Strategies to Increase the Demand for Childhood Vaccination in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

A group of researchers carried out a systematic review and meta-analysis to evaluate whether demand-side interventions - e.g., knowledge transfer or communication campaigns - increase uptake of routine childhood vaccination in low- and middle-income countries. Their search strategy led them to identify 11 studies comprising four randomised controlled trials, six cluster randomised controlled trials, and one controlled before-and-after study published in English between 1996 and 2013. Participants were generally parents of young children exposed to an eligible intervention. Six studies demonstrated low risk of bias, and five studies had moderate to high risk of bias.

Having conducted a pooled analysis considering all 11 studies, with data from 11,512 participants, the researchers found that demand-side interventions were associated with significantly higher receipt of vaccines, relative risk (RR): 1.30, (95% confidence interval, CI: 1.17-1.44). Subgroup analyses also demonstrated significant effects of seven education and knowledge translation studies, RR: 1.40 (95% CI: 1.20-1.63) and of four studies that used incentives (two monetary and two non-monetary), RR: 1.28 (95% CI: 1.12-1.45).

They conclude: "Demand-side strategies to improve vaccination coverage are important because they are inherently equity-oriented and address specific barriers to coverage related to financial constraints, opportunity costs, knowledge and prioritization. Future research should seek to refine our understanding of which approaches are most effective in specific contexts. Studies investigating the value of knowledge translation and incentives-based interventions offered in combination are also required. Studies that simultaneously consider supply- and demand-side interventions - and enable us to evaluate their relative effectiveness - are of particular interest. Finally, studies should consider whether interventions can be delivered effectively at scale and in the long term."

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