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

[摘要] ENGLISH ABSTRACT: Background: Despite their proven effectiveness in reducing childhood infectious diseases,the uptake of vaccines remains suboptimal in low and middle-income countries. Identifyingstrategies for transmitting accurate vaccine information to caregivers would boost childhoodvaccination coverage in these countries. The aim of this review was to assess the effects onvaccination coverage of interventions to inform or educate caregivers about childhoodvaccination in low and middle-income countries, compared to standard immunisationpractices. We chose only information and education because doing a review of all possibleinterventions for increasing coverage would take more time and resources.Methods: In May 2015 we conducted a comprehensive search of both peer-reviewed andgrey literature. We searched PubMed, Scopus, Cochrane Central Register of ControlledTrials, Web of Science, Cumulative Index of Nursing and Allied Health, prospective trialregistries, and reference lists of relevant publications. We included only individualrandomised controlled trials (RCTs). The systematic review is registered in the PROSPEROInternational Prospective Register of systematic reviews, registration numberCRD42014010141Results: Our search identified 963 records from which eight studies were consideredpotentially eligible. After assessment of eligibility, we included six studies and two studieswere excluded. Four included studies were conducted in Pakistan, one in India, and one inNepal.The six studies reported immunisation status after community-based information or face-tofaceeducation. 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 vaccinationcoverage: risk ratio (RR) 1.36, 95 % Confidence interval (CI) 1.14 to 1.62. However, therewas significant statistical heterogeneity: χ2 (df=5) = 14.26; P=0.01, I2=65 %. Theheterogeneity could be explained, at least in part, by the type of intervention.Three studies used community-based information. Two reported DTP3 coverage and onereported coverage with at least one vaccine. Combining data for the three studies shows thatcommunity-based information improves vaccination coverage (RR 1.61, 95%CI 1.19 to2.18), 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 forthe 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 notsignificant: χ2 (df = 1) =1.97, P=0.16, I2=49.3%.Conclusions: This review shows a significant improvement in childhood immunisationcoverage that was observed in caregivers who received education or information on theimportance of vaccines, compared to those who received standard health promotion messagesonly. The review demonstrates that providing vaccine-related education to caregivers in aneffective manner may improve childhood immunisation coverage in low and middle-incomecountry settings.Keywords: Information, education, parents, caregivers, childhood vaccination, low andmiddle-income countries.

[发布机构] Stellenbosch University