|dc.description.abstract||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
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
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
Keywords: Information, education, parents, caregivers, childhood vaccination, low and