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.

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Integrating family planning and immunization services in Malawi was found to be feasible and beneficial

In this mixed-methods implementation study, routine immunization and family planning services were integrated across health facilities and community sites across two rural districts in Malawi, Dowa and Ntchisi. The total number of women accessing family planning services during the study period increased by 14% while DPT immunization rates for children remained consistent. In interviews, parents and providers found the integration of family planning and immunization services to be feasible and beneficial, indicating a win-win for both services.

Cooper CM, Wille J, Shire S et al.. 2020. Integrated Family Planning and Immunization Service Delivery at Health Facility and Community Sites in Dowa and Ntchisi Districts of Malawi: A Mixed Methods Process Evaluation. International Journal of Environmental Research and Public Health. 17(12).

Investments in polio eradication in Africa improved overall immunization systems and increased coverage of routine vaccinations

A systematic review of 8 African countries that had wild polio virus transmission and significant polio eradication activities found evidence that the huge investments made in polio have strengthened capacity in almost all aspects of the overall immunization systems, especially in the areas of microplanning, service delivery, capacity-building (especially supportive supervision and on-the-job training), and program management. This led to substantial increases in coverage of other routine vaccinations – BCG, DPT, measles – in all 8 countries over a 25-year period (1989-2014), including a more than a 3-fold increase in DPT3 coverage in 2 countries and a more than a 2-fold increase in 3 other countries.

Anya BPM, Moturi E, Aschalew T et al.. 2016. Contribution of polio eradication initiative to strengthening routine immunization: lessons learnt in the WHO African region. Vaccine. 34(43).

Collapse of primary healthcare during humanitarian emergencies can lead to infectious disease outbreaks in neighboring areas

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.

Paniz-Mondolfi AE, Tami A, Grillet ME et al.. 2019. Resurgence of vaccine-preventable diseases in Venezuela as a regional public health threat in the Americas. Emerging Infectious Diseases. 25(4).

Socioeconomic factors affect vaccination rates, highlighting the need for targeted vaccine programs in different settings

In Tanzania, 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.

Nadella, P., Smith, E.R., Muhihi, A., et al.. 2019. Determinants of delayed or incomplete diphtheria-tetanus-pertussis vaccination in parallel urban and rural birth cohorts of 30,956 infants in Tanzania.. BMC Infectious Diseases. 19(188).

Immunizations for DPT, polio, and measles improve children’s growth and overall health

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.

Bhargava, A., Guntupalli, A.M., Lokshin, M.. 2011. Health Care Utilization, socioeconomic factors and child health in India. Journal of Biosocial Sciences. 43(6).

Poverty negatively affects the timing of vaccines given to children

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.

Le Polain de Waroux, O., Schellenberg, J.R., Manzi, F., et al.. 2013. Timeliness and completeness of vaccination and risk factors for low and late vaccine uptake in young children living in rural southern Tanzania.. International Health. 5(2).

Location of health facilities drastially affects the immunization of children

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.

Maternal education is a strong predictor of vaccine coverage

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.

Arsenault, C., Harper, S., Nandi, A., et al.. 2017. Monitoring equity in vaccination coverage: A systematic analysis of demographic and health surveys from 45 Gavi-supported countries. Vaccine. 5(6).

Parental education can be one of the most significant drivers of vaccine coverage inequities

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.

Childhood vaccination provides an opportunity to deliver additional interventions

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.

Olusanya, B.O.. 2009. Optimising the use of routine immunisation clinics for early childhood development in sub-Saharan Africa. Vaccine. 27.