Impact of digital health interventions in improving pediatric immunization coverage and timeliness in low- and middle-income countries: a systematic review and meta-analysis.
Fred Lawrence D Samante, Vince Justin U Tiu, Earl Jerald F Cansino et al.
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In 30 seconds
This systematic review and meta-analysis assessed randomized controlled trials of digital interventions to improve pediatric vaccination outcomes in low- and middle-income countries. Across 22 studies involving 68,664 participants, reminder-only, education, and combined reminder-and-education strategies each improved coverage of target vaccines compared with usual care. The largest pooled relative effect was reported for education (RR 1.953; 95% CI 1.076-3.542). Digital interventions also improved timely receipt of pentavalent vaccines, although estimates varied substantially across studies.
Key findings
- Reminder-only interventions improved target-vaccine coverage versus usual care (RR 1.273; 95% CI 1.086-1.492; I 2 = 93.3%).
- Education interventions improved coverage (RR 1.953; 95% CI 1.076-3.542; I 2 = 62.3%), as did combined reminders and education (RR = 1.721; 95% CI 1.377-2.152; I 2 = 0%).
- Digital interventions improved timely pentavalent vaccine receipt (RR 1.547; 95% CI 1.104-2.167; I 2 = 95.4%).
- Reminder effects were evident in urban settings (RR 1.141; 95% CI 1.079-1.207), while the rural estimate included no effect (RR 1.050; 95% CI 0.994-1.109).
Why it matters
Missed or delayed childhood vaccination remains an important barrier to preventing vaccine-preventable disease in LMICs. The pooled trial evidence suggests digital approaches can improve both coverage and timeliness, while the differing results by intervention type and setting highlight that effects may not be uniform. These findings can inform evaluation and design of immunization programmes using digital tools.
What to keep in mind
Heterogeneity was substantial for several pooled outcomes, including reminder-only coverage, timely pentavalent vaccination, and caregiver acceptability, limiting confidence that effects will be consistent across settings.