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Knop MR, Nagashima-Hayashi M, Lin R, Saing CH, Ung M, Oy S, Yam ELY, Zahari M, Yi S. Impact of mHealth interventions on maternal, newborn, and child health from conception to 24 months postpartum in low- and middle-income countries: a systematic review. BMC Med 2024; 22:196. [PMID: 38750486 PMCID: PMC11095039 DOI: 10.1186/s12916-024-03417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/01/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies have been harnessed in low- and middle-income countries (LMICs) to address the intricate challenges confronting maternal, newborn, and child health (MNCH). This review aspires to scrutinize the effectiveness of mHealth interventions on MNCH outcomes during the pivotal first 1000 days of life, encompassing the period from conception through pregnancy, childbirth, and post-delivery, up to the age of 2 years. METHODS A comprehensive search was systematically conducted in May 2022 across databases, including PubMed, Cochrane Library, Embase, Cumulative Index to Nursing & Allied Health (CINAHL), Web of Science, Scopus, PsycINFO, and Trip Pro, to unearth peer-reviewed articles published between 2000 and 2022. The inclusion criteria consisted of (i) mHealth interventions directed at MNCH; (ii) study designs, including randomized controlled trials (RCTs), RCT variations, quasi-experimental designs, controlled before-and-after studies, or interrupted time series studies); (iii) reports of outcomes pertinent to the first 1000 days concept; and (iv) inclusion of participants from LMICs. Each study was screened for quality in alignment with the Cochrane Handbook for Systematic Reviews of Interventions and the Joanne Briggs Institute Critical Appraisal tools. The included articles were then analyzed and categorized into 12 mHealth functions and outcome domain categories (antenatal, delivery, and postnatal care), followed by forest plot comparisons of effect measures. RESULTS From the initial pool of 7119 articles, we included 131 in this review, comprising 56 RCTs, 38 cluster-RCTs, and 37 quasi-experimental studies. Notably, 62% of these articles exhibited a moderate or high risk of bias. Promisingly, mHealth strategies, such as dispatching text message reminders to women and equipping healthcare providers with digital planning and scheduling tools, exhibited the capacity to augment antenatal clinic attendance and enhance the punctuality of child immunization. However, findings regarding facility-based delivery, child immunization attendance, and infant feeding practices were inconclusive. CONCLUSIONS This review suggests that mHealth interventions can improve antenatal care attendance and child immunization timeliness in LMICs. However, their impact on facility-based delivery and infant feeding practices varies. Nevertheless, the potential of mHealth to enhance MNCH services in resource-limited settings is promising. More context-specific implementation studies with rigorous evaluations are essential.
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Affiliation(s)
- Marianne Ravn Knop
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Michiko Nagashima-Hayashi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Ruixi Lin
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mengieng Ung
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sreymom Oy
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Esabelle Lo Yan Yam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Marina Zahari
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA.
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Gilano G, Sako S, Molla B, Dekker A, Fijten R. The effect of mHealth on childhood vaccination in Africa: A systematic review and meta-analysis. PLoS One 2024; 19:e0294442. [PMID: 38381753 PMCID: PMC10880990 DOI: 10.1371/journal.pone.0294442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/31/2023] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Vaccine-preventable diseases are the public health problems in Africa, although vaccination is an available, safe, simple, and effective method prevention. Technologies such as mHealth may provide maternal access to health information and support decisions on childhood vaccination. Many studies on the role of mHealth in vaccination decisions have been conducted in Africa, but the evidence needs to provide conclusive information to support mHealth introduction. This study provides essential information to assist planning and policy decisions regarding the use of mHealth for childhood vaccination. METHODS We conducted a systematic review and meta-analysis for studies applying mHealth in Africa for vaccination decisions following the Preferred Reporting Items for Systematic and Meta-Analysis [PRISMA] guideline. Databases such as CINAHL, EMBASE, PubMed, PsycINFO, Scopus, Web of Science, Google Scholar, Global Health, HINARI, and Cochrane Library were included. We screened studies in Endnote X20 and performed the analysis using Revman 5.4.1. RESULTS The database search yielded 1,365 articles [14 RCTs and 4 quasi-experiments] with 21,070 participants satisfied all eligibility criteria. The meta-analysis showed that mHealth has an OR of 2.15 [95% CI: 1.70-2.72; P<0.001; I2 = 90%] on vaccination rates. The subgroup analysis showed that regional differences cause heterogeneity. Funnel plots and Harbord tests showed the absence of publication bias, while the GRADE scale showed a moderate-quality body of evidence. CONCLUSION Although heterogeneous, this systematic review and meta-analysis showed that the application of mHealth could potentially improve childhood vaccination in Africa. It increased childhood vaccination by more than double [2.15 times] among children whose mothers are motivated by mHealth services. MHealth is more effective in less developed regions and when an additional incentive party with the messaging system. However, it can be provided at a comparably low cost based on the development level of regions and can be established as a routine service in Africa. REGISTRATION PROSPERO: CRD42023415956.
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Affiliation(s)
- Girma Gilano
- Department of Public Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Sewunet Sako
- Department of Public Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Berihun Molla
- Department of Public Health Informatics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Andre Dekker
- Department of Radiation Oncology [Maastro], GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rianne Fijten
- Department of Radiation Oncology [Maastro], GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Hashemi S, Bai L, Gao S, Burstein F, Renzenbrink K. Sharpening clinical decision support alert and reminder designs with MINDSPACE: A systematic review. Int J Med Inform 2024; 181:105276. [PMID: 37948981 DOI: 10.1016/j.ijmedinf.2023.105276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/07/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Clinical decision support (CDS) alerts and reminders aim to influence clinical decisions, yet they are often designed without considering human decision-making behaviour. While this behaviour is comprehensively described by behavioural economics (BE), the sheer volume of BE literature poses a challenge to designers when identifying behavioural effects with utility to alert and reminder designs. This study tackles this challenge by focusing on the MINDSPACE framework for behaviour change, which collates nine behavioural effects that profoundly influence human decision-making behaviour: Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitment, and Ego. METHOD A systematic review searching MEDLINE, Embase, PsycINFO, and CINAHL Plus to explore (i) the usage of MINDSPACE effects in alert and reminder designs and (ii) the efficacy of those alerts and reminders in influencing clinical decisions. The search queries comprised ten Boolean searches, with nine focusing on the MINDSPACE effects and one focusing on the term mindspace. RESULTS 50 studies were selected from 1791 peer-reviewed journal articles in English from 1970 to 2022. Except for ego, eight of nine MINDSPACE effects were utilised to design alerts and reminders, with defaults and norms utilised the most in alerts and reminders, respectively. Overall, alerts and reminders informed by MINDSPACE effects showed an average 71% success rate in influencing clinical decisions (alerts 73%, reminders 69%). Most studies utilised a single effect in their design, with higher efficacy for alerts (64%) than reminders (41%). Others utilised multiple effects, showing higher efficacy for reminders (28%) than alerts (9%). CONCLUSION This review presents sufficient evidence demonstrating the MINDSPACE framework's merits for designing CDS alerts and reminders with human decision-making considerations. The framework can adequately address challenges in identifying behavioural effects pertinent to the effective design of CDS alerts and reminders. The review also identified opportunities for future research into other relevant effects (e.g., framing).
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Affiliation(s)
- Sarang Hashemi
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia.
| | - Lu Bai
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Shijia Gao
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Frada Burstein
- Department of Human-Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
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Kazemian A, Hoseinzadeh M, Banihashem Rad SA, Jouya A, Tahani B. Nudging oral habits; application of behavioral economics in oral health promotion: a critical review. Front Public Health 2023; 11:1243246. [PMID: 38145077 PMCID: PMC10739307 DOI: 10.3389/fpubh.2023.1243246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Background Oral health disorders significantly contribute to the global incidence of chronic diseases. Nudge interventions have demonstrated effectiveness in enhancing people's decision-making and self-management capacities in a cost-efficient manner. As a result, these interventions could be valuable tools for fostering improved oral care habits. This critical review explores potential behavioral nudges applicable to promoting oral health. Methods A thorough electronic literature search was conducted on Scopus, Embase, and PubMed databases for papers published post-2008. The search focused on empirical evidence concerning the direct and indirect application of Nudge theory in oral health enhancement. In addition, the investigation included the nudge intervention's role in managing common non-communicable disease risk factors (tobacco, alcohol, and sugar) and their use in other health sectors. Results and conclusion There is a dearth of studies on behavioral economics, particularly those involving reward and reminder techniques. However, various successful nudge interventions have been identified in other sectors that aim to improve health decisions. These include strategies encouraging healthier nutritional choices, tobacco and alcohol cessation, medication compliance, routine physical activity, and regular health check-ups. Such interventions can also have direct or indirect positive impacts on oral health. Implementing these interventions within an oral care framework could promote oral health due to similar underlying cognitive mechanisms. However, different types of nudge interventions have varying degrees of effectiveness. Furthermore, factors such as the method of delivery and the characteristics of the targeted population significantly influence the outcome of the intervention. Hence, it is imperative to conduct extensive studies in diverse socioeconomic settings to fully understand the potentials, limitations, and impacts of nudge interventions in promoting oral health.
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Affiliation(s)
- Ali Kazemian
- Department of Community Oral Health, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Melika Hoseinzadeh
- Dental Research Center, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ahmad Banihashem Rad
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Anahid Jouya
- Department of Community Oral Health, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahareh Tahani
- Department of Oral Public Health, Dental Research Center, School of Dentistry, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Lohiniva AL, Nurzhynska A, Mueed A, Ali A, Ahmed K, Ayiku P, Amo-Adjei J, Kawakatsu Y, Shetye M, Greiner K, McIntosh R. Strengthening polio vaccine demand in Ghana: Understanding the factors influencing uptake of the vaccine and the effectiveness of different message frames. PLoS One 2023; 18:e0279809. [PMID: 36763581 PMCID: PMC9916648 DOI: 10.1371/journal.pone.0279809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/15/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Ghana has experienced recent polio outbreaks. Behavioral insights can be used to understand behavior and create demand for the polio vaccine. METHODS This cross-sectional study is based on an interactive mobile phone survey that explored factors influencing the uptake of the polio vaccine among Ghanaian mothers with children younger than five years old. The survey also explores the mothers' intention to vaccinate their children in the future as well as an experiment with short polio vaccine voice message nudges to identify the most effective message frames in encouraging vaccination. The study sample was drawn from volunteers from a mobile service platform. Linear probability model regressions with Ordinary Least Squares (OLS) estimates were used to analyze the data. RESULTS In total, data from 708 caregivers was assessed. Out of the sample, 35% (n = 250) had not vaccinated their children against polio, around 8% (n = 53) of respondents stated they did not plan to do so, while 28% expressed intent to do so during the next polio vaccination campaign. Higher vaccination of children against polio, i.e. better uptake of the polio vaccine, appeared to be associated with children's caregivers knowing that polio causes paralysis (with a coefficient of 0.13 (95% CI: 0.02, 0.24), i.e. 13% more likely than not to have their child vaccinated). Higher vaccine uptake also appeared to be associated with the perception that the polio vaccine is safe (with a coefficient of 0.11 (95% CI: 0.01, 0.22), i.e. 11% more likely than not to have their child vaccinated). Another factor in increasing vaccine uptake is whether caregivers receive support from healthcare workers with a coefficient of 0.11 (95% CI: 0.02, 0.20), i.e. 11% more likely than not to have their child vaccinated. Crucially, difficulty accessing the polio vaccine appeared to be associate with a negative change in vaccine uptake (with a coefficient of -0.16 (95% CI: -0.23, -0.08), i.e. 16% less likely to have their child vaccinated). Satisfaction with the information provided by vaccinators was also associated with better vaccine uptake (with a coefficient of 0.12 (95% CI: 0.05, 0.20) i.e. 12% more likely than not to have their child vaccinated); and having seen or heard something negative about the polio vaccine with a coefficient of 0.10 (95% CI: 0.03, 0.17), i.e. 10% more likely than not to have their child vaccinated. The social norms message frame was statistically significant with a coefficient of 0.06 (95% CI: -0.004, 012). CONCLUSION The findings from this study suggest that most women with children under the age of 5 appear to have vaccinated their children against polio. Many more caregivers express an intention to vaccinate their children, never having done so before. The behavior and the intention to vaccinate are both driven by a number of factors that must be addressed to create demand for the polio vaccine. Targeted message frames appeared to be statistically significant drivers of vaccine uptake. However, more research is required to understand how they impact vaccine behavior and future intention for vaccination.
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Affiliation(s)
- Anna-Leena Lohiniva
- Social and Behaviour Change Section, UNICEF Ghana Country Office, Accra, Ghana,* E-mail:
| | | | | | | | | | | | - Joshua Amo-Adjei
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Yoshito Kawakatsu
- Department of Data and Analytics, UNICEF HQ, New York, New York, United States of America
| | - Mrunal Shetye
- Health Section, UNICEF Ghana Country Office, Accra, Ghana
| | - Karen Greiner
- Social and Behaviour Change Section, UNICEF West and Central Africa, Dagar, Senegal
| | - Ross McIntosh
- UNICEF Polio, UNICEF HQ, New York, New York, United States of America
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McCulloh RJ, Darden PM, Snowden J, Ounpraseuth S, Lee J, Clarke M, Newcomer SR, Fu L, Hubberd D, Baldner J, Garza M, Kerns E. Improving pediatric COVID-19 vaccine uptake using an mHealth tool (MoVeUp): study protocol for a randomized, controlled trial. Trials 2022; 23:911. [PMID: 36307830 PMCID: PMC9616622 DOI: 10.1186/s13063-022-06819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) vaccines demonstrate excellent effectiveness against infection, severe disease, and death. However, pediatric COVID-19 vaccination rates lag among individuals from rural and other medically underserved communities. The research objective of the current protocol is to determine the effectiveness of a vaccine communication mobile health (mHealth) application (app) on parental decisions to vaccinate their children against COVID-19. METHODS Custodial parents/caregivers with ≥ 1 child eligible for COVID-19 vaccination who have not yet received the vaccine will be randomized to download one of two mHealth apps. The intervention app will address logistical and motivational barriers to pediatric COVID-19 vaccination. Participants will receive eight weekly push notifications followed by two monthly push notifications (cues to action) regarding vaccinating their child. Through branching logic, users will access customized content based on their locality, degree of rurality-urbanicity, primary language (English/Spanish), race/ethnicity, and child's age to address COVID-19 vaccine knowledge and confidence gaps. The control app will provide push notifications and information on general pediatric health and infection prevention and mitigation strategies based on recommendations from the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC). The primary outcome is the proportion of children who complete COVID-19 vaccination series. Secondary outcomes include the proportion of children who receive ≥ 1 dose of COVID-19 vaccine and changes in parent/caregiver scores from baseline to immediately post-intervention on the modified WHO SAGE Vaccine Hesitancy Scale adapted for the COVID-19 vaccine. DISCUSSION The COVID-19 pandemic inflicts disproportionate harm on individuals from underserved communities, including those in rural settings. Maximizing vaccine uptake in these communities will decrease infection rates, severe illness, and death. Given that most US families from these communities use smart phones, mHealth interventions hold the promise of broad uptake. Bundling multiple mHealth vaccine uptake interventions into a single app may maximize the impact of deploying such a tool to increase COVID-19 vaccination. The new knowledge to be gained from this study will directly inform future efforts to increase COVID-19 vaccination rates across diverse settings and provide an evidentiary base for app-based vaccine communication tools that can be adapted to future vaccine-deployment efforts. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov NCT05386355 . Registered on May 23, 2022.
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Affiliation(s)
- Russell J McCulloh
- Children's Hospital & Medical Center, 8200 Dodge St., Omaha, NE, 68114, USA.
| | - Paul M Darden
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Jessica Snowden
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Songthip Ounpraseuth
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Jeannette Lee
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Martina Clarke
- College of Information Science & Technology, University of Nebraska Omaha, 172 Peter Kiewit Institute, 1110 South 67th Street, Omaha, NE, 68182, USA
| | - Sophia R Newcomer
- School of Public Health and Community Health Sciences, University of Montana, Skaggs Building Room 177, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Linda Fu
- Office of the Director, National Institutes of Health, 11601 Landsdown Sreet, Rockville, MD, 20852, USA
| | - DeAnn Hubberd
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Jaime Baldner
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Maryam Garza
- University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Ellen Kerns
- University of Nebraska Medical Center, 42nd and Emile St., Omaha, NE, 68131, USA
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McCulloh RJ, Darden P, Snowden J, Ounpraseuth S, Lee J, Clarke M, Newcomer SR, Fu L, Hubberd D, Baldner J, Garza M, Kerns E. Improving pediatric COVID-19 vaccine uptake using an mHealth tool (MoVeUP): a randomized, controlled trial. RESEARCH SQUARE 2022:rs.3.rs-2070396. [PMID: 36238712 PMCID: PMC9558439 DOI: 10.21203/rs.3.rs-2070396/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Coronavirus disease 2019 (COVID-19) vaccines demonstrate excellent effectiveness against infection, severe disease, and death. However, pediatric COVID-19 vaccination rates lag among individuals from rural and other medically underserved communities. The research objective of the current protocol is to determine the effectiveness of a vaccine communication mobile health (mHealth) application (app) on parental decisions to vaccinate their children against COVID-19. Methods: Custodial parents/caregivers with ≥1 child eligible for COVID-19 vaccination who have not yet received the vaccine will be randomized to download one of two mHealth apps. The intervention app will address logistical and motivational barriers to pediatric COVID-19 vaccination. Participants will receive eight weekly push notifications followed by two monthly push notifications (cues to action) regarding vaccinating their child. Through branching logic, users will access customized content based on their locality, degree of rurality-urbanicity, primary language (English/Spanish), race/ethnicity, and child's age to address COVID-19 vaccine knowledge and confidence gaps. The control app will provide push notifications and information on general pediatric health and infection prevention and mitigation strategies based on recommendations from the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC). The primary outcome is the proportion of children who complete COVID-19 vaccination series. Secondary outcomes include the proportion of children who receive ≥1 dose of COVID-19 vaccine and changes in parent/caregiver scores from baseline to immediately post-intervention on the modified WHO SAGE Vaccine Hesitancy Scale adapted for the COVID-19 vaccine. Discussion: The COVID-19 pandemic inflicts disproportionate harm on individuals from underserved communities, including those in rural settings. Maximizing vaccine uptake in these communities will decrease infection rates, severe illness, and death. Given that most US families from these communities use smart phones, mHealth interventions hold the promise of broad uptake. Bundling multiple mHealth vaccine-uptake interventions into a single app may maximize the impact of deploying such a tool to increase COVID-19 vaccination. The new knowledge to be gained from this study will directly inform future efforts to increase COVID-19 vaccination rates across diverse settings and provide an evidentiary base for app-based vaccine communication tools that can be adapted to future vaccine-deployment efforts. Clinical Trials Registration: Name of the registry: clinicaltrials.gov Trial registration number: NCT05386355 Date of registration: May 23, 2022 URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT05386355.
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Wariri O, Okomo U, Kwarshak YK, Utazi CE, Murray K, Grundy C, Kampmann B. Timeliness of routine childhood vaccination in 103 low-and middle-income countries, 1978-2021: A scoping review to map measurement and methodological gaps. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000325. [PMID: 36962319 PMCID: PMC10021799 DOI: 10.1371/journal.pgph.0000325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Abstract
Empiric studies exploring the timeliness of routine vaccination in low-and middle-income countries (LMICs) have gained momentum in the last decade. Nevertheless, there is emerging evidence suggesting that these studies have key measurement and methodological gaps that limit their comparability and utility. Hence, there is a need to identify, and document these gaps which could inform the design, conduct, and reporting of future research on the timeliness of vaccination. We synthesised the literature to determine the methodological and measurement gaps in the assessment of vaccination timeliness in LMICs. We searched five electronic databases for peer-reviewed articles in English and French that evaluated vaccination timeliness in LMICs, and were published between 01 January 1978, and 01 July 2021. Two reviewers independently screened titles and abstracts and reviewed full texts of relevant articles, following the guidance framework for scoping reviews by the Joanna Briggs Institute. From the 4263 titles identified, we included 224 articles from 103 countries. China (40), India (27), and Kenya (23) had the highest number of publications respectively. Of the three domains of timeliness, the most studied domain was 'delayed vaccination' [99.5% (223/224)], followed by 'early vaccination' [21.9% (49/224)], and 'untimely interval vaccination' [9% (20/224)]. Definitions for early (seven different definitions), untimely interval (four different definitions), and delayed vaccination (19 different definitions) varied across the studies. Most studies [72.3% (166/224)] operationalised vaccination timeliness as a categorical variable, compared to only 9.8% (22/224) of studies that operationalised timeliness as continuous variables. A large proportion of studies [47.8% (107/224)] excluded the data of children with no written vaccination records irrespective of caregivers' recall of their vaccination status. Our findings show that studies on vaccination timeliness in LMICs has measurement and methodological gaps. We recommend the development and implement of guidelines for measuring and reporting vaccination timeliness to bridge these gaps.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Chigozie Edson Utazi
- WorldPop, School of geography and Environmental Science, University of Southampton, Southampton, United Kingdom
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Kris Murray
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- MRC Centre for Global Infectious Disease Analysis, Imperial College School of Public Health, Imperial College London, London, United Kingdom
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Al-Mustapha AI, Abubakar MI, Oyewo M, Esighetti RE, Ogundijo OA, Bolanle LD, Fakayode OE, Olugbon AS, Oguntoye M, Elelu N. Socio-Demographic Characteristics of COVID-19 Vaccine Recipients in Kwara State, North Central Nigeria. Front Public Health 2022; 9:773998. [PMID: 35071159 PMCID: PMC8766999 DOI: 10.3389/fpubh.2021.773998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Understanding key socio-demographic variables of 2019 coronavirus disease (COVID-19) vaccine recipients is crucial to improving its acceptance and Nigeria's COVID-19 control strategy. The survey was conducted as a non-probability cross-sectional survey of 2,936 COVID-19 vaccine recipients in Kwara State. Our findings revealed that 74% (n = 2,161) of the vaccine recipients were older than 40 years. Forty percent (n = 1,180) of the vaccine recipients earned a monthly income >100,000 Naira (equivalent to US $200). Most of the vaccine recipients (64%, n = 1,880) had tertiary education, while 15% (n = 440) of them had no formal education. Almost half of the recipients (47%, n = 1,262) were government employees and 28.8% (n = 846) of them had health-related backgrounds. Only 17% (n = 499) of the vaccine recipients have been screened for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), of which 21% (n = 105/499) of them were tested positive. Only 47% (n = 1,378) had been fully immunized. The prevalence of confirmed COVID-19 cases among COVID-19 vaccine recipients in Kwara State was 3.6% (n = 105/2,936). The most recurrent adverse events following immunization (AEFIs) among vaccine recipients were fever (14%, n = 411), pain at injection site (47%, n = 1,409), headache (19%, n = 558), and body weakness (9%, n = 264). The need to protect themselves from the deadly virus was the main reason that prompted people to voluntarily accept the COVID-19 vaccine. There is a high level of COVID-19 vaccine acceptance among respondents across all social classes including those with no formal education, those with very low monthly income (< US $2 per day), and in untested population. Hence, vaccine donors should prioritize equitable distribution to Low-and-Middle-income Countries (LMICs) such as Nigeria, and health authorities should improve vaccine advocacy to focus on vaccine safety and efficacy.
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Affiliation(s)
- Ahmad Ibrahim Al-Mustapha
- Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin, Nigeria.,Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria.,Infectious Diseases and One Health, Faculty of Pharmaceutical Sciences, Universite de Tours, Tours, France
| | - Musa Imam Abubakar
- Regional Disease Surveillance Systems Enhancement Project (REDISSE) II, Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
| | - Muftau Oyewo
- Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin, Nigeria.,Nigerian Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | | | - Oluwaseun Adeolu Ogundijo
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lukman Dele Bolanle
- Department of Public Health, Kwara State Ministry of Health, Ilorin, Nigeria
| | | | - Abdullateef Saliman Olugbon
- Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin, Nigeria
| | - Michael Oguntoye
- Kwara State Primary Healthcare Development Agency, Ilorin, Nigeria
| | - Nusirat Elelu
- Kwara State Primary Healthcare Development Agency, Ilorin, Nigeria.,Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ilorin, Ilorin, Nigeria
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10
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Solís Arce JS, Warren SS, Meriggi NF, Scacco A, McMurry N, Voors M, Syunyaev G, Malik AA, Aboutajdine S, Adeojo O, Anigo D, Armand A, Asad S, Atyera M, Augsburg B, Awasthi M, Ayesiga GE, Bancalari A, Björkman Nyqvist M, Borisova E, Bosancianu CM, Cabra García MR, Cheema A, Collins E, Cuccaro F, Farooqi AZ, Fatima T, Fracchia M, Galindo Soria ML, Guariso A, Hasanain A, Jaramillo S, Kallon S, Kamwesigye A, Kharel A, Kreps S, Levine M, Littman R, Malik M, Manirabaruta G, Mfura JLH, Momoh F, Mucauque A, Mussa I, Nsabimana JA, Obara I, Otálora MJ, Ouédraogo BW, Pare TB, Platas MR, Polanco L, Qureshi JA, Raheem M, Ramakrishna V, Rendrá I, Shah T, Shaked SE, Shapiro JN, Svensson J, Tariq A, Tchibozo AM, Tiwana HA, Trivedi B, Vernot C, Vicente PC, Weissinger LB, Zafar B, Zhang B, Karlan D, Callen M, Teachout M, Humphreys M, Mobarak AM, Omer SB. COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries. Nat Med 2021; 27:1385-1394. [PMID: 34272499 PMCID: PMC8363502 DOI: 10.1038/s41591-021-01454-y] [Citation(s) in RCA: 556] [Impact Index Per Article: 185.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/28/2021] [Indexed: 02/08/2023]
Abstract
Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.
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Affiliation(s)
| | | | | | | | - Nina McMurry
- WZB Berlin Social Science Center, Berlin, Germany
| | - Maarten Voors
- Wageningen University & Research, Wageningen, the Netherlands
| | - Georgiy Syunyaev
- WZB Berlin Social Science Center, Berlin, Germany.,International Center for the Study of Institutions and Development (ICSID), HSE University, Moscow, Russia.,Columbia University, New York, NY, USA
| | | | | | - Opeyemi Adeojo
- Busara Center for Behavioral Economics, Lagos, Nigeria.,Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Deborah Anigo
- Busara Nigeria, Lagos, Nigeria.,Agricultural and Rural Development Secretariat, Federal Capital Territory Administration, Abuja, Nigeria
| | - Alex Armand
- Nova School of Business and Economics, Lisbon, Portugal.,The Institute for Fiscal Studies, London, UK
| | - Saher Asad
- Lahore University of Management Sciences, Lahore, Pakistan
| | - Martin Atyera
- Innovations for Poverty Action (IPA) Uganda, Kampala, Uganda
| | | | | | | | - Antonella Bancalari
- The Institute for Fiscal Studies, London, UK.,University of St Andrews, St Andrews, UK.,Redes Peru, Lima, Peru
| | | | - Ekaterina Borisova
- International Center for the Study of Institutions and Development (ICSID), HSE University, Moscow, Russia.,Ghent University, Department of Economics, Ghent, Belgium
| | | | | | - Ali Cheema
- Lahore University of Management Sciences, Lahore, Pakistan.,Institute of Development and Economic Alternatives, Lahore, Pakistan
| | | | - Filippo Cuccaro
- Innovations for Poverty Action (IPA) Sierra Leone, Freetown, Sierra Leone
| | - Ahsan Zia Farooqi
- Institute of Development and Economic Alternatives, Lahore, Pakistan
| | | | - Mattia Fracchia
- Nova School of Business and Economics, Lisbon, Portugal.,NOVAFRICA, Lisbon, Portugal
| | | | | | - Ali Hasanain
- Lahore University of Management Sciences, Lahore, Pakistan
| | - Sofía Jaramillo
- Innovations for Poverty Action (IPA) Colombia, Bogotá, Colombia
| | - Sellu Kallon
- Wageningen University & Research, Wageningen, the Netherlands.,Institute of Public Administration and Management, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Arjun Kharel
- Centre for the Study of Labour and Mobility (CESLAM), Kathmandu, Nepal
| | | | - Madison Levine
- Wageningen University & Research, Wageningen, the Netherlands
| | | | - Mohammad Malik
- Institute of Development and Economic Alternatives, Lahore, Pakistan
| | | | | | - Fatoma Momoh
- Innovations for Poverty Action (IPA) Sierra Leone, Freetown, Sierra Leone
| | - Alberto Mucauque
- Associação NOVAFRICA para o Desenvolvimento Empresarial e Económico de Moçambique, Maputo, Mozambique
| | - Imamo Mussa
- Associação NOVAFRICA para o Desenvolvimento Empresarial e Económico de Moçambique, Maputo, Mozambique
| | | | - Isaac Obara
- Busara Center for Behavioral Economics, Lagos, Nigeria
| | | | | | - Touba Bakary Pare
- Innovations for Poverty Action (IPA) Burkina Faso, Ouagadougou, Burkina Faso
| | | | - Laura Polanco
- Innovations for Poverty Action (IPA) Colombia, Bogotá, Colombia
| | | | - Mariam Raheem
- Centre for Economic Research in Pakistan (CERP), Lahore, Pakistan
| | - Vasudha Ramakrishna
- Yale Research Initiative on Innovation and Scale (Y-RISE), New Haven, CT, USA
| | - Ismail Rendrá
- Associação NOVAFRICA para o Desenvolvimento Empresarial e Económico de Moçambique, Maputo, Mozambique
| | - Taimur Shah
- Centre for Economic Research in Pakistan (CERP), Lahore, Pakistan
| | | | | | - Jakob Svensson
- Institute for International Economic Studies (IIES), Stockholm University, Stockholm, Sweden
| | - Ahsan Tariq
- Institute of Development and Economic Alternatives, Lahore, Pakistan
| | | | - Hamid Ali Tiwana
- Institute of Development and Economic Alternatives, Lahore, Pakistan
| | | | - Corey Vernot
- Yale Research Initiative on Innovation and Scale (Y-RISE), New Haven, CT, USA
| | - Pedro C Vicente
- Nova School of Business and Economics, Lisbon, Portugal.,NOVAFRICA, Lisbon, Portugal
| | | | - Basit Zafar
- Centre for Economic Research in Pakistan (CERP), Lahore, Pakistan.,University of Michigan, Ann Arbor, MI, USA
| | | | - Dean Karlan
- Innovations for Poverty Action (IPA), New York, NY, USA.,Kellogg School of Management at Northwestern University, Evanston, IL, USA
| | - Michael Callen
- London School of Economics and Political Science, London, UK
| | | | - Macartan Humphreys
- WZB Berlin Social Science Center, Berlin, Germany.,Columbia University, New York, NY, USA
| | | | - Saad B Omer
- Yale Institute for Global Health, New Haven, CT, USA.
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