves vaccination coverage (RR 1.24, 95% CI 1.01 to 1.53), with significant statistical heterogeneity: χ2 (df = 2) =7.63, P = 0.02, I2=74%. The differences between the subgroups (i.e. information versus education) were not significant: χ2 (df = 1) =1.97, P=0.16, I2=49.3%. Conclusions: This review shows a significant improvement in childhood immunisation coverage that was observed in caregivers who received education or information on the importance of vaccines, compared to those who received standard health promotion messages only. The review demonstrates that providing vaccine-related education to caregivers in an effective manner may improve childhood immunisation coverage in low and middle-income country settings. Keywords: Information, education, parents, caregivers, childhood vaccination, low and middle-income countries.

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