A systematic review of strategies for reducing missed opportunities for vaccination. Issue 21 (17th May 2018)

• Record Type: Journal Article
• Authors: Jaca, Anelisa; Mathebula, Lindi; Iweze, Arthur; Pienaar, Elizabeth; Wiysonge, Charles S.
• Is Part Of: Vaccine. Volume 36:Issue 21(2018)
• Page Start: 2921
• Page End: 2927
• Publication Date: 2018-05-17
• Subjects: Immunization -- Vaccination -- Uptake -- Coverage -- Missed opportunities; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2018.04.028
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: Missed opportunities for vaccination (MOVs) are currently receiving unprecedented global attention. WHO is coordinating efforts to assess the burden of MOVs and to implement interventions to reduce them. We conducted a systematic review and found a dearth of evidence on effective interventions to reduce MOVs, especially in low and middle-income countries. Promising provider-oriented interventions include education and prompts/reminders. Promising recipient-oriented interventions include education and tracking using community health workers. Rigorous studies are required to confirm these findings and increase the certainty of the current evidence base. Abstract: Background: Missed opportunities for vaccination (MOVs) occur when persons eligible for vaccination visit a health facility and do not get the vaccines they need. We conducted a systematic review to assess effects of interventions for reducing MOVs. Methods: We searched PubMed, Scopus, and the Cochrane Central Register of Controlled Trials in April 2017. Three authors independently screened search outputs, reviewed potentially eligible papers, assessed risk of bias, and extracted data; resolving disagreements by consensus. We expressed study results as risk ratios (RR) with 95% confidence intervals (CI) and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Results: Six studies (five trials and one cohort study) met our inclusion criteria, all conducted in the United States of America. All six studies had various limitations and were classified as having a high risk of bias. We found moderate certainty evidence that the following interventions probably improve vaccination coverage: patient education (RR 1.92, 95% CI 1.38–2.68), patient tracking using community health workers (RR 1.18, 95% CI 1.11–1.25), and patient tracking and provider prompts (RR 1.24, 95% CI 1.18–1.31). In addition, we found low certainty evidence that concurrent interventions targeting health-facility (education, prompts, and audit and feedback) and family settings (phone calls) may increase vaccination coverage (RR 1.25, 95% CI 1.08–1.46). Conclusions: The currently available evidence suggests that patient education, patient tracking, outreach sessions, and provider prompts reduce missed opportunities for vaccination and improve vaccination coverage. Rigorous studies are required to confirm these findings and increase the certainty of the current evidence base. WHO is currently coordinating efforts to generate such evidence, especially from low-income and middle-income countries, and it is likely that the data will be available in the next few years.