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Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review
BACKGROUND: Childhood vaccination is among the most effective public health interventions available for the prevention of communicable disease, but coverage in many humanitarian settings is sub-optimal. This systematic review critically evaluated peer-review and grey literature evidence on the effec...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9589562/ https://www.ncbi.nlm.nih.gov/pubmed/36274130 http://dx.doi.org/10.1186/s12913-022-08653-4 |
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author | Ismail, Sharif A. Lam, Sze Tung Bell, Sadie Fouad, Fouad M. Blanchet, Karl Borghi, Josephine |
author_facet | Ismail, Sharif A. Lam, Sze Tung Bell, Sadie Fouad, Fouad M. Blanchet, Karl Borghi, Josephine |
author_sort | Ismail, Sharif A. |
collection | PubMed |
description | BACKGROUND: Childhood vaccination is among the most effective public health interventions available for the prevention of communicable disease, but coverage in many humanitarian settings is sub-optimal. This systematic review critically evaluated peer-review and grey literature evidence on the effectiveness of system-level interventions for improving vaccination coverage in protracted crises, focusing on how they work, and for whom, to better inform preparedness and response for future crises. METHODS: Realist-informed systematic review of peer-reviewed and grey literature. Keyword-structured searches were performed in MEDLINE, EMBASE and Global Health, CINAHL, the Cochrane Collaboration and WHOLIS, and grey literature searches performed through the websites of UNICEF, the Global Polio Eradication Initiative (GPEI) and Technical Network for Strengthening Immunization Services. Results were independently double-screened for inclusion on title and abstract, and full text. Data were extracted using a pre-developed template, capturing information on the operating contexts in which interventions were implemented, intervention mechanisms, and vaccination-related outcomes. Study quality was assessed using the MMAT tool. Findings were narratively synthesised. RESULTS: 50 studies were included, most describing interventions applied in conflict or near-post conflict settings in sub-Saharan Africa, and complex humanitarian emergencies. Vaccination campaigns were the most commonly addressed adaptive mechanism (n = 17). Almost all campaigns operated using multi-modal approaches combining service delivery through multiple pathways (fixed and roving), health worker recruitment and training and community engagement to address both vaccination supply and demand. Creation of collaterals through service integration showed generally positive evidence of impact on routine vaccination uptake by bringing services closer to target populations and leveraging trust that had already been built with communities. Robust community engagement emerged as a key unifying mechanism for outcome improvement across almost all of the intervention classes, in building awareness and trust among crisis-affected populations. Some potentially transformative mechanisms for strengthening resilience in vaccination delivery were identified, but evidence for these remains limited. CONCLUSION: A number of interventions to support adaptations to routine immunisation delivery in the face of protracted crisis are identifiable, as are key unifying mechanisms (multi-level community engagement) apparently irrespective of context, but evidence remains piecemeal. Adapting these approaches for local system resilience-building remains a key challenge. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08653-4. |
format | Online Article Text |
id | pubmed-9589562 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-95895622022-10-24 Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review Ismail, Sharif A. Lam, Sze Tung Bell, Sadie Fouad, Fouad M. Blanchet, Karl Borghi, Josephine BMC Health Serv Res Research Article BACKGROUND: Childhood vaccination is among the most effective public health interventions available for the prevention of communicable disease, but coverage in many humanitarian settings is sub-optimal. This systematic review critically evaluated peer-review and grey literature evidence on the effectiveness of system-level interventions for improving vaccination coverage in protracted crises, focusing on how they work, and for whom, to better inform preparedness and response for future crises. METHODS: Realist-informed systematic review of peer-reviewed and grey literature. Keyword-structured searches were performed in MEDLINE, EMBASE and Global Health, CINAHL, the Cochrane Collaboration and WHOLIS, and grey literature searches performed through the websites of UNICEF, the Global Polio Eradication Initiative (GPEI) and Technical Network for Strengthening Immunization Services. Results were independently double-screened for inclusion on title and abstract, and full text. Data were extracted using a pre-developed template, capturing information on the operating contexts in which interventions were implemented, intervention mechanisms, and vaccination-related outcomes. Study quality was assessed using the MMAT tool. Findings were narratively synthesised. RESULTS: 50 studies were included, most describing interventions applied in conflict or near-post conflict settings in sub-Saharan Africa, and complex humanitarian emergencies. Vaccination campaigns were the most commonly addressed adaptive mechanism (n = 17). Almost all campaigns operated using multi-modal approaches combining service delivery through multiple pathways (fixed and roving), health worker recruitment and training and community engagement to address both vaccination supply and demand. Creation of collaterals through service integration showed generally positive evidence of impact on routine vaccination uptake by bringing services closer to target populations and leveraging trust that had already been built with communities. Robust community engagement emerged as a key unifying mechanism for outcome improvement across almost all of the intervention classes, in building awareness and trust among crisis-affected populations. Some potentially transformative mechanisms for strengthening resilience in vaccination delivery were identified, but evidence for these remains limited. CONCLUSION: A number of interventions to support adaptations to routine immunisation delivery in the face of protracted crisis are identifiable, as are key unifying mechanisms (multi-level community engagement) apparently irrespective of context, but evidence remains piecemeal. Adapting these approaches for local system resilience-building remains a key challenge. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08653-4. BioMed Central 2022-10-23 /pmc/articles/PMC9589562/ /pubmed/36274130 http://dx.doi.org/10.1186/s12913-022-08653-4 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Ismail, Sharif A. Lam, Sze Tung Bell, Sadie Fouad, Fouad M. Blanchet, Karl Borghi, Josephine Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review |
title | Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review |
title_full | Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review |
title_fullStr | Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review |
title_full_unstemmed | Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review |
title_short | Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review |
title_sort | strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9589562/ https://www.ncbi.nlm.nih.gov/pubmed/36274130 http://dx.doi.org/10.1186/s12913-022-08653-4 |
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