Jain Monica, Shisler Shannon, Lane Charlotte, Bagai Avantika, Brown Elizabeth, Engelbert Mark, Vardy Yoav, Eyers John, Leon Daniela Anda, Parsekar Shradha S
International Initiative for Impact Evaluation (3ie) New Delhi India.
International Initiative for Impact Evaluation (3ie) Washington USA.
Campbell Syst Rev. 2022 Jul 27;18(3):e1253. doi: 10.1002/cl2.1253. eCollection 2022 Sep.
Immunisation is one of the most cost-effective interventions to prevent and control life-threatening infectious diseases. Nonetheless, rates of routine vaccination of children in low- and middle-income countries (LMICs) are strikingly low or stagnant. In 2019, an estimated 19.7 million infants did not receive routine immunisations. Community engagement interventions are increasingly being emphasised in international and national policy frameworks as a means to improve immunisation coverage and reach marginalised communities. This systematic review examines the effectiveness and cost-effectiveness of community engagement interventions on outcomes related to childhood immunisation in LMICs and identifies contextual, design and implementation features that may be associated with effectiveness. We identified 61 quantitative and mixed methods impact evaluations and 47 associated qualitative studies related to community engagement interventions for inclusion in the reteview. For cost-effectiveness analysis 14 of the 61 studies had the needed combination of cost and effectiveness data. The 61 included impact evaluations were concentrated in South Asia and Sub-Saharan Africa and spread across 19 LMICs. The review found that community engagement interventions had a small but significant, positive effect on all primary immunisation outcomes related to coverage and their timeliness. The findings are robust to exclusion of studies assessed as high risk of bias. Qualitative evidence indicates appropriate intervention design, including building in community engagement features; addressing common contextual barriers of immunisation and leveraging facilitators; and accounting for existing implementation constraints and practicalities on the ground are consistently cited as reasons for intervention success. Among the studies for which we were able to calculate cost-effectiveness, we find that the median non-vaccine cost per dose of intervention to increase immunisation coverage by 1% was US $3.68. Given the broad scope of the review in terms of interventions and outcomes, there is significant variation in findings. Among the various types of community engagement interventions, those that involve creation of community buy-in or development of new cadres of community-based structures were found to have consistent positive effect on more primary vaccination coverage outcomes than if the engagement is limited to the design or delivery of an intervention or is a combination of the various types. The evidence base for sub-group analysis for female children was sparse (only two studies) and the effect on coverage of both full immunisation and third dose of diphtheria pertussis tetanus for this group was insignificant.
免疫接种是预防和控制危及生命的传染病最具成本效益的干预措施之一。尽管如此，低收入和中等收入国家（LMICs）儿童的常规疫苗接种率仍然极低或停滞不前。2019年，估计有1970万婴儿未接受常规免疫接种。在国际和国家政策框架中，社区参与干预措施越来越受到重视，被视为提高免疫接种覆盖率和覆盖边缘化社区的一种手段。本系统评价考察了社区参与干预措施对LMICs中与儿童免疫接种相关结果的有效性和成本效益，并确定了可能与有效性相关的背景、设计和实施特征。我们确定了61项定量和混合方法的影响评估以及47项与社区参与干预措施相关的定性研究，以纳入本综述。在成本效益分析方面，61项研究中有14项具备所需的成本和效益数据组合。纳入的61项影响评估集中在南亚和撒哈拉以南非洲，分布在19个LMICs国家。该综述发现，社区参与干预措施对所有与覆盖率及其及时性相关的主要免疫接种结果都有微小但显著的积极影响。这些发现对于排除被评估为存在高偏倚风险的研究具有稳健性。定性证据表明，适当的干预设计，包括融入社区参与特征；解决免疫接种常见的背景障碍并利用促进因素；以及考虑到现有的实施限制和当地实际情况，一直被认为是干预成功的原因。在我们能够计算成本效益的研究中，我们发现每增加1%的免疫接种覆盖率，每剂干预措施的非疫苗成本中位数为3.68美元。鉴于本综述在干预措施和结果方面的广泛范围，研究结果存在显著差异。在各种类型的社区参与干预措施中，那些涉及创造社区认同感或培养新的社区基层结构干部的干预措施，比那些仅限于干预措施的设计或实施，或各种类型组合的干预措施，对更多主要疫苗接种覆盖率结果具有一致的积极影响。针对女童的亚组分析证据基础薄弱（仅有两项研究），该组对全程免疫覆盖率和白喉、百日咳、破伤风第三剂覆盖率的影响不显著。
