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Madagascar's EPI vaccine programs: A systematic review uncovering the role of a child's sex and other barriers to vaccination

BACKGROUND: Immunizations are one of the most effective tools a community can use to increase overall health and decrease the burden of vaccine-preventable diseases. Nevertheless, socioeconomic status, geographical location, education, and a child's sex have been identified as contributing to i...

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Autores principales: Hahesy, Emma, Cruz-Espinoza, Ligia Maria, Nyirenda, Gabriel, Tadesse, Birkneh Tilahun, Kim, Jerome H., Marks, Florian, Rakotozandrindrainy, Raphael, Wetzker, Wibke, Haselbeck, Andrea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9523513/
https://www.ncbi.nlm.nih.gov/pubmed/36187658
http://dx.doi.org/10.3389/fpubh.2022.995788
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author Hahesy, Emma
Cruz-Espinoza, Ligia Maria
Nyirenda, Gabriel
Tadesse, Birkneh Tilahun
Kim, Jerome H.
Marks, Florian
Rakotozandrindrainy, Raphael
Wetzker, Wibke
Haselbeck, Andrea
author_facet Hahesy, Emma
Cruz-Espinoza, Ligia Maria
Nyirenda, Gabriel
Tadesse, Birkneh Tilahun
Kim, Jerome H.
Marks, Florian
Rakotozandrindrainy, Raphael
Wetzker, Wibke
Haselbeck, Andrea
author_sort Hahesy, Emma
collection PubMed
description BACKGROUND: Immunizations are one of the most effective tools a community can use to increase overall health and decrease the burden of vaccine-preventable diseases. Nevertheless, socioeconomic status, geographical location, education, and a child's sex have been identified as contributing to inequities in vaccine uptake in low- and middle-income countries (LMICs). Madagascar follows the World Health Organization's Extended Programme on Immunization (EPI) schedule, yet vaccine distribution remains highly inequitable throughout the country. This systematic review sought to understand the differences in EPI vaccine uptake between boys and girls in Madagascar. METHODS: A systematic literature search was conducted in August 2021 through MEDLINE, the Cochrane Library, Global Index Medicus, and Google Scholar to identify articles reporting sex-disaggregated vaccination rates in Malagasy children. Gray literature was also searched for relevant data. All peer-reviewed articles reporting sex-disaggregated data on childhood immunizations in Madagascar were eligible for inclusion. Risk of bias was assessed using a tool designed for use in systematic reviews. Data extraction was conducted with a pre-defined data extraction tool. Sex-disaggregated data were synthesized to understand the impact of a child's sex on vaccination status. FINDINGS: The systematic search identified 585 articles of which a total of three studies were included in the final data synthesis. One additional publication was included from the gray literature search. Data from included articles were heterogeneous and, overall, indicated similar vaccination rates in boys and girls. Three of the four articles reported slightly higher vaccination rates in girls than in boys. A meta-analysis was not conducted due to the heterogeneity of included data. Six additional barriers to immunization were identified: socioeconomic status, mother's education, geographic location, supply chain issues, father's education, number of children in the household, and media access. INTERPRETATION: The systematic review revealed the scarcity of available sex-stratified immunization data for Malagasy children. The evidence available was limited and heterogeneous, preventing researchers from conclusively confirming or denying differences in vaccine uptake based on sex. The low vaccination rates and additional barriers identified here indicate a need for increased focus on addressing the specific obstacles to vaccination in Madagascar. A more comprehensive assessment of sex-disaggregated vaccination status of Malagasy children and its relationship with such additional obstacles is recommended. Further investigation of potential differences in vaccination status will allow for the effective implementation of strategies to expand vaccine coverage in Madagascar equitably. FUNDING AND REGISTRATION: AH, BT, FM, GN, and RR are supported by a grant from the Bill and Melinda Gates Foundation (grant number: OPP1205877). The review protocol is registered in the Prospective Register of Systematic Reviews (PROSPERO ID: CRD42021265000).
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spelling pubmed-95235132022-10-01 Madagascar's EPI vaccine programs: A systematic review uncovering the role of a child's sex and other barriers to vaccination Hahesy, Emma Cruz-Espinoza, Ligia Maria Nyirenda, Gabriel Tadesse, Birkneh Tilahun Kim, Jerome H. Marks, Florian Rakotozandrindrainy, Raphael Wetzker, Wibke Haselbeck, Andrea Front Public Health Public Health BACKGROUND: Immunizations are one of the most effective tools a community can use to increase overall health and decrease the burden of vaccine-preventable diseases. Nevertheless, socioeconomic status, geographical location, education, and a child's sex have been identified as contributing to inequities in vaccine uptake in low- and middle-income countries (LMICs). Madagascar follows the World Health Organization's Extended Programme on Immunization (EPI) schedule, yet vaccine distribution remains highly inequitable throughout the country. This systematic review sought to understand the differences in EPI vaccine uptake between boys and girls in Madagascar. METHODS: A systematic literature search was conducted in August 2021 through MEDLINE, the Cochrane Library, Global Index Medicus, and Google Scholar to identify articles reporting sex-disaggregated vaccination rates in Malagasy children. Gray literature was also searched for relevant data. All peer-reviewed articles reporting sex-disaggregated data on childhood immunizations in Madagascar were eligible for inclusion. Risk of bias was assessed using a tool designed for use in systematic reviews. Data extraction was conducted with a pre-defined data extraction tool. Sex-disaggregated data were synthesized to understand the impact of a child's sex on vaccination status. FINDINGS: The systematic search identified 585 articles of which a total of three studies were included in the final data synthesis. One additional publication was included from the gray literature search. Data from included articles were heterogeneous and, overall, indicated similar vaccination rates in boys and girls. Three of the four articles reported slightly higher vaccination rates in girls than in boys. A meta-analysis was not conducted due to the heterogeneity of included data. Six additional barriers to immunization were identified: socioeconomic status, mother's education, geographic location, supply chain issues, father's education, number of children in the household, and media access. INTERPRETATION: The systematic review revealed the scarcity of available sex-stratified immunization data for Malagasy children. The evidence available was limited and heterogeneous, preventing researchers from conclusively confirming or denying differences in vaccine uptake based on sex. The low vaccination rates and additional barriers identified here indicate a need for increased focus on addressing the specific obstacles to vaccination in Madagascar. A more comprehensive assessment of sex-disaggregated vaccination status of Malagasy children and its relationship with such additional obstacles is recommended. Further investigation of potential differences in vaccination status will allow for the effective implementation of strategies to expand vaccine coverage in Madagascar equitably. FUNDING AND REGISTRATION: AH, BT, FM, GN, and RR are supported by a grant from the Bill and Melinda Gates Foundation (grant number: OPP1205877). The review protocol is registered in the Prospective Register of Systematic Reviews (PROSPERO ID: CRD42021265000). Frontiers Media S.A. 2022-09-16 /pmc/articles/PMC9523513/ /pubmed/36187658 http://dx.doi.org/10.3389/fpubh.2022.995788 Text en Copyright © 2022 Hahesy, Cruz-Espinoza, Nyirenda, Tadesse, Kim, Marks, Rakotozandrindrainy, Wetzker and Haselbeck. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Hahesy, Emma
Cruz-Espinoza, Ligia Maria
Nyirenda, Gabriel
Tadesse, Birkneh Tilahun
Kim, Jerome H.
Marks, Florian
Rakotozandrindrainy, Raphael
Wetzker, Wibke
Haselbeck, Andrea
Madagascar's EPI vaccine programs: A systematic review uncovering the role of a child's sex and other barriers to vaccination
title Madagascar's EPI vaccine programs: A systematic review uncovering the role of a child's sex and other barriers to vaccination
title_full Madagascar's EPI vaccine programs: A systematic review uncovering the role of a child's sex and other barriers to vaccination
title_fullStr Madagascar's EPI vaccine programs: A systematic review uncovering the role of a child's sex and other barriers to vaccination
title_full_unstemmed Madagascar's EPI vaccine programs: A systematic review uncovering the role of a child's sex and other barriers to vaccination
title_short Madagascar's EPI vaccine programs: A systematic review uncovering the role of a child's sex and other barriers to vaccination
title_sort madagascar's epi vaccine programs: a systematic review uncovering the role of a child's sex and other barriers to vaccination
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9523513/
https://www.ncbi.nlm.nih.gov/pubmed/36187658
http://dx.doi.org/10.3389/fpubh.2022.995788
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