Shah Monica P, Morgan Christopher J, Beeson James G, Peach Elizabeth, Davis Jessica, McPake Barbara, Wallace Aaron S
Global Immunization Division, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Jhpiego, a Johns Hopkins University Affiliate, Baltimore, MD 21231, USA.
Vaccines (Basel). 2024 Nov 23;12(12):1313. doi: 10.3390/vaccines12121313.
: The integration of maternal and child health services (MCH) with routine immunization is an important global health strategy, particularly in low- and middle-income countries (LMICs). However, evidence is lacking regarding the best practices for service integration and the effect of integration on immunization and linked health service outcomes. : We searched publication databases and gray literature for articles published between 2011 and 2020 that include approaches to integrating MCH services with immunizations during the first two years of life in LMICs. Abstracts and full-text articles were screened for eligibility. For the included articles, data extraction and analysis examined the descriptive characteristics of studies, outcomes, and implementation considerations. : Among the 16,578 articles screened, 44 met the criteria for inclusion, representing 34 studies, of which 29 were from Africa. The commonly linked MCH services were family planning (24%), human immunodeficiency virus (HIV) diagnosis or care (21%), and malaria prevention or control (21%). Multiple integration strategies were typically used; the co-location of linked services (65%), the provision of extra services by immunization staff (41%), and/or the provision of extra information by immunization staff (41%) were the most common. In general, integration improved MCH service outcomes (76%) and was either beneficial (55%) or neutral for immunization (35%), with some examples in family planning, malaria, and HIV where integrated services were not beneficial. Important implementation considerations included the careful matching of target populations in service re-design, ensuring support from policy, logistics, and information systems, the provision of adequate training and support of staff to avoid overload, clear client communication regarding service integration, and the need to address community concerns. : Integrating MCH services with routine immunization can expand linked services and improve immunization coverage. This study has identified key implementation considerations relevant to both childhood and adult vaccination programs. More research is needed regarding costs and client preferences.
妇幼保健服务（MCH）与常规免疫接种相结合是一项重要的全球卫生战略，在低收入和中等收入国家（LMICs）尤为如此。然而，关于服务整合的最佳实践以及整合对免疫接种和相关卫生服务结果的影响，目前仍缺乏证据。
我们在出版物数据库和灰色文献中搜索了2011年至2020年期间发表的文章，这些文章涵盖了低收入和中等收入国家在生命最初两年将妇幼保健服务与免疫接种相结合的方法。对摘要和全文进行了资格筛选。对于纳入的文章，数据提取和分析考察了研究的描述性特征、结果以及实施方面的考虑因素。
在筛选的16578篇文章中，44篇符合纳入标准，代表34项研究，其中29项来自非洲。常见的相关妇幼保健服务包括计划生育（24%）、人类免疫缺陷病毒（HIV）诊断或护理（21%）以及疟疾预防或控制（21%）。通常采用多种整合策略；相关服务的同址设置（65%）、免疫接种工作人员提供额外服务（41%）和/或免疫接种工作人员提供额外信息（41%）是最常见的。总体而言，整合改善了妇幼保健服务结果（76%），对免疫接种有益（55%）或呈中性（35%），在计划生育、疟疾和HIV方面有一些整合服务无益处的例子。重要的实施考虑因素包括在重新设计服务时仔细匹配目标人群，确保政策、后勤和信息系统的支持，为工作人员提供充分培训和支持以避免负担过重，就服务整合与客户进行清晰沟通，以及解决社区关切的必要性。
将妇幼保健服务与常规免疫接种相结合可以扩大相关服务并提高免疫接种覆盖率。本研究确定了与儿童和成人疫苗接种计划相关的关键实施考虑因素。关于成本和客户偏好，还需要更多研究。
