Timeliness of routine childhood vaccination in low- and middle-income countries, 1978-2021: Protocol for a scoping review to map methodologic gaps and determinants.

Oghenebrume Wariri,Yakubu Kevin Kwarshak,Chris Grundy,Uduak Okomo,Beate Kampmann,Kris A. Murray,Charles Shey Wiysonge

doi:10.1371/journal.pone.0253423

Abstract

The literature on the timeliness of childhood vaccination (i.e. vaccination at the earliest appropriate age) in low-and middle-income countries has important measurement and methodological issues that may limit their usefulness and cross comparison. We aim to conduct a comprehensive scoping review to map the existing literature with a key focus on how the literature on vaccination timeliness has evolved, how it has been defined or measured, and what determinants have been explored in the period spanning the last four decades. This scoping review protocol was developed based on the guidance for scoping reviews from the Joanna Briggs Institute. We will include English and French language peer-reviewed publications and grey literature on the timeliness of routine childhood vaccination in low-and middle-income countries published between January 1978 through to 2021. A three-step search strategy that involves an initial search of two databases to refine the keywords, a full search of all included electronic databases, and screening of references of previous studies for relevant articles missing from our full search will be employed. The search will be conducted in five electronic databases: MEDLINE, EMBASE, Global Health, CINAHL and Web of Science. Google search will also be conducted to identify relevant grey literature on vaccination timeliness. All retrieved titles from the search will be imported into Endnote X9.3.3 (Clarivate Analytics) and deduplicated. Two reviewers will screen the titles, abstracts and full texts of publications for eligibility using Rayyan-the web based application for screening articles for systematic reviews. Using a tailored data extraction template, we will extract relevant information from eligible studies. The study team will analyse the extracted data using descriptive statistical methods and thematic analysis. The results will be presented using tables, while charts and maps will be used to aid the visualisation of the key findings and themes. The proposed review will generate evidence on key methodological gaps in the literature on timeliness of childhood vaccination. Such evidence would shape the direction of future research, and assist immunisation programme managers and country-level stakeholders to address the needs of their national immunisation system.

Highlights

Since the World Health Organization (WHO) introduced the Expanded Programme on Immunization (EPI) in 1974 [1], the proportion of children protected against vaccine-preventable diseases (VPDs) continue to increase with more than a billion children vaccinated in the last decade alone [2]
The reporting of the scoping review output will be conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist [17]. This scoping review will answer the following key research questions: 1. How has the literature on childhood vaccination timeliness in lowand middle-income countries (LMICs) evolved in the last four decades?
Mapping the evidence on how vaccination timeliness has been measured in LMICs over the past four decades will highlight critical methodological gaps that will aid future research to adopt a more robust measurement of vaccination timeliness

Summary

Introduction

Since the World Health Organization (WHO) introduced the Expanded Programme on Immunization (EPI) in 1974 [1], the proportion of children protected against vaccine-preventable diseases (VPDs) continue to increase with more than a billion children vaccinated in the last decade alone [2]. About 2–3 million deaths from diseases such as diphtheria, tetanus, pertussis and measles are prevented yearly with lifesaving childhood vaccines [2]. In lowand middle-income countries (LMICs), current estimates suggest that between 2000 and 2019, 36 million deaths have been averted among children under 5 by vaccination programmes [3]. EPI has drastically reduced the incidence of, and deaths from VPDs, its success across and within countries vary, especially in LMICs. The usual metric employed for assessing the success of immunisation systems is routine vaccination coverage at specific ages [4]. The usual metric employed for assessing the success of immunisation systems is routine vaccination coverage at specific ages [4] This metric, does not take into consideration whether the vaccines have been received in a timely manner, in accordance with the recommended national vaccination windows. Endangers the health of children and compromises herd immunity, with potential implications for VPDs outbreaks irrespective of coverage rates

Objectives

Methods

Conclusion