SUPPORT Summaries
Evidence of the effects of health system interventions
for low- and middle-income countries
Evidence of the effects of health system interventions
for low- and middle-income countries
August, 2008 - SUPPORT Summary of a systematic review | print this article |
Routine immunisation during childhood is considered to be the single most effective way of controlling many diseases, including measles, polio, diphtheria, pertussis and tetanus. Not all children receive their recommended vaccinations. One approach to increasing childhood immunisation rates is to remind parents about immunisations that are due (reminders), or overdue (recall).
− Technology or physical infrastructure to provide reminders (e.g. telephones, computers, a functioning postal system) and literacy of parents (e.g. for post cards);
− Resources to provide the additional clinical and administrative infrastructure to implement reminder and recall programmes;
− Vaccines.
A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyse data from the included studies.
SUPPORT – was an international project to support the use of policy relevant reviews and trials to inform decisions about maternal and child health in low- and middle-income countries, funded by the European Commission (FP6) and the Canadian Institutes of Health Research.
Vaccination programmes are key components of healthcare services in low and middleincome countries, but coverage is often low, especially in South Asia and sub-Saharan Africa. Increasing the number of people who are vaccinated could lower death and disease rates. One approach to increasing immunisation rates involves reminding people about their vaccinations.
This summary is based on an update of a Cochrane systematic review first published in 2005. The summary focuses on the part of the review that considered the effects of different types of parent reminder and recall systems in improving the rates of routine childhood immunisations.
High: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low.
Moderate: This research provides a good indication of the likely effect. The likelihood that effect will be substantially different† is moderate.
Low: This research provides some indication of the likely effect. Howevver, the likelihood that it will be substantially different† is high.
Very low: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high.
* This is sometimes referred to as 'quality of evidence' or 'confidence in the estimate'.
† Substantially different = a large enough difference that it might affect a decision.
See last page for more information.
The review included 43 studies, most of which were done in the USA; none were done in low or middle-income countries. The included studies were, however, done in diverse settings, some of which were aimed at low-income groups in high-income countries. The focus of this summary is on child health. Therefore studies in the review targeted at adult immunisations are not considered in this summary.
Fourteen of the 43 included studies used a variety of methods to remind parents about their child’s routine vaccinations. Two studies were excluded from the meta-analysis, one because of a potential error in its analysis, the other because of its design. Of the 12 remaining studies, eight used a letter alone or in combination with other interventions. Other interventions included postcards, telephone calls and home visits. All types of reminder and recall systems appeared to improve immunisation rates with person-toperson telephone reminders being the most effective single approach.
This article makes a case for improved vaccination programmes: Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, Lee BW, Lolekha S, Peltola H, Ruff TA, Santosham M, Schmitt HJ. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bulletin of the World Health Organisation 2008; 86: 140-146.
A systematic review of interventions to improve coverage for child immunisation in low and middleincome countries is underway: Oyo-Ita A, Nwachukwu CE, Oringanje CM, Meremikwu MM. Interventions for improving coverage for child immunisation in developing countries (Protocol). Cochrane Database of Systematic Reviews 2008, Issue 3.
Shaun Treweek and Andy Oxman, Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
None declared. For details, see: http://www.support-collaboration.org/summaries/coi.htm
This summary has been peer reviewed by: Julie Jacobson Vann, USA; Cristian Herrera and Tomás Pantoja, Chile; Tracey Perez Koehlmoos, Bangladesh; Emeka Nwachukwu, Nigeria; Pierre Ongolo Zogo, Cameroon.
Treweek S, Oxman AD. Do parent reminder and recall systems improve the rates of routine childhood immunisations? A SUPPORT Summary of a systematic review. August 2008. http://www.supportcollaboration.org/summaries.htm
