Abstract

BackgroundIn 2014, over half (54%) of the world’s population lived in urban areas and this proportion will increase to 66% by 2050. This urbanizing trend has been accompanied by an increasing number of people living in urban poor communities and slums. Lower immunization coverage is found in poorer urban dwellers in many contexts. This study aims to identify factors associated with immunization coverage in poor urban areas and slums, and to identify interventions to improve coverage.MethodsWe conducted a systematic review, searching Medline, Embase, Global Health, CINAHL, Web of Science and The Cochrane Database with broad search terms for studies published between 2000 and 2016.ResultsOf 4872 unique articles, 327 abstracts were screened, leading to 63 included studies: 44 considering factors and 20 evaluating interventions (one in both categories) in 16 low or middle-income countries. A wide range of socio-economic characteristics were associated with coverage in different contexts. Recent rural-urban migration had a universally negative effect. Parents commonly reported lack of awareness of immunization importance and difficulty accessing services as reasons for under-immunization of their children. Physical distance to clinics and aspects of service quality also impacted uptake. We found evidence of effectiveness for interventions involving multiple components, especially if they have been designed with community involvement. Outreach programmes were effective where physical distance was identified as a barrier. Some evidence was found for the effective use of SMS (text) messaging services, community-based education programmes and financial incentives, which warrant further evaluation. No interventions were identified that provided services to migrants from rural areas.ConclusionDifferent factors affect immunization coverage in different urban poor and slum contexts. Immunization services should be designed in collaboration with slum-dwelling communities, considering the local context. Interventions should be designed and tested to increase immunization in migrants from rural areas.

Highlights

  • In 2014, over half (54%) of the world’s population lived in urban areas and this proportion will increase to 66% by 2050

  • By 2050 this proportion is expected to increase to 66%, adding approximately 2.5 billion new urban dwellers, of whom 90% will be in Asia and Africa [2]

  • The aim of this study is to identify the factors associated with immunization coverage in low-income urban areas and slums in low and middleincome countries (LMICs), and identify the evidence for interventions to improve coverage

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Summary

Introduction

In 2014, over half (54%) of the world’s population lived in urban areas and this proportion will increase to 66% by 2050 This urbanizing trend has been accompanied by an increasing number of people living in urban poor communities and slums. By 2050 this proportion is expected to increase to 66%, adding approximately 2.5 billion new urban dwellers, of whom 90% will be in Asia and Africa [2]. This trend towards urbanization is closely linked with an increasing population living in urban poor communities and slum environments [2].

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