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Immunization, urbanization and slums – a systematic review of factors and interventions
BACKGROUND: In 2014, over half (54%) of the world’s population lived in urban areas and this proportion will increase to 66% by 2050. This urbanizing trend has been accompanied by an increasing number of people living in urban poor communities and slums. Lower immunization coverage is found in poore...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465583/ https://www.ncbi.nlm.nih.gov/pubmed/28595624 http://dx.doi.org/10.1186/s12889-017-4473-7 |
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author | Crocker-Buque, Tim Mindra, Godwin Duncan, Richard Mounier-Jack, Sandra |
author_facet | Crocker-Buque, Tim Mindra, Godwin Duncan, Richard Mounier-Jack, Sandra |
author_sort | Crocker-Buque, Tim |
collection | PubMed |
description | BACKGROUND: In 2014, over half (54%) of the world’s population lived in urban areas and this proportion will increase to 66% by 2050. This urbanizing trend has been accompanied by an increasing number of people living in urban poor communities and slums. Lower immunization coverage is found in poorer urban dwellers in many contexts. This study aims to identify factors associated with immunization coverage in poor urban areas and slums, and to identify interventions to improve coverage. METHODS: We conducted a systematic review, searching Medline, Embase, Global Health, CINAHL, Web of Science and The Cochrane Database with broad search terms for studies published between 2000 and 2016. RESULTS: Of 4872 unique articles, 327 abstracts were screened, leading to 63 included studies: 44 considering factors and 20 evaluating interventions (one in both categories) in 16 low or middle-income countries. A wide range of socio-economic characteristics were associated with coverage in different contexts. Recent rural-urban migration had a universally negative effect. Parents commonly reported lack of awareness of immunization importance and difficulty accessing services as reasons for under-immunization of their children. Physical distance to clinics and aspects of service quality also impacted uptake. We found evidence of effectiveness for interventions involving multiple components, especially if they have been designed with community involvement. Outreach programmes were effective where physical distance was identified as a barrier. Some evidence was found for the effective use of SMS (text) messaging services, community-based education programmes and financial incentives, which warrant further evaluation. No interventions were identified that provided services to migrants from rural areas. CONCLUSION: Different factors affect immunization coverage in different urban poor and slum contexts. Immunization services should be designed in collaboration with slum-dwelling communities, considering the local context. Interventions should be designed and tested to increase immunization in migrants from rural areas. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12889-017-4473-7) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5465583 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-54655832017-06-09 Immunization, urbanization and slums – a systematic review of factors and interventions Crocker-Buque, Tim Mindra, Godwin Duncan, Richard Mounier-Jack, Sandra BMC Public Health Research Article BACKGROUND: In 2014, over half (54%) of the world’s population lived in urban areas and this proportion will increase to 66% by 2050. This urbanizing trend has been accompanied by an increasing number of people living in urban poor communities and slums. Lower immunization coverage is found in poorer urban dwellers in many contexts. This study aims to identify factors associated with immunization coverage in poor urban areas and slums, and to identify interventions to improve coverage. METHODS: We conducted a systematic review, searching Medline, Embase, Global Health, CINAHL, Web of Science and The Cochrane Database with broad search terms for studies published between 2000 and 2016. RESULTS: Of 4872 unique articles, 327 abstracts were screened, leading to 63 included studies: 44 considering factors and 20 evaluating interventions (one in both categories) in 16 low or middle-income countries. A wide range of socio-economic characteristics were associated with coverage in different contexts. Recent rural-urban migration had a universally negative effect. Parents commonly reported lack of awareness of immunization importance and difficulty accessing services as reasons for under-immunization of their children. Physical distance to clinics and aspects of service quality also impacted uptake. We found evidence of effectiveness for interventions involving multiple components, especially if they have been designed with community involvement. Outreach programmes were effective where physical distance was identified as a barrier. Some evidence was found for the effective use of SMS (text) messaging services, community-based education programmes and financial incentives, which warrant further evaluation. No interventions were identified that provided services to migrants from rural areas. CONCLUSION: Different factors affect immunization coverage in different urban poor and slum contexts. Immunization services should be designed in collaboration with slum-dwelling communities, considering the local context. Interventions should be designed and tested to increase immunization in migrants from rural areas. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12889-017-4473-7) contains supplementary material, which is available to authorized users. BioMed Central 2017-06-08 /pmc/articles/PMC5465583/ /pubmed/28595624 http://dx.doi.org/10.1186/s12889-017-4473-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Crocker-Buque, Tim Mindra, Godwin Duncan, Richard Mounier-Jack, Sandra Immunization, urbanization and slums – a systematic review of factors and interventions |
title | Immunization, urbanization and slums – a systematic review of factors and interventions |
title_full | Immunization, urbanization and slums – a systematic review of factors and interventions |
title_fullStr | Immunization, urbanization and slums – a systematic review of factors and interventions |
title_full_unstemmed | Immunization, urbanization and slums – a systematic review of factors and interventions |
title_short | Immunization, urbanization and slums – a systematic review of factors and interventions |
title_sort | immunization, urbanization and slums – a systematic review of factors and interventions |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5465583/ https://www.ncbi.nlm.nih.gov/pubmed/28595624 http://dx.doi.org/10.1186/s12889-017-4473-7 |
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