The impact of interventions by a community-based organization on inner-city vaccination coverage: Fulton County, Georgia, 1992-1993

Abstract

Objective: To evaluate the impact of interventions by a community-based organization on immunization rates.

Design: Controlled community intervention trial.

Setting and participants: Children aged 3 to 59 months in Fulton County, Georgia, who were patients of 1 of 4 public clinics (clinic based), or residents of 1 of 9 inner-city communities (residence based).

Interventions: (1) Clinic-based intervention included monthly review of clinic vaccination records to identify undervaccinated children followed by contact with family (reminder-recall strategy); (2) residence-based intervention included door-to-door assessment and education campaigns followed by mobile van vaccinations, temporary on-site vaccination stations, free child care and transportation to providers, incentives of food and baby products, focus groups, and coalitions with local organizations (community saturation with vaccination messages and opportunities).

Outcome measures: Change in vaccination rates after 1 year based on clinic record reviews and population surveys.

Results: For clinic-based intervention, series completion rates improved from 43% (87/204) to 58% (99/170) in intervention clinics (P=.003), while rates in control clinics did not change from the baseline of 52% (81/157 to 78/150), for a net difference between intervention and control arms of +15 percentage points (P=.046). For residence-based intervention, age-appropriate vaccination rates improved from 44% (154/347) to 61% (260/429) in intervention communities (+17 percentage points; P<.001) compared with improvement of 44% (78/178) to 58% (129/221) for control communities (+14 percentage points; P=.004), but the difference between arms was not significant (+3 percentage points, P=.78).

Conclusions: Reminder-recall activities by the community-based organization improved vaccination rates in intervention clinics compared with control clinics. A statistically significant impact on vaccination rates could not be detected for residence-based interventions by the community-based organization.