Strategies for Increasing Immunization Rates Among Children and in Low to Middle Income Countries-Juniper Publishers
Juniper Publishers-Journal of Pediatrics
Abstract
The article reviews the importance and what
strategies are effective in improving immunization rates in children and
adults. How can we help improve immunization rates in the U.S. and in
LMICs? Do strategies to improve childhood vaccination rates work? [1,2]
reported the importance of immunizations as an important childhood
preventive health maintenance program towards improving childhood
survival.
This is an important feature for childhood health for two reasons:
- Direct reduction in disease through immunization and
- It allows time during visit to review for other treatable conditions [3].
Reported immunizations as the most successful
public health prevention program for preventing childhood diseases and
untimely illnesses or death in childhood. The WHO highly recommends safe
monitoring and administration of vaccinations. In conclusion [1] found
mostly a low level of evidence to support each strategy for improving
immunization rates among children in LMICs and there is some low level
of evidence for a combined effect among strategies as follows:
information handouts, health education with reminder cards at
facilities, immunization outreach with and without household incentives,
home visits, and integration of immunization with other services [4].
Found some significance in single-method interventions, but found a
combined effect more promising to increase vaccine rates. Further well
conducted RCTs are needed.
Background Summary
Human papillomavirus (HPV) is the most common
sexually transmitted infection in the United States with approximately
79 million Americans are infected with HPV both men and women alike.
Each year an estimated 14million people become newly infected. Not all
100 types of HPV cause pathological disease,
however some do and can lead to genital warts,
different types of cancers (i.e., cervical, vulvar, vaginal, penile,
anal, and oropharyngeal). There are approximately 27,000 adults affected
by HPV associated cancer annually and approximately 360,000 people
experience genital warts. HPV vaccine is the primary prevention for HPV
associated diseases. HPV vaccine rates like others in a series tend to
drop by the time of the last dose by about 20%. Overall HPV vaccination
rates are low at 40% for girls and 22% for boys [1,2].
Reported the importance of immunizations as an
important childhood preventive health maintenance program towards
improving childhood survival.
This is an important feature for childhood health for two reasons
- Direct reduction in disease through immunization and
- It allows time during visit to review for other treatable conditions [1].
In a Cochrane review studied interventions for
improving coverage of childhood immunizations in low and middle-income
countries (LMICs) updated from prior review in 2011 [3], reported
immunizations as the most successful public health prevention program
for preventing childhood diseases and untimely illnesses or death in
childhood. The WHO highly recommends a safe monitoring and
administration of vaccinations. Vaccines typically have a high safety
profile and side effects are minimal, if at all, mostly site redness,
fatigue, and tenderness for a couple days [4].
Study Purpose
Completed a systematic review to evaluate the
effectiveness of interventions or strategies for increasing HPV
vaccination rates and [1,2] also completed a review to examine
interventions or strategies for improving vaccination rates in childhood
in LMICs. According to the [5] in the U.S. many immunization rates are
overall fairly high, but gaps still exist and there is still room for
improvement timeliness at the recommended age is essential for
proper coverage. In 2011 in the U.S., 4 cases of rubella, no cases
of diphtheria, 36 cases of tetanus, and no polio cases existed at
the time. Vaccines in a series were noted to be a problem such as
DTaP from 19-35 months of age only 84.6% of the children had
completed the four dose series in 2011 [5]. In cases of outbreaks,
it is often found that it may exist in an unimmunized person
or a person at risk due to illness or immunocompromise. Flu
vaccination rates in health care workers and the elderly population
overall are less than 70% [5]. Sustainable strategies for improving
vaccination rates to reduce vaccine preventable diseases remain
an important role in our health care prevention plan.
Research Question
The research question is clear what strategies are effective in
improving immunization rates in children and adults? How can
we help improve immunization rates in the U.S. and in LMICs? Do
strategies to improve childhood vaccination rates work?
Research Design
Studies reviewed included randomized controlled trials (RCT)
[1], non-RCTs, controlled before after studies, and interrupted
time series conducted in LMICs involving children age 0-4 years,
caregivers, and healthcare providers in a Cochrane Review
meta-analysis [4]. Studies included RCTs, quasi-experimental or
observational studies all quantitative data.
Sample Size and Selection
Studies reviewed included randomized controlled trials (RCT)
[1], non-RCTs, controlled before after studies, and interrupted
time series conducted in LMICs involving children age 0-4 years,
caregivers, and healthcare providers. Two authors independently
reviewed studies for eligibility. Study participants were over 1,692
[4] Located 2,569 studies in the primary search and included 34
studies in the review that met inclusion criteria.
Measuring Instruments
Used RR for dichotomous data and planned to report costs
with a mean difference (MD) [1], but no studies reported this type
of data. Confidence intervals (CI) for all measures [4]. Utilized a
forest plot of selected results of intervention studies measuring
series initiation of >1 dose of HPV vaccine and additional results is
shown in an additional forest plot.
Statistical Analyses
Consisted of 14 studies (10 cluster RCTs and 4 individual
RCTs) all met inclusion criteria. Study locations included states
in the U.S. (i.e. Georgia) and other countries such as (i.e., Ghana,
Honduras, India, Mali, Mexico, Nicaragua, Nepal, Pakistan, and
Zimbabwe) [1]. One study had a unclear risk of bias and 13 had
high risk of bias. Interventions or strategies utilized were as
follows: community based health education (3 studies), facilitybased
health education (3 studies), household incentives (three
studies), regular immunization, outreach sessions (1 study), home visits (1 study), and supportive supervision (1 study), and
information campaigns (1 study), and integration of immunization
services with intermittent prevention treatment of malaria (1
study). There was a moderate level of evidence to support health
education at town meetings or at home (risk ratio (RR) 1.68, 95%
confidence interval (CI) 1.09 to 2.59).
Conclusion
[1] Found mostly a low level of evidence to support each
strategy for improving immunization rates among children in
LMICs and there is some low level of evidence for a combined
effect among strategies as follows: information handouts, health
education with reminder cards at facilities, immunization
outreach with and without household incentives, home visits,
and integration of immunization with other services. Further well
conducted RCTs are needed. [4] Found some significance in singlemethod
interventions but found a combined effect more promising
to increase vaccine rates. More studies were recommended to
integrate in multi-type facilities and adapted into practice on a
wide scale.
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