The Knowledge Hub

What is the Knowledge Hub?

Explore the VoICE Knowledge Hub—a searchable database featuring the latest peer-reviewed research on immunization benefits, especially in low- and middle-income countries. Browse the Knowledge Hub using a variety of different filters to find vaccine evidence based on country, region, topic, or disease. Click on a tag to find more evidence on a specific area, such as the return on investment of vaccines or impacts of infectious disease outbreaks.


Diseases & Vaccines


WHO Regions


Immunization Terms

Children born in a health facility are more likely to receive full vaccinations compared to those born at home

A study in Ghana using nationally representative survey data found that children born in an institutional setting had a substantially higher proportion of full vaccination (73.9%) compared to those born at home (60.8%). Children born in a health facility—either public or private—had 1.71 times the odds of receiving a full vaccination schedule compared to children born at home.

Moran EB, Wagner AL, Asiedu-Bekoe F et al.. 2020. Socioeconomic characteristics associated with the introduction of new vaccines and full childhood vaccination in Ghana. Vaccine. 38(14).

High rates of drug-resistant bacteria found in sickle cell disease patients in Ghana

A study of sickle cell disease patients in Ghana found that pneumoccocus bacteria found in their noses and throats had high rates of drug resistance with 37% of positive samples resistant to penicillin and 34% resistant to multiple drugs (typically penicillin + tetracycline + cotrimoxazole).

Dayie NTK, Tetteh-Ocloo G, Labi AK et al.. 2018. Pneumococcal carriage among sickle cell disease patients in Accra, Ghana: Risk factors, serotypes and antibiotic resistance. PLoS One. 13(11).

Investing in maternal health improves immunization rates and overall health of mothers and children

Use of recommended maternal health care services — defined as at least 4 antenatal care visits, having a skilled attendant at birth, and delivery in a health facility — was a predictor of timely vaccination of mothers’ infants in a study conducted in Ghana. Compared to children whose mothers received one or two of these services, infants born to mothers who received all three interventions were roughly 30% more likely to be fully vaccinated by 12-23 months of age, while children whose mothers received none of these services were only about half as likely to be fully vaccinated. Investing in maternal health, which creates familiarity with the health system and increases mothers’ knowledge about disease prevention, can improve the health of both the mother and her children beyond infancy.

McGlynn N, Wilk P, Luginaah I et al.. 2015. Increased use of recommended maternal health care as a determinant of immunization and appropriate care for fever and diarrhoea in Ghana: an analysis pooling three demographic and health surveys. Health Policy and Planning. 30(7).

Children of divorced mothers and mothers who work part-time are less likely to be fully immunized

Children of divorced mothers in Ghana were three times less likely to be fully immunized than mothers cohabitating with a partner. In addition, it was found that children of mothers who work part time were approximately 2.3 times less likely to be fully immunized than mothers who work full time.

Anokye, R., Acheampong, E., Budu-Ainooson, A., et al.. 2018. Socio-demographic determinants of childhood immunization incompletion in Koforidua, Ghana. BMC Reserach Notes. 11(656).

Immunization can help reduce the risk of stunting caused by diarrhea in children

A pooled analysis of nine studies assessing the effects of diarrhea on stunting prior to the age of 24 months showed that the odds of stunting were significantly increased with each diarrheal episode. Each day of diarrhea prior to attaining 24 months of age also contributed to the risk of stunting. For each five episodes of diarrhea, the odds of stunting increased by 13%. In addition, once a child becomes stunted, only 6% of those stunted at 6 months of age recovered by 24 months of age.

Checkley, W., Buckley, G., Gilman, R.H., et al.. 2008. Multi-country analysis of the effects of diarrhoea on childhood stunting. International Journal of Epidemiology. 37(4).

The empowerment of women is associated with higher odds of childhood vaccinations

A systematic review of studies from countries in Africa and Southeast Asia investigated the relationship between a woman’s “agency” (defined as the woman’s ability to state her goals and to act upon them with motivation and purpose) and childhood immunizations in lower-income settings. The review found a general pattern among studies in which higher agency among mothers was associated with higher odds of childhood immunizations. Empowering women in these settings shows promise as a means to improve child health.

Thorpe, S., VanderEnde, K., Peters, C., et al.. 2016. The influence of women’s empowerment on child immunisation coverage in low, lower-middle, and upper-middle income countries: a systematic review of the literature.. Maternal and Child Health Journal. 20(1).

Diarrhea is associated with pneumonia in undernourished children

In a recent review of data from developing countries, researchers found that episodes of diarrhea may predispose undernourished children to pneumonia.

Schlaudecker, E.P., Steinhoff, M.C. and Moore, S.R.. 2011. Interactions of diarrhea, pneumonia, and malnutrition in childhood: recent evidence from developing countries. Current Opinion in Infectious Diseases. 24(5).

Undernourished children have a higher likelihood for diarrhea and pneumonia but immunization can improve infant growth

Multiple studies show that

  1. Diarrhea and pneumonia impair children’s growth and that underlying malnutrition is a major risk factor for these conditions.
  2. “Episodes of diarrhea may predispose to pneumonia in undernourished children” and
  3. Immunization against influenza (in mothers) and Streptococcus pneumoniae may improve infant growth. In addition, new studies from Bangladesh, Colombia, Ghana, and Israel further support the paradigm that malnutrition is a key risk factor for diarrhea and pneumonia.

Schlaudecker, E.P., Steinhoff, M.C. and Moore, S.R.. 2011. Interactions of diarrhea, pneumonia, and malnutrition in childhood: recent evidence from developing countries. Current Opinion in Infectious Diseases. 24(5).

Vaccines are most cost-effective in low income countries

An analysis of the impact of rotavirus vaccine in 25 countries found that the rates of vaccination in all countries were highest and risk mortality lowest in the top two wealth quintile’s coverage. Countries differed in the relative inequities in these two underlying variables. Cost per DALYs averted in substantially greater in the higher quintiles. In all countries, the greatest potential vaccine benefit was in the poorest quintiles; however, reduced vaccination coverage lowered the projected vaccine benefit.

Rheingans, R., Atherly, D., and Anderson, J.. 2012. Distributional impact of rotavirus vaccination in 25 GAVI countries: Estimating disparities in benefits and cost-effectiveness. Vaccine. 30(1).

Pediatric pneumococcal or Hib meningitis surviviors had a higher likelihood for neuropsychological deficits

In a systematic literature review of studies in Africa, it was found that 25% of children who survived pneumococcal or Hib meningitis had neuropsychological deficits.

Ramakrishnan, M., Ulland, A.J., Steinhardt, L.C., et al. 2009. Sequelae due to bacterial meningitis among African children: a systematic literature review. BMC Medicine. 7(47).