Department of Health Evidence, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands.
Access-To-Medicines Research Center, KU Leuven, Naamsestraat 69, Leuven, Belgium.
Health Policy Plan. 2022 Feb 8;37(2):281-291. doi: 10.1093/heapol/czab139.
Routine vaccination annually prevents millions of deaths worldwide but is underutilized in sub-Saharan Africa (SSA). The complexity of socio-cultural factors impacting vaccine uptake is not well understood. Hence, this paper aims to review the socio-cultural determinants of vaccine uptake and visualize their interrelationships. We conducted a literature search using Pubmed and Embase databases, including articles published from 2000 to 2019 describing socio-cultural demand-side determinants for vaccine uptake. Using the Andersen and Newman Framework of Health Services Utilization, demand-side determinants were categorized as predisposing, enabling or need factors. A qualitative system dynamics approach was employed to visualize how these factors and their dynamic interrelationships influence vaccine uptake. This visualization, by means of a causal-loop diagram (CLD), was mostly based on a qualitative input, with the majority being statements of the authors. These statements were abstracted from the papers found in the review. Quantification was done by counting direct (statistical) associations between each determinant and 'timely and full routine immunization coverage'. A total of 90 articles, primarily from Nigeria (n = 23), Ethiopia (n = 17) and Kenya (n = 11), met the inclusion criteria. We find that maternal autonomy and the perceived benefits caregivers attach to vaccination and exert their influences on many other factors through several feedback loops, thereby influencing timely and full routine immunization coverage. Utilization of health services (supply-related) and access to information (demand-related) were considered as high-potential leverage points. Quantification has shown that maternal autonomy and perceived benefit have an unclear evidence base. Future research should focus on these key players as they play a central role in multiple complex pathways, through which they could influence the uptake of vaccines in SSA.
常规疫苗接种每年在全球范围内预防了数百万人的死亡，但在撒哈拉以南非洲（SSA）的利用率较低。影响疫苗接种率的社会文化因素的复杂性尚未得到很好的理解。因此，本文旨在综述疫苗接种的社会文化决定因素，并可视化它们的相互关系。我们使用 Pubmed 和 Embase 数据库进行了文献检索，包括 2000 年至 2019 年发表的描述疫苗接种社会文化需求方决定因素的文章。使用安德森和纽曼卫生服务利用框架，将需求方决定因素分为倾向、使能或需求因素。采用定性系统动力学方法可视化这些因素及其动态相互关系如何影响疫苗接种率。这种可视化是通过因果回路图（CLD）实现的，主要基于定性输入，其中大部分是作者的陈述。这些陈述是从综述中找到的论文中抽象出来的。通过计算每个决定因素与“及时和全面常规免疫覆盖率”之间的直接（统计）关联进行量化。共有 90 篇文章符合纳入标准，主要来自尼日利亚（n=23）、埃塞俄比亚（n=17）和肯尼亚（n=11）。我们发现，母亲自主权和照顾者对疫苗接种的感知益处通过几个反馈回路对许多其他因素产生影响，从而影响及时和全面的常规免疫接种覆盖率。卫生服务的利用（与供应有关）和信息的获取（与需求有关）被认为是高潜力的杠杆点。量化表明，母亲自主权和感知益处的证据基础尚不清楚。未来的研究应集中在这些关键参与者身上，因为他们在多个复杂途径中发挥着核心作用，通过这些途径，他们可以影响 SSA 疫苗的接种率。
