Sylwer fod y cymhwysiad hwn dan ddatblygiad. Os ydych chi'n gweld unrhyw gamgymeriadau neu os nad yw rhywbeth yn gweithio, cysylltwch â ni yn evidence.service@wales.nhs.uk.
Adolygiad Systematig
This Cochrane review aimed to evaluate the effectiveness of intervention strategies to boost and sustain high childhood immunisation coverage in low‐ and middle‐income countries (LMICs).
Fourteen studies (10 cluster RCTs and four individual RCTs) met our inclusion criteria. These were conducted in Georgia (one study), Ghana (one study), Honduras (one study), India (two studies), Mali (one study), Mexico (one study), Nicaragua (one study), Nepal (one study), Pakistan (four studies), and Zimbabwe (one study). One study had an unclear risk of bias, and 13 had high risk of bias. The interventions evaluated in the studies included community‐based health education (three studies), facility‐based health education (three studies), household incentives (three studies), regular immunisation outreach sessions (one study), home visits (one study), supportive supervision (one study), information campaigns (one study), and integration of immunisation services with intermittent preventive treatment of malaria (one study).
The reviewers found moderate‐certainty evidence that health education at village meetings or at home probably improves coverage with three doses of diphtheria‐tetanus‐pertussis vaccines (DTP3: RR 1.68, 95% CI 1.09 to 2.59). We also found low‐certainty evidence that facility‐based health education plus redesigned vaccination reminder cards may improve DTP3 coverage (RR 1.50, 95% CI 1.21 to 1.87). Household monetary incentives may have little or no effect on full immunisation coverage (RR 1.05, 95% CI 0.90 to 1.23, low‐certainty evidence). Regular immunisation outreach may improve full immunisation coverage (RR 3.09, 95% CI 1.69 to 5.67, low‐certainty evidence) which may substantially improve if combined with household incentives (RR 6.66, 95% CI 3.93 to 11.28, low‐certainty evidence). Home visits to identify non‐vaccinated children and refer them to health clinics may improve uptake of three doses of oral polio vaccine (RR 1.22, 95% CI 1.07 to 1.39, low‐certainty evidence). There was low‐certainty evidence that integration of immunisation with other services may improve DTP3 coverage (RR 1.92, 95% CI 1.42 to 2.59).
Providing parents and other community members with information on immunisation, health education at facilities in combination with redesigned immunisation reminder cards, regular immunisation outreach with and without household incentives, home visits, and integration of immunisation with other services may improve childhood immunisation coverage in LMIC. Most of the evidence was of low certainty, which implies a high likelihood that the true effect of the interventions will be substantially different. There is thus a need for further well‐conducted RCTs to assess the effects of interventions for improving childhood immunisation coverage in LMICs.