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Too little but not too late: results of a literature review to improve routine immunization programs in developing countries.

Ryman TK, Dietz V, Cairns KL - BMC Health Serv Res (2008)

Bottom Line: Much was learned from the 25 papers, such as the use of non-health workers to provide numerous services at the community level.However it was startling to see how few papers were identified and in particular how few were of strong scientific quality.Proposed areas of additional research include integration of additional services with immunization delivery, collaboration of immunization programs with new partners, best approaches to new vaccine introduction, and how to improve service delivery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road MS-E05, Atlanta, GA 30333, USA. tryman@cdc.gov

ABSTRACT

Background: Globally, immunization services have been the center of renewed interest with increased funding to improve services, acceleration of the introduction of new vaccines, and the development of a health systems approach to improve vaccine delivery. Much of the credit for the increased attention is due to the work of the GAVI Alliance and to new funding streams. If routine immunization programs are to take full advantage of the newly available resources, managers need to understand the range of proven strategies and approaches to deliver vaccines to reduce the incidence of diseases. In this paper, we present strategies that may be used at the sub-national level to improve routine immunization programs.

Methods: We conducted a systematic review of studies and projects reported in the published and gray literature. Each paper that met our inclusion criteria was rated based on methodological rigor and data were systematically abstracted. Routine-immunization - specific papers with a methodological rigor rating of greater than 60% and with conclusive results were reported.

Results: Greater than 11,000 papers were identified, of which 60 met our inclusion criteria and 25 papers were reported. Papers were grouped into four strategy approaches: bringing immunizations closer to communities (n = 11), using information dissemination to increase demand for vaccination (n = 3), changing practices in fixed sites (n = 4), and using innovative management practices (n = 7).

Conclusion: Immunization programs are at a historical crossroads in terms of developing new funding streams, introducing new vaccines, and responding to the global interest in the health systems approach to improving immunization delivery. However, to complement this, actual service delivery needs to be strengthened and program managers must be aware of proven strategies. Much was learned from the 25 papers, such as the use of non-health workers to provide numerous services at the community level. However it was startling to see how few papers were identified and in particular how few were of strong scientific quality. Further well-designed and well-conducted scientific research is warranted. Proposed areas of additional research include integration of additional services with immunization delivery, collaboration of immunization programs with new partners, best approaches to new vaccine introduction, and how to improve service delivery.

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Related in: MedlinePlus

Review Methods. see attached file 1.
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Figure 1: Review Methods. see attached file 1.

Mentions: Only 25 papers met our criteria for inclusion in this review (Table 3). All of the gray literature papers were excluded; most of these papers lacked detailed information or methodology details and so received too low a score to be included. The remaining papers were grouped by the general approach used to improve immunization programs (Figure 1). There were numerous groupings which could have been used to organize the findings, and some papers inevitably overlap. Ultimately, we chose categories that we felt would be most beneficial and the most "user-friendly" for national and sub-national program managers to identify strategies. The four groups were: bringing immunizations closer to communities (n = 11), using information dissemination to increase demand for vaccinations (n = 3), changing practices in fixed sites (n = 4), and using innovative management practices (n = 7). In the selected papers, the most consistently reported outcome indicator was the percentage change in fully vaccinated children (FVC), although some papers used other outcomes such as percentage change in vaccination coverage for specific antigens, dropout from routine immunizations as measured by coverage for an early vaccine when compared to that of a later vaccine, or timeliness of vaccination for a specified antigen.


Too little but not too late: results of a literature review to improve routine immunization programs in developing countries.

Ryman TK, Dietz V, Cairns KL - BMC Health Serv Res (2008)

Review Methods. see attached file 1.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2474611&req=5

Figure 1: Review Methods. see attached file 1.
Mentions: Only 25 papers met our criteria for inclusion in this review (Table 3). All of the gray literature papers were excluded; most of these papers lacked detailed information or methodology details and so received too low a score to be included. The remaining papers were grouped by the general approach used to improve immunization programs (Figure 1). There were numerous groupings which could have been used to organize the findings, and some papers inevitably overlap. Ultimately, we chose categories that we felt would be most beneficial and the most "user-friendly" for national and sub-national program managers to identify strategies. The four groups were: bringing immunizations closer to communities (n = 11), using information dissemination to increase demand for vaccinations (n = 3), changing practices in fixed sites (n = 4), and using innovative management practices (n = 7). In the selected papers, the most consistently reported outcome indicator was the percentage change in fully vaccinated children (FVC), although some papers used other outcomes such as percentage change in vaccination coverage for specific antigens, dropout from routine immunizations as measured by coverage for an early vaccine when compared to that of a later vaccine, or timeliness of vaccination for a specified antigen.

Bottom Line: Much was learned from the 25 papers, such as the use of non-health workers to provide numerous services at the community level.However it was startling to see how few papers were identified and in particular how few were of strong scientific quality.Proposed areas of additional research include integration of additional services with immunization delivery, collaboration of immunization programs with new partners, best approaches to new vaccine introduction, and how to improve service delivery.

View Article: PubMed Central - HTML - PubMed

Affiliation: Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road MS-E05, Atlanta, GA 30333, USA. tryman@cdc.gov

ABSTRACT

Background: Globally, immunization services have been the center of renewed interest with increased funding to improve services, acceleration of the introduction of new vaccines, and the development of a health systems approach to improve vaccine delivery. Much of the credit for the increased attention is due to the work of the GAVI Alliance and to new funding streams. If routine immunization programs are to take full advantage of the newly available resources, managers need to understand the range of proven strategies and approaches to deliver vaccines to reduce the incidence of diseases. In this paper, we present strategies that may be used at the sub-national level to improve routine immunization programs.

Methods: We conducted a systematic review of studies and projects reported in the published and gray literature. Each paper that met our inclusion criteria was rated based on methodological rigor and data were systematically abstracted. Routine-immunization - specific papers with a methodological rigor rating of greater than 60% and with conclusive results were reported.

Results: Greater than 11,000 papers were identified, of which 60 met our inclusion criteria and 25 papers were reported. Papers were grouped into four strategy approaches: bringing immunizations closer to communities (n = 11), using information dissemination to increase demand for vaccination (n = 3), changing practices in fixed sites (n = 4), and using innovative management practices (n = 7).

Conclusion: Immunization programs are at a historical crossroads in terms of developing new funding streams, introducing new vaccines, and responding to the global interest in the health systems approach to improving immunization delivery. However, to complement this, actual service delivery needs to be strengthened and program managers must be aware of proven strategies. Much was learned from the 25 papers, such as the use of non-health workers to provide numerous services at the community level. However it was startling to see how few papers were identified and in particular how few were of strong scientific quality. Further well-designed and well-conducted scientific research is warranted. Proposed areas of additional research include integration of additional services with immunization delivery, collaboration of immunization programs with new partners, best approaches to new vaccine introduction, and how to improve service delivery.

Show MeSH
Related in: MedlinePlus