Top

International Journal of Public Health

Published in:

01-11-2015 | Review

Exposing concerns about vaccination in low- and middle-income countries: a systematic review

Authors: Daniel Cobos Muñoz, Laura Monzón Llamas, Xavier Bosch-Capblanch

Published in: International Journal of Public Health | Issue 7/2015

Abstract

Objectives

Concerns about vaccination lead to under- and no-vaccination. Our objective is to synthesise and expose evidence on individuals’ and communities’ concerns about vaccination to influence current debates on strategies to improve vaccination coverage in low- and middle-income countries.

Methods

Systematic literature review till February 2014, following standard methods. Published and grey literature that focused on individuals and community concerns on childhood vaccinations were selected.

Results

44 quantitative, qualitative and mixed-methods studies were included. Main reported concerns referred to perceptions of vaccine harms (e.g. attribution of fatal events). Other concerns included programme distrust (mainly due to rumours and conspiracies) and health system unfriendliness.

Conclusions

Concerns about vaccination are widespread and further worsen the challenges related to programmatic and health system barriers to vaccination. There is a disconnection between qualitative and quantitative research which misses the opportunity to quantify what is reported in the former. Strikingly, there is a wealth of evidence on concerns but much lesser evidence on interventions to address them. We welcome World Health Organization initiative to tackle vaccine hesitancy and call for the synthesis of evidence and production of guidance on strategies to address concerns on vaccination.

Available only for authorised users

Abdulraheem IS, Onajole AT, Jimoh AAG, Oladipo AR (2011) Reasons for incomplete vaccination and factors for missed opportunities among rural Nigerian children. J Public Health Epidemiol 3(4):194–203

Abhijeet I, Dixit JV, Deven D (2013) Reasons behind incomplete immunization: a cross sectional study at Urban Health Centre of Government Medical College, Aurangabad. Natl J Community Med 4(2):353–356

Akmatov MK, Mikolajczjk RT, Kretzschmar M, Kramer A (2009) Attitudes and beliefs of parents about childhood vaccinations in post-soviet countries the example of Kyrgyzstan. Pediatr Infect Dis J 637–640. doi:10.1097/INF.0b013e3181966401

Ambe JP, Omotara BA, Mandu Baba M (2001) Perceptions, beliefs and practices of mothers in sub-urban and rural areas towards measles and measles vaccination in Northern Nigeria. Trop Dr 31(2):89–90

Angadi MM, Jose AP, Udgiri R, Masali KA, Sorganvi V (2013) A study of knowledge, attitude and practices on immunization of children in urban slums of bijapur city, karnataka, India. J Clin Diagn Res 7(12):2803–2806PubMed

Asgary R, Kam E, Mumm L, Arole S (2011) Evaluating immunization rates and barriers to immunization for children 1 to 5 years old in rural India. Am J Trop Med Hyg 60th Annu Meet Am Soc Trop Med Hyg ASTMH 2011 Phila PA US Conf Start 20111204 Conf End 20111208 Conf Publ (var.pagings) 85(6 suppl. 1):34

Babalola S (2011) Maternal reasons for non-immunisation and partial immunisation in northern Nigeria. J Paediatr Child Health 47:276–281. doi:10.1111/j.1440-1754.2010.01956.x CrossRefPubMed

Babirye JN, Rutebemberwa E, Kiguli J, Wamani H, Nuwaha F, Engebretsen IM (2011) More support for mothers: a qualitative study on factors affecting immunisation behaviour in Kampala, Uganda. BMC Public Health 723. doi:10.1186/1471-2458-11-723

Bedford H, Elliman D (2000) Concerns about immunisation. Br Med J 320:240–243CrossRef

Bedford J, Singh A, Ponferrada MB, Eldred L (2013) Access to health services: analysing non-financial barriers in Ghana, Bangladesh, Vietnam and Rwanda using qualitative methods. UNICEF

Bosch-Capblanch X, Banerjee K, Burton A (2012) Unvaccinated children in years of increasing coverage: how many and who are they? Evidence from 96 low- and middle-income countries. Trop Med Int Health 697–710. doi:10.1111/j.1365-3156.2012.02989.x

Braka F, Asiimwe D, Soud F, Lewis RF, Makumbi I, Gust D (2012) A qualitative analysis of vaccine safety perceptions and concerns among caretakers in Uganda. Matern Child Health J 1045–1052. doi:10.1007/s10995-011-0826-5

Brown KF, Kroll JS, Hudson MJ, Ramsay M, Green J, Long SJ, Vincent CA, Fraser G, Sevdalis N (2010) Factors underlying parental decisions about combination childhood vaccinations including MMR: a systematic review. Vaccine 4235–4248. doi:10.1016/j.vaccine.2010.04.052

Canavati S, Plugge E, Suwanjatuporn S, Sombatrungjaroen S, Nosten F (2011) Barriers to immunization among children of migrant workers from Myanmar living in Tak province, Thailand. Bull World Health Organ 528–531. doi:10.2471/Blt.10.084244

Chaturvedi S, Dasgupta R, Adhish V, Ganguly KK, Rai S, Sushant L, Srabasti S, Arora NK (2009) Deconstructing social resistance to pulse polio campaign in two North Indian districts. Indian Pediatr 963–974

Critical Appraisal Skills Programme (CASP) (2014) CASP qualitative research checklist 31.05.13, Oxford. http://media.wix.com/ugd/dded87_29c5b002d99342f788c6ac670e49f274.pdf. Accessed Feb 2014

Dasgupta R, Chaturvedi S, Adhish SV, Ganguly KK, Rai S, Sushant L, Arora NK (2008) Social determinants, polio ‘endgame’: a qualitative study in high risk districts of India. Indian Pediatr 45:357–365PubMed

Dugas M, Dube E, Kouyate B, Sanou A, Bibeau G (2009) Portrait of a lengthy vaccination trajectory in Burkina Faso: from cultural acceptance of vaccines to actual immunization. BMC Int Health Hum Rights S9. doi:10.1186/1472-698X-9-S1-S9

Effective Public Health Practice Project (2010) Quality assessment tool for quantitative studies. http://www.ephpp.ca/PDF/Quality%20Assessment%20Tool_2010_2.pdf. Accessed Feb 2014

Etokidem AJ, Ndifon W (2013) Myths and misconceptions as barriers to uptake of immunization services in Nigeria. J Vaccines Vaccination 4(7):204. doi:10.4172/2157-7560.1000204

European Centre for Disease Prevention and Control (2013) Review of scientific literature on drivers and barriers of seasonal influenza vaccination coverage in the EU/EEA. Stockholm

Falagas ME, Zarkadoulia E (2008) Factors associated with suboptimal compliance to vaccinations in children in developed countries: a systematic review. Curr Med Res Opin 1719–1741. doi:10.1185/03007990802085692

Favin M, Steinglass R, Fields R, Banerjee K, Sawhney M (2012) Why children are not vaccinated: a review of the grey literature. Int Health 229–238. doi:10.1016/j.inhe.2012.07.004

Figueiredo GLA, Pina JC, Tonete VLP, de Lima RAG, de Mello DF (2011) Experiences of families in the immunization of Brazilian children under two years old. Rev Lat-Am Enferm 598–605. doi:10.1590/S0104-11692011000300020

Fourn L, Haddad S, Fournier P, Gansey R (2009) Determinants of parents’ reticence toward vaccination in urban areas in Benin (West Africa). BMC Int Health Hum Rights S14. doi:10.1186/1472-698X-9-S1-S14

Fowler GL, Kennedy A, Leidel L, Kohl KS, Khromava A, Bizhanova G, Shui I, Gust D (2007) Vaccine safety perceptions and experience with adverse events following immunization in Kazakhstan and Uzbekistan: a summary of key informant interviews and focus groups. Vaccine 3536–3543. doi:10.1016/j.vaccine.2007.01.082

Helman CG, Yogeswaran P (2004) Perceptions of childhood immunisations in rural Transkei—a qualitative study. SAMJ South Afr Med J 94(10):835–838

Hendry M, Lewis R, Clements A, Damery S, Wilkinson C (2013) “HPV? Never heard of it!”: a systematic review of girls’ and parents’ information needs, views and preferences about human papillomavirus vaccination Vaccine 31:5152–5167. doi:10.1016/j.vaccine.2013.08.091

Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration

Institute of Medicine (IOM) (2012) The childhood immunization schedule and safety. Stakeholder concerns, scientific evidence and future

Jackson N, Waters E, Guidelines for Systematic Reviews in Health P and Public Health T (2005) Criteria for the systematic review of health promotion and public health interventions. Health Promot Int 367–374. doi:10.1093/heapro/dai022

Joseph N, Subba SH, Nelliyanil M, Kotian SM, Haridath AC, Kishor N, Attavar S, Poornima P, Rane DV, Chaithali H, Husain J (2011) A study of the knowledge and attitude towards pulse polio immunization in semi urban areas of South India. Australas Med J 4(2):81–86. doi:10.4066/AMJ.2011.532 PubMedCentralCrossRefPubMed

Kata A (2010) A postmodern Pandora’s box: anti-vaccination misinformation on the Internet. Vaccine 28:1709–1716. doi:10.1016/j.vaccine.2009.12.022 CrossRefPubMed

Kaufman J, Synnot A, Ryan R, Hill S, Horey D, Willis N, Lin V, Robinson P (2013) Face to face interventions for informing or educating parents about early childhood vaccination. Cochrane Database Syst Rev CD010038. doi:10.1002/14651858.CD010038.pub2

Kaur SM (2010) Knowledge and attitude of fathers of 12–24 months of age children towards the practice of immunization in Amritsar. Indian J Matern Child Health 12(3):9

Khowaja AR, Khan SA, Nizam N, Omer SB, Zaidi A (2012) Parental perceptions surrounding polio and self-reported non-participation in polio supplementary immunization activities in Karachi, Pakistan: a mixed methods study. Bull World Health Organ 822–830. doi:10.2471/BLT.12.106260

Kolendorf K, Aaby P, Westergaard S, Deckert T (1978) Absorption, effectiveness and side effects of highly purified porcine NPH-insulin preparations (Leo). Eur J Clin Pharmacol 117–124. doi:10.7860/JCDR/2013/6565.3763

Koruk I, Simsek Z, Koruk ST (2013) A case of childhood vaccination barrier: migrant and seasonal farmworkers. Turk J Med Sci 424–429. doi:10.3906/sag-1112-20

Larson HJ, Cooper LZ, Eskola J, Katz SL, Ratzan S (2011) Addressing the vaccine confidence gap. Lancet 526–535. doi:10.1016/S0140-6736(11)60678-8

Larson HJ et al (2013) Measuring vaccine confidence: analysis of data obtained by a media surveillance system used to analyse public concerns about vaccines. Lancet Infect Dis 13:606–613. doi:10.1016/s1473-3099(13)70108-7 CrossRefPubMed

Larson HJ, Jarrett C, Eckersberger E, Smith DM, Paterson P (2014) Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007–2012. Vaccine 2150–2159. doi:10.1016/j.vaccine.2014.01.081

Logullo P, Barbosa de Carvalho H, Saconi R, Massad E (2008a) Factors affecting compliance with the measles vaccination schedule in a Brazilian city. Sao Paulo Med J 166–171

Logullo P, de Carvalho HB, Saconi R, Massad E (2008b) Fear of injections is a reason for not to vaccinate their children, say caretakers. Vaccine 141–143. doi:10.1016/j.vaccine.2007.09.075

Manjunath U, Pareek RP (2003) Maternal knowledge and perceptions about the routine immunization programme—a study in a semiurban area in Rajasthan. Indian J Med Sci 57(4):158–163PubMed

Mills E, Jadad AR, Ross C, Wilson K (2005a) Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination. J Clin Epidemiol 1081–1088. doi:10.1016/j.jclinepi.2005.09.002

Mills E, Montori VM, Ross CP, Shea B, Wilson K, Guyatt GH (2005b) Systematically reviewing qualitative studies complements survey design: an exploratory study of barriers to paediatric immunisations. J Clin Epidemiol 1101–1108. doi:10.1016/j.jclinepi.2005.01.014

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6. doi:10.1371/journal.pmed.100009

Naeem M, Adil M, Zia-Ul-Islam Khan M, Abbas SH (2011) Coverage and causes of missed BCG vaccination: a user perspective study. J Med Sci 19(3):122–125

Naeem M, Abbas SH, Gul S, Adil M, Khan MZUI, Khan MS (2012a) Causes of immunization failure in DPT vaccination in urban and rural areas of Peshawar. J Med Sci 20(4):187–191

Naeem M, Khan MZ, Muhammad A, Abbas SH, Ayasha K, Khan MU, Naz SM (2012b) Coverage and causes of non immunization in National Immunization Days for polio; a consumer and provider perspective study in Peshawar. J Postgrad Med Inst 26(1):48–54

Namuigi P, Phuanukoonnon S (2005) Barriers to measles immunization: the beliefs and attitudes of caregivers in Goroka, Eastern Highlands Province, Papua New Guinea. P N G Med J 48(3–4):183–187PubMed

Obute JA, Arulogun OS (2007) Parents’ awareness and perception of the polio eradication programme in Gombe Local Government Area, Gombe State, Nigeria. Int J Health Promot Educ 81–86

Oladokun RE, Adedokun BO, Lawoyin TO (2010) Children not receiving adequate immunization in Ibadan, Nigeria: what reasons and beliefs do their mothers have? Niger J Clin Pract 173–178

Olufowote JO (2011) Local resistance to the global eradication of polio: newspaper coverage of the 2003–2004 vaccination stoppage in northern Nigeria. Health Commun 743–753. doi:10.1080/10410236.2011.566830

Oyo-Ita A, Nwachukwu CE, Oringanje C, Meremikwu MM (2011) Interventions for improving coverage of child immunization in low- and middle-income countries. Cochrane Database Syst Rev CD008145. doi:10.1002/14651858.CD008145.pub2

Perry H, Nurani S, Abdul Quaiyum M, Jinnah SA, Sharma A (2007) Barriers to immunization among women and children living in slums of Zone 3 of Dhaka City, Bangladesh. A qualitative assessment. International Centre for Diarrhoeal Disease Research, Bangladesh [ICDDR, B]

Qutaiba BA-lO, Bahari MB, Al-Qazaz HK, Salih MR, Jamshed SQ, Elkalmi RM (2014) Are parents’ knowledge and practice regarding immunization related to pediatrics’ immunization compliance? A mixed method study. BMC Pediatr 20. doi:10.1186/1471-2431-14-20

Rainey JJ, Watkins M, Ryman TK, Sandhu P, Bo A, Banerjee K (2011) Reasons related to non-vaccination and under-vaccination of children in low and middle income countries: findings from a systematic review of the published literature, 1999–2009. Vaccine 8215–8221. doi:10.1016/j.vaccine.2011.08.096

Sadaf A, Richards JL, Glanz J, Salmon DA, Omer SB (2013) A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy. Vaccine 4293–4304. doi:10.1016/j.vaccine.2013.07.013

Saeterdal I, Lewin S, Austvoll-Dahlgren A, Glenton C, Munabi-Babigumira S (2014) Interventions aimed at communities to inform and/or educate about early childhood vaccination. Cochrane Database Syst Rev CD010232. doi:10.1002/14651858.CD010232.pub2

SAGE Working Group on Vaccine Hesitancy (2013a) A model of determinants of vaccine hesitancy. http://www.who.int/immunization/sage/meetings/2014/october/1_Report_WORKING_GROUP_vaccine_hesitancy_final.pdf

SAGE Working Group on Vaccine Hesitancy (2013b) Vaccine hesitancy landscape analysis of organisations working on the issue of vaccine hesitancy. http://www.who.int/immunization/sage/meetings/2013/april/1_Model_analyze_driversofvaccineConfidence_22_March.pdf

Santos LB, Barreto CCM, Silva FLS, Silva KCDO (2011) Percepção das mães quanto à importância da imunização infantil. Perception of mothers regarding the importance of child immunization. Rev RENE 621–626

Schwarz NG, Gysels M, Pell C, Gabor J, Schlie M, Issifou S, Lell B, Kremsner PG, Grobusch MP, Pool R (2009) Reasons for non-adherence to vaccination at mother and child care clinics (MCCs) in Lambarene, Gabon. Vaccine 5371–5375. doi:10.1016/j.vaccine.2009.0

Sheikh A, Iqbal B, Ehtamam A, Rahim M, Shaikh HA, Usmani HA, Nasir J, Ali S, Zaki M, Wahab TA, Wasim W, Aftab AA (2013) Reasons for non-vaccination in pediatric patients visiting tertiary care centers in a polio-prone country. Arch Public Health 19. doi:10.1186/0778-7367-71-19

Sheldon SJ, Alons C (2003) A study to describe barriers to childhood vaccination in Mozambique. Final report. [Maputo]. Ministerio da Saude, Mozambique

Sia D, Fournier P, Sondo BK (2011) Local vaccination cultures: the central role of health agents in rural settings of Burkina Faso Global Health Promotion. 18:68–80. doi:10.1177/1757975911404747

Tadesse H, Deribew A, Woldie M (2009) Explorative assessment of factors affecting child immunization in Wonago district, Gedeo zone, South Ethiopia. Arch Med Sci 5(2):233–240

Tickner S, Leman PJ, Woodcock A (2006) Factors underlying suboptimal childhood immunisation. Vaccine 24:7030–7036. doi:10.1016/j.vaccine.2006.06.060 CrossRefPubMed

Tirado Otávaro AF, Moreno Uribe CM (2006) Factores asociados a las bajas coberturas de vacunación en Santa Bárbara (Antioquia). Med UPB 26(1):33–42

Topuzoglu A, Ay P, Hidiroglu S, Gurbuz Y (2007) The barriers against childhood immunizations: a qualitative research among socio-economically disadvantaged mothers. Eur J Public Health 348–352. doi:10.1093/eurpub/ckl250

Torun SD, Bakirci N (2006) Vaccination coverage and reasons for non-vaccination in a district of Istanbul. BMC Public Health 6:125PubMedCentralCrossRefPubMed

Torun SD, Demir F, Hidiroglu S, Kalaca S (2008) Measles vaccination coverage and reasons for non-vaccination. Public Health 192–194. doi:10.1016/j.puhe.2007.06.004

Trim K, Nagji N, Elit L, Roy K (2012) Parental knowledge, attitudes and behaviours towards human papillomavirus vaccination for their children: a systematic review from 2001 to 2011. Obstet Gynecol Int 2012:921236. doi:10.1155/2012/921236 PubMedCentralCrossRefPubMed

Uddin MJ, Larson CP, Oliveras E, Khan AI, Quaiyum MA, Saha NC, Ahmed F, Khan IA, Shamsuzzaman (2008) Coverage of child immunization in rural hard-to-reach Haor areas of Bangladesh: acceptability of alternative strategies. International Centre for Diarrhoeal Disease Research, Bangladesh [ICDDR,B]

Wallace A, Dietz V, Cairns KL (2009) Integration of immunization services with other health interventions in the developing world: what works and why? Systematic literature review. Trop Med Int Health TMIH 14:11–19. doi:10.1111/j.1365-3156.2008.02196.x CrossRef

WHO (2012a) Poliomyelitis: intensification of the global eradication initiative. WHO, Geneva

WHO (2012b) Global measles and rubella strategic plan 2012–2020. WHO, Geneva

WHO (2013) Strategic advisory group of experts (SAGE) on immunization. Terms of reference. WHO, Geneva

WHO (2014a) Principles and considerations for adding a vaccine to a national immunization programme: from decision to implementation and monitoring. World Health Organization, Geneva

WHO (2014b) Immunisation supply chain and logistics. A neglected bust essential system for national immunization programmes. WHO, Dept. Immunization, Vaccines and Biologicals, Geneva, Switzerland

WHO (2014c) Meeting of the strategic advisory group of experts on immunization, October 2014—conclusions and recommendations. WER 50 89:561–576

WHO (2014d) WHO/UNICEF coverage estimates 2013. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragebcg.html. Accessed Feb 2015

Williams S (2014) What are the factors that contribute to parental vaccine-hesitancy and what can we do about it? Hum Vaccines Immunother 10:2584–2595CrossRef

World Bank (2014) Country and lending groups 2014. The World Bank. http://data.worldbank.org/about/country-classifications/country-and-lending-groups. Accessed Feb 2014

Title: Exposing concerns about vaccination in low- and middle-income countries: a systematic review
Authors: Daniel Cobos Muñoz
Laura Monzón Llamas
Xavier Bosch-Capblanch
Publication date: 01-11-2015
Publisher: Springer Basel
Published in: International Journal of Public Health / Issue 7/2015
Print ISSN: 1661-8556
Electronic ISSN: 1661-8564
DOI: https://doi.org/10.1007/s00038-015-0715-6

At a glance: The STEP trials

Springer Medicine

Exposing concerns about vaccination in low- and middle-income countries: a systematic review

Abstract

Objectives

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2015

Global standards for global health in a globalized economy!

What research tells us about knowledge transfer strategies to improve public health in low-income countries: a scoping review

Global health and environmental pollution

A systematic literature review of the quality of evidence for injury and rehabilitation interventions in humanitarian crises

The mental health impact of bed bug infestations: a scoping review

Climate change: an opportunity for health promotion practitioners?