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. 2017 Sep 26;17(1):681.
doi: 10.1186/s12913-017-2626-0.

Determinants of effective vaccine coverage in low and middle-income countries: a systematic review and interpretive synthesis

David E Phillips  1 , Joseph L Dieleman  2 , Stephen S Lim  2 , Jessica Shearer  3
Affiliations

Determinants of effective vaccine coverage in low and middle-income countries: a systematic review and interpretive synthesis

David E Phillips et al. BMC Health Serv Res. .

Abstract

Background: Many children in low and middle-income countries remain unvaccinated, and vaccines do not always produce immunity. Extensive research has sought to understand why, but most studies have been limited in breadth and depth. This study documents existing evidence on determinants of vaccination and immunization and presents a conceptual framework of determinants.

Methods: We used systematic review, content analysis, thematic analysis and interpretive synthesis to document and analyze the existing evidence on determinants of childhood vaccination and immunization.

Results: We documented 1609 articles, including content analysis of 78 articles. Three major thematic models were described in the context of one another. Interpretive synthesis identified similarities and differences between studies, resulting in a conceptual framework with three principal vaccine utilization determinants: 1) Intent to Vaccinate, 2) Community Access and 3) Health Facility Readiness.

Conclusion: This study presents the most comprehensive systematic review of vaccine determinants to date. The conceptual framework represents a synthesis of multiple existing frameworks, is applicable in low and middle-income countries, and is quantitatively testable. Future researchers can use these results to develop competing conceptual frameworks, or to analyze data in a theoretically-grounded way. This review enables better research in the future, further understanding of immunization determinants, and greater progress against vaccine preventable diseases around the world.

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Conflict of interest statement

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Not applicable

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram of search and selection. The systematic review assessed 1621 articles for their degree of relevance, and included the 78 most-relevant articles in qualitative synthesis
Fig. 2
Fig. 2
Network of determinants to vaccine effective coverage. This figure displays the full picture of determinants to vaccination and immunity. For details on individual determinants, refer to Table 2 and Table 3
Fig. 3
Fig. 3
Network of determinants to vaccine effective coverage. This figure displays an example of findings from Thematic Analysis. Vaccination determinants in Fig. 2 have been labeled to represent one thematic model: proximity. For details on individual determinants, refer to Table 2
Fig. 4
Fig. 4
This figure displays the output from Interpretive Synthesis: a complete conceptual framework of vaccine determinants in its simplest possible form. Conceptual framework for vaccine coverage
See this image and copyright information in PMC

References

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