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Prevalence and dynamics of missed opportunities for vaccination among children in Africa : applying systems thinking in a systematic review and meta-analysis of observational studies

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Adamu, Abdu A., Sarki, Ahmed M., Uthman, Olalekan A., Wiyeh, Alison B., Gadanya, Muktar A. and Wiysonge, Charles S. (2019) Prevalence and dynamics of missed opportunities for vaccination among children in Africa : applying systems thinking in a systematic review and meta-analysis of observational studies. Expert Review of Vaccines, 18 (5). pp. 547-558. doi:10.1080/14760584.2019.1588728

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Official URL: http://dx.doi.org/10.1080/14760584.2019.1588728

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Abstract

Objective

To estimate the prevalence of missed opportunities for vaccination (MOV) among children aged 0 – 23 months attending healthcare facilities in Africa and explore the factors responsible for MOV using systems thinking.

Research design and methods

We conducted a systematic review and meta-analysis of studies reporting the proportion MOVs. Five electronic databases were searched. A random effects model was fitted to obtain pooled estimates of MOV and a causal loop diagram (CLD) was constructed to explore the dynamics of the causes of MOV. MOV was defined as any contact with health services in Africa, by an unvaccinated or under-vaccinated child, aged 0 – 23 months, who is eligible for vaccination and free of any contraindication, which does not result in vaccination.

Results

421 publications were found, of which 20 studies from 14 countries were included. The pooled prevalence of MOV was estimated to be 27.26% (95%CI: 18.80 – 36.62). A CLD with seven reinforcing and two balancing loops were constructed.

Conclusion

Our findings suggest that about one in every four children under the age of two who visited health facilities in 14 African countries missed the vaccination they were eligible to receive. To enable continent-wide estimates, more MOV assessments are required.

Item Type: Journal Article
Subjects: R Medicine > RJ Pediatrics
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET)
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Vaccination of children -- South Africa
Journal or Publication Title: Expert Review of Vaccines
Publisher: Taylor & Francis (Routledge)
ISSN: 1476-0584
Official Date: 20 March 2019
Dates:
DateEvent
20 March 2019Published
1 March 2019Available
25 February 2019Accepted
Volume: 18
Number: 5
Page Range: pp. 547-558
DOI: 10.1080/14760584.2019.1588728
Status: Peer Reviewed
Publication Status: Published
Publisher Statement: “This is an Accepted Manuscript of an article published by Taylor & Francis in Expert Review of Vaccines on 01/03/2019, available online: http://www.tandfonline.com/10.1080/14760584.2019.1588728”
Access rights to Published version: Restricted or Subscription Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDNational Research Foundation (South Africa)http://viaf.org/viaf/137694659

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