Patient/Caregiver oriented strategies to improve childhood immunization: A systematic review and meta-analysis

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Kumar M1, Jaiswal N1, Singh M1, Singh M1, Agarwal A1, Dhatwalia SK1, Pradhan P1, Pant P1
1Post Graduate Institute of Medical Education and Research, Chandigarh


Childhood vaccinations are amongst the most effective health interventions. WHO estimates that over 21 million children were unvaccinated in the year 2019, with over half residing in India, Nigeria and Pakistan.


Evaluate the effectiveness of various patient/client-oriented strategies applied to boost an sustain high childhood immunization coverage.


The review included randomized controlled trials (including quasi and cluster-randomized) with

children or parents or guardians or school teachers as study participants and comparing patient

oriented interventions like parent/guardian education, redesigned immunization cards, outreach interventions, reminder/recall interventions and giving incentives with routine practices. The included studies should discuss on childhood immunization status &/or occurrence of vaccine preventable diseases in children &/or any adverse events. The studies were excluded if they compared two PCOI and did not compare them with routine practices. The outcomes of the current systematic review included proportion of un-immunized children and sustaining high immunization coverage as primary outcomes and the secondary outcomes included adverse events due to vaccines and occurrence of any vaccine preventable diseases


26 studies met inclusion criteria. Patient/client oriented interventions (PCOI) proved effective in increasing the increasing the number of children completing the scheduled immunizations. Combining interventions with any of the other PCOI proved effective with number needed to treat (NNT) of four while reminder/recall investigations had a NNT of twelve. Though only two studies discussed the effect of incentives and fifteen studies discussed the effect of reminder/recall interventions on increasing the immunization rates. The outreach interventions, parent education and redesigning immunization cards were also effective in boosting the childhood immunization status


There is a need for initiating a large multi-centric, multi-armed randomized trial comparing the various strategies for improving childhood immunization rates and assessment of feasibility and sustainability

Acknowledgement: Indian Council for Medical Research, New Delhi & Centre for Advanced research in Evidence Based Child Health, PGIMER, Chadigarh, India