Johri Mira, Pérez Myriam Cielo, Arsenault Catherine, Sharma Jitendar K, Pai Nitika Pant, Pahwa Smriti, Sylvestre Marie-Pierre
Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-458, 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada .
Département d'administration de la santé, Université de Montréal, Montréal, Canada .
Bull World Health Organ. 2015 May 1;93(5):339-346C. doi: 10.2471/BLT.14.146951. Epub 2015 Mar 23.
To investigate which strategies to increase demand for vaccination are effective in increasing child vaccine coverage in low- and middle-income countries.
We searched MEDLINE, EMBASE, Cochrane library, POPLINE, ECONLIT, CINAHL, LILACS, BDSP, Web of Science and Scopus databases for relevant studies, published in English, French, German, Hindi, Portuguese and Spanish up to 25 March 2014. We included studies of interventions intended to increase demand for routine childhood vaccination. Studies were eligible if conducted in low- and middle-income countries and employing a randomized controlled trial, non-randomized controlled trial, controlled before-and-after or interrupted time series design. We estimated risk of bias using Cochrane collaboration guidelines and performed random-effects meta-analysis.
We identified 11 studies comprising four randomized controlled trials, six cluster randomized 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. We conducted a pooled analysis considering all 11 studies, with data from 11,512 participants. 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 which used incentives, RR: 1.28 (95% CI: 1.12-1.45).
Demand-side interventions lead to significant gains in child vaccination coverage in low- and middle-income countries. Educational approaches and use of incentives were both effective strategies.
探讨在低收入和中等收入国家，哪些增加疫苗接种需求的策略能有效提高儿童疫苗接种覆盖率。
我们检索了MEDLINE、EMBASE、Cochrane图书馆、POPLINE、ECONLIT、CINAHL、LILACS、BDSP、科学引文索引和Scopus数据库，查找截至2014年3月25日以英文、法文、德文、印地文、葡萄牙文和西班牙文发表的相关研究。我们纳入了旨在增加儿童常规疫苗接种需求的干预措施研究。如果研究在低收入和中等收入国家进行，并采用随机对照试验、非随机对照试验、前后对照或中断时间序列设计，则符合纳入标准。我们使用Cochrane协作指南评估偏倚风险，并进行随机效应荟萃分析。
我们确定了11项研究，包括4项随机对照试验、6项整群随机对照试验和1项1996年至2013年期间以英文发表的前后对照研究。参与者通常是接触合格干预措施的幼儿的父母。6项研究显示偏倚风险较低，5项研究有中度至高度偏倚风险。我们对所有11项研究进行了汇总分析，数据来自11,512名参与者。需求侧干预措施与疫苗接种率显著提高相关，相对风险（RR）：1.30，（95%置信区间，CI：1.17 - 1.44）。亚组分析还显示，7项教育和知识转化研究有显著效果，RR：1.40（95%CI：1.20 - 1.63），4项使用激励措施的研究有显著效果，RR：1.28（95%CI：1.12 - 1.45）。
需求侧干预措施能在低收入和中等收入国家显著提高儿童疫苗接种覆盖率。教育方法和激励措施的使用都是有效的策略。
