Strategies for improving childhood routine immunization coverage: a global systematic review & meta-analyses
Abstract
Background: Childhood vaccination is one of the most effective public health interventions for protecting children from serious illness and death. Vaccinating children is essential to reducing the burden of vaccine-preventable diseases and achieving global immunization goals.
Objective: We conducted a systematic review of global research evaluating strategies designed to increase routine childhood vaccination among children under five years of age.
Methods: We searched four major health databases and reviewed studies that tested interventions such as educational programs, outreach activities, reminders, financial incentives, health worker training, and service delivery approaches. A total of 35 studies were assessed and deemed eligible to be included in the review. We assessed the quality of the evidence and synthesized findings using both statistical analysis and narrative review methods.
Results: We identified 28 different strategies aimed at improving childhood vaccination coverage. Overall, most approaches resulted in modest improvements, with effectiveness varying across settings and populations. A small number of strategies demonstrated more consistent benefits. These included: (1) cash transfer programs, which provided small but meaningful improvements in full vaccination coverage; (2) home-based identification and outreach approaches, which helped health systems identify and reach children who had missed vaccinations; and (3) informational vaccination sessions, delivered in health facilities or community settings, which improved uptake of key childhood vaccines.
Conclusions: Our findings suggest that no single strategy is universally effective. They highlight that success depends on the local context. Achieving the goals of Immunization Agenda 2030 will require expanding effective strategies and adapting them to local contexts.