VoICE : Search Immunization Evidence

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The VoICE tool is a compendium of the many direct and downstream impacts of vaccine-preventable disease and immunization. The database contains summary explanations of the link between immunization and each impact, as well as sources of evidence for each link. You can browse the VoICE tool by topic, or use the filters to find results based on topic, disease or vaccine, location and published year.

17 Key Concepts, 12 Sources
Key Concept

Key Evidence: Children who were born as the fourth or fifth child in their household were more than twice as likely to be incompletely vaccinated with BCG, measles vaccine, and pentavalent vaccine than those who were born as the second or third child in their household.

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Key Concept

Key Evidence: In Tanzania, poverty was found to have a negative effect on receiving vaccines on time (at the recommended age). Children in the wealthiest quintile experienced 19% fewer delays for BCG vaccination, 23% fewer delays for the third dose of DTP vaccination, and 31% fewer delays for the first dose of measles-containing vaccine compared to children of the poorest quintile.

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Key Concept

Key Evidence: A small study from the Philippines, published in a Working Paper from Harvard University, found that children immunized with 6 basic vaccines scored better on three cognitive tests (verbal, mathematics and language) at age 11 compared to children who received none of these 6 vaccines.

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Key Concept

Key Evidence: Children in Tanzania living 5 km or greater distance from the nearest healthcare facility were less likely to be immunized than children living less than 5 km from facilities. Compared to children living close a health facility, children far from a health facility had almost three times the risk of missing out on BCG, 84% higher risk of missing the third dose of DTP, and 48% higher risk of missing the first dose of measles-containing vaccine. Of children who did receive BCG, those living more than 5 km from facilities were 26% more likely to received BCG vaccine late than children close to the facility.

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Key Concept

Key Evidence: In a study of immunization in the Philippines, children vaccinated against 6 diseases performed significantly better on verbal reasoning, math, and language tests than those who were unvaccinated. (note: Researchers did not find an association with physical growth.)

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Key Concept

Key Evidence: Wealth and mother’s education are significant predictors of vaccination rates in both urban and rural settings. However, low paternal education, lack of antenatal care, and home births were significantly associated with low vaccination rates only in rural settings. This suggests the need for tailored vaccine programs.

From the VoICE Editors: This study compared the significance of risk factors for low vaccination rates in rural versus urban settings in Tanzania.

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Key Evidence: A study conducted in Eastern Uganda found that Ugandan children whose mothers had some secondary schooling were 50% more likely to have received scheduled vaccinations by 6 months of age than children whose mothers had attended school only through primary level. This effect became more pronounced with delivery of the later doses of each vaccine (OPV2, 3 & DPT-HB-Hib 2,3).

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Key Concept

Key Evidence: A study looking at WHO data from member states shows that globally, coverage of the third dose of DTP is 26% higher among children born to mothers with some secondary education compared to mothers with no education.

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Key Evidence: Researchers looking at vaccination coverage in 45 low- and middle-income countries found that maternal education is a strong predictor of vaccine coverage. Children of the least educated mothers are 55% less likely to have received measles containing vaccine and three doses of DTP vaccine than children of the most educated mothers.

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Key Concept

Key Evidence: An impact evaluation for a women’s empowerment program in India found that the children of mothers who participated the empowerment program were significantly more likely to be vaccinated against DTP, measles, and tuberculosis than children of mothers not involved in the program. This study also found that the women’s empowerment program had positive spillover effects: In villages where the program occurred, children of mothers not in the program (non-participants) were 9 to 32% more likely to be immunized against measles than in villages where the program did not occur (controls). Overall, measles vaccine coverage was nearly 25% higher in the program villages compared to the control villages.

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Key Concept

Key Evidence: In an analysis of immunization coverage in 45 low- and lower-middle income Gavi-eligible countries, researchers found that overall, maternal and paternal education were two of the most significant drivers of coverage inequities in these countries. Pooling the data from all countries, the authors found that “children of the most educated mothers are 1.45 times more likely to have received DTP3 than children of the least educated mothers.” The same held true for measles vaccines with a 1.45-fold likelihood of vaccination in children of the most educated mothers.

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Key Concept

Key Evidence: A study of Kenyan children under 5 years of age found that immunization with polio, BCG, DPT, and measles to be protective against stunting in young children (27% less likely to be stunted than unimmunized children under age 2 years). In addition, children with diarrhea and cough in the 2 weeks prior to the survey were 80-90% more likely to be underweight or to suffer from wasting.

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Key Concept

Key Evidence: Globally, coverage of the third dose of DTP is 15% higher among children in the highest compared to lowest wealth quintile. However, this masks differences of up to 64% in the most inequitable countries (Nigeria).

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Key Evidence: In Tanzania, poverty was found to have a negative effect on receiving vaccines on time (at the recommended age). Children in the wealthiest quintile experienced 19% fewer delays for BCG vaccination, 23% fewer delays for the third dose of DTP vaccination, and 31% fewer delays for the first dose of measles-containing vaccine compared to children of the poorest quintile.

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Key Concept

Key Evidence: The humanitarian emergency in Venezuela, and resulting collapse of its primary health care infrastructure, has caused measles and diphtheria to reemerge — disproportionately affecting indigenous populations — and to spread to neighboring countries. This sets the stage for the potential reemergence of polio. The re-establishment of measles as an endemic disease in Venezuela (with >5,500 confirmed cases) and its spread to neighboring countries threaten the measles-free status.

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Key Concept

Key Evidence: The humanitarian emergency in Venezuela, and resulting collapse of its primary health care infrastructure, has caused measles and diphtheria to reemerge — disproportionately affecting indigenous populations — and spread to neighboring countries. This sets the stage for the potential reemergence of polio. The re-establishment of measles as an endemic disease in Venezuela (with >5,500 confirmed cases) and its spread to neighboring countries threaten the measles-free status.

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Key Concept

Key Evidence: Modeling of data from India’s National Family Health Survey-3 indicated that vaccinations against DPT, polio and measles were significant positive predictors of a child’s height, weight and hemoglobin concentration. This was ascertained post modeling of data obtained from over 25,000 children.

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Key Evidence: A study in Kenya revealed that immunization with polio, BCG, DPT and measles had protective effects with respect to stunting in children under 5 years of age. In children under the age of 2 years, immunized children were 27% less likely to experience stunting when compared to unimmunized children. Additionally, children who suffered from cough or diarrhea in the 2 weeks prior to the study showed an 80-90% higher probability of being underweight or experiencing wasting.

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Key Concept

Key Evidence: A study of Kenyan children under 5 years of age found that children with diarrhea and cough in the 2 weeks prior to the survey were 80-90% more likely to be underweight or to suffer from wasting.

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Key Concept

Key Evidence: A recent review looks at evidence linking vaccinations in early infancy to childhood development services. BCG and DPT have the highest coverage of any vaccines worldwide and are typically administered within 6 weeks of birth. This timing offers the opportunity to deliver a range of early childhood development interventions such as newborn hearing screening, sickle cell screening, treatment and surveillance, maternal education around key newborn care issues such as jaundice, and tracking early signs of poor growth and nutrition.

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Key Concept

Key Evidence: Wealth and mother’s education are significant predictors of vaccination rates in both urban and rural settings.  However, low paternal education, lack of antenatal care, and home births were significantly associated with low vaccination rates only in rural settings. This suggests the need for tailored vaccine programs.

From the VoICE editors: This study compared the significance of risk factors for low vaccination rates in rural versus urban settings in Tanzania. 

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Key Evidence: Globally, coverage of the third dose of DTP is 8% higher among urban dwellers compared to children raised in a rural environment.

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