Background
Methods
Protocol, registration and preliminary review
Eligibility criteria
Search
Study selection
Inclusion | Exclusion | Relevance | Extraction |
---|---|---|---|
Supplies evidence for at least one determinant | Adult vaccines besides HPV | Comprehensiveness | Country/region |
Animal vaccines | Emphasis | Review | |
Levels and trends of coverage | Geography | Study design | |
English language | Consequences of utilization | Novelty | Study population |
Health impact | Outcomes | Related studies | |
Highly-specific subpopulations | Antigen(s) | ||
Vaccine effectiveness/efficacy/safety | Outcome(s) | ||
Disease treatment | Determinant(s) | ||
Pathobiology | Exhaustive | ||
Future vaccines | Proximity | ||
Cost effectiveness | Pathway(s) | ||
General health care utilization | Effect size(s) | ||
Impact of a single intervention | Theme(s) | ||
Vaccine manufacturing | Thematic excerpts | ||
Promotion of a particular vaccine technology |
Data collection process
Data items
Risk of bias
Summary measures and content analysis
Synthesis of results
Thematic analysis
Critical interpretive synthesis
Additional analyses
Results
Study selection
Study characteristics and content analysis
Theme | Determinant | Description | Relationship | Evidence | Label in Fig. 2
|
---|---|---|---|---|---|
Facility Readiness | Facility Readiness (Routine) | Health facility is ready to vaccinate children | Directly impacts Utilization | [44] | 1 |
Service HR/Mgmt | Adequate health facility staff to meet demand | Directly impacts Facility Readiness | 2 | ||
Training | Adequate health facility staff training | Moderates Service HR/Mgmt | 3 | ||
Performance Assessment | Procedures for facility staff performance assessment | Moderates Service HR/Mgmt | 4 | ||
Disbursement/Fund Mgmt | Adequate resources and management for health facility staff | Directly impacts Service HR/Mgmt, Training, Performance Assessment | 5 | ||
Waste Disposal | Procedures and equipment for vaccine waste | Directly impacts Facility Readiness | 6 | ||
Facility Vaccine Supply | Health facility has vaccines to administer | Directly impacts Facility Readiness | 7 | ||
Facility Storage Capacity | Health facility has sufficient capacity in refrigerators and freezers to store vaccines | Moderates Facility Vaccine Supply | 8 | ||
Stock/Flow Awareness | Staff members know the status of vaccine inventory | Moderates Facility Vaccine Supply | 9 | ||
Consumption Forecasting | Appropriate anticipation of future demand | Directly impacts Stock/Flow Awareness | 10 | ||
Transaction Visibility | Adequate resources dedicated to supply chain transparency | Directly impacts Stock/Flow Awareness | 11 | ||
Transaction Reporting | Adequate resources dedicated to communication of transactions | Directly impacts Stock/Flow Awareness | 12 | ||
Supply LMIS | Logistics management information system for tracking supply | Moderates Transaction Reporting, Transaction Visibility | 13 | ||
Inventory HR/Mgmt | Adequate resources dedicated to inventory management | Directly impacts Stock/Flow Awareness | 14 | ||
Training | Adequate inventory management training | Moderates Inventory HR/Mgmt | 15 | ||
Performance Assessment | Procedures for inventory management performance assessment | Moderates Inventory HR/Mgmt | 16 | ||
Disbursement/Fund Mgmt | Adequate resources and management for inventory management | Directly impacts Inventory HR/Mgmt, Training, Performance Assessment | 17 | ||
Intermediary Vaccine Supply | Intermediate storage facility has vaccines to distribute | Directly impacts Facility Vaccine Supply | 18 | ||
Intermediary Storage Capacity | Intermediate storage facility has sufficient capacity in refrigerators and freezers to store vaccines | Moderates Intermediary Vaccine Supply | 19 | ||
Facility Distribution Method | Established means of transporting stock from intermediate storage to health facility | Directly impacts Facility Vaccine Supply | 20 | ||
Distribution Equipment | Vehicles and other equipment to distribute supply from intermediate storage to health facility | Moderates Facility Distribution Method | 21 | ||
Distribution HR/Mgmt | Adequate resources dedicated to distribution management | Moderates Facility Vaccine Supply, Intermediary Vaccine Supply | 22 | ||
Training | Adequate distribution management training | Moderates Distribution HR/Mgmt | 23 | ||
Performance Assessment | Procedures for distribution system performance assessment | Moderates Distribution HR/Mgmt | 24 | ||
Disbursement/Fund Mgmt | Adequate resources and management for distribution systems | Directly impacts Distribution HR/Mgmt, Training, Performance Assessment | 25 | ||
Country Vaccine Supply | Central storage facility has vaccines to distribute | Directly impacts Intermediary Vaccine Supply | 26 | ||
Country Storage Capacity | Central storage facility has sufficient capacity in refrigerators and freezers to store vaccines | Moderates Country Vaccine Supply | 27 | ||
Intermediary Distribution Method | Established means of transporting stock from central to intermediate storage | Directly impacts Intermediary Vaccine Supply | 28 | ||
Distribution Equipment | Vehicles and other equipment to distribute supply from central to intermediate storage | Moderates Intermediary Distribution Method | 29 | ||
Leadership and Consistency | Oversight and decision-making in vaccine systems | Directly impacts Disbursement/Fund Mgmt, Outreach Protocol, Demand Generation Activities, Community Partnership, Service Cost, Supply LMIS | 30 | ||
Political Commitment | High-level support for vaccination systems | Directly impacts Leadership and Consistency, Funding | 31 | ||
Development Partner Participation | High-level engagement from development partners in vaccination systems | Directly Impacts Political Commitment, Funding, Country Vaccine Supply | 32 | ||
Funding | Adequate high-level funding for vaccination systems | Directly impacts Disbursement/Fund Mgmt, Facility Infrastructure, Service Cost | 33 | ||
Facility Readiness (Outreach) | Health facility is ready to vaccinate children through outreach activities | Directly impacts Utilization | 34 | ||
Outreach Transportation | Adequate vehicles to conduct outreach activities | Directly impacts Facility Readiness (Outreach) | 35 | ||
Mobile Storage Capacity | Health facility has sufficient capacity to store vaccines during outreach activities | Directly impacts Facility Readiness (Outreach) | [31] | 36 | |
Outreach Protocol | Procedures and plans for outreach activities | Directly impacts Mobile Storage Capacity, Outreach Transportation | 37 | ||
Decision to Vaccinate | Community Partnership | Active and positive relationship between health facility and community | Directly impacts Quality of Care, Community Awareness, Attitude | 38 | |
Demand Generation Activities | Health facility encourages vaccine utilization in the community | Directly impacts Perceived Safety, Need, Effectiveness, Community Awareness, Attitude, Vaccine Awareness, Attitude | 39 | ||
Quality of Care | Quality of care at health facility for vaccination | Directly impacts Wait Time, Perceived Quality of Care | 40 | ||
Facility Infrastructure | Quality of health facility building and equipment | Directly impacts Wait Time, Perceived Quality of Care | 41 | ||
Service Cost | Cost of vaccine services charged to the mother or caretaker by the health facility | Moderates Ability to Finance Service | 42 | ||
Wait Time | Wait time at health facility for vaccination | Directly impacts Perceived Quality of Care | 43 | ||
Patient Volume | Number of patients who typically visit health facility | Directly impacts Wait Time | [9] | 44 | |
Decision to Vaccinate | Mother or caretaker intends to vaccinate the child | Directly impacts Utilization | 45 | ||
Vaccine Awareness, Attitude | Mother or caretaker is aware of vaccine and perceives it to be beneficial | Directly impacts Decision to Vaccinate, Perceived Eligibility | 46 | ||
Perceived Quality of Care | Mother or caretaker perceptions about the quality of care in the health facility | Directly impacts Vaccine Awareness, Attitude | 47 | ||
Education | Mother or caretaker education | Directly impacts Vaccine Awareness, Attitude | 48 | ||
Prior Use | Child has been vaccinated previously | Directly impacts Vaccine Awareness, Attitude, Child Has Card | 49 | ||
Child Has Card | Child has vaccine card for recording doses | Directly impacts Vaccine Awareness, Attitude | 50 | ||
Perceived Safety, Need, Effectiveness | Mother or caretaker perceives that there is risk of disease and the vaccine is safe and effective | Directly impacts Vaccine Awareness, Attitude | 51 | ||
Community Awareness, Attitude | Influential community members are aware of the vaccine and perceive it to be beneficial | Directly impacts Vaccine Awareness, Attitude, Perceived Safety, Need, Effectiveness, Patient Volume | 52 | ||
Perceived Eligibility | Mother or caretaker perceives that child is eligible for vaccination | Directly impacts Decision to Vaccinate | 53 | ||
Child Eligibility | Child Eligibility | Child meets criteria to be eligible for vaccination | Directly impacts Utilization | 54 | |
Child Health | Child is healthy enough to be vaccinated | Directly impacts Child Eligibility, Perceived Eligibility | 55 | ||
Child Age | Child is of the appropriate age to be vaccinated | Directly impacts Child Eligibility, Perceived Eligibility | 56 | ||
Child Sex | Sex of child | Directly impacts Perceived Eligibility | 57 | ||
Mother Able | Mother Able | Mother or caretaker has access to the means and time to vaccinate the child | Directly impacts Utilization | 58 | |
Ability to Finance Service | Mother or caretaker can afford any cost of vaccine services | Directly impacts Mother Able, Decision to Vaccinate | 59 | ||
Ability to Finance Transport | Mother or caretaker can afford any cost of transportation | Directly impacts Mother Able, Decision to Vaccinate | 60 | ||
Ability to Spare Time | Mother or caretaker can take time out of other responsibilities to vaccinate the child | Directly impacts Mother Able, Decision to Vaccinate | 61 | ||
Insurance | Whether the mother or caretaker has health insurance | Moderates Ability to Finance Service | 62 | ||
SES | Socio-economic status of mother or caretaker | Directly impacts Ability to Finance Service | 63 | ||
Transport Time/Cost | Duration and cost of transportation to health facility incurred by mother or caretaker | Moderates Ability to Finance Transport, Ability to Spare Time | 64 | ||
Parity | Number of siblings of the child | Directly impacts Ability to Spare Time | 65 | ||
Distance | Distance from household to health facility | Directly impacts Transport Time/Cost | 66 | ||
Marital Status | Mother or caretaker marital status | Directly impacts Ability to Spare Time | 67 | ||
Maternal Health | Mother or caretaker health | Directly impacts Mother Able, Decision to Vaccinate | 68 |
Theme | Determinant | Description | Relationship | Evidence | Label in Fig. 2
|
---|---|---|---|---|---|
Vaccine Viability | Vaccine Viability | Vaccine is functional | Directly impacts Effectiveness | 69 | |
Cold Storage | Adequate storage temperature at each stage of the distribution system | Directly impacts Vaccine Viability | 70 | ||
Cold Transport | Adequate distribution temperature in distribution system | Directly impacts Cold Storage | 71 | ||
Monitoring | Systems in place for monitoring/correcting cold storage and transport | Directly impacts Cold Transport | 72 | ||
Maintenance | Adequate resources dedicated to cold chain maintenance and repairs | Directly impacts Cold Storage, Cold Transport | 73 | ||
Energy Source | Type of energy used to power cold storage | Directly impacts Cold Storage | 74 | ||
Season/Weather | Seasonal and weather-related issues that may influence transportation and temperature | Directly impacts Cold Storage | 75 | ||
HR | Adequate number and cadres of health facility staff | Directly impacts Coadministration, Cold Storage | 76 | ||
Training | Adequate health facility staff training | Moderates HR | 77 | ||
Vaccine Guidelines | Adequate guidelines for vaccine administration | Directly impacts Training | 78 | ||
Vaccine Formulation | Type of vaccine | Directly impacts Vaccine Guidelines | 79 | ||
Coadministration | Other vaccines administered to the child | Directly impacts Effectiveness | 80 | ||
Host Factors | Age at first dose | Age at which child received the first dose of the vaccine | Directly impacts Effectiveness | 81 | |
Dosage Interval | Time between doses received | Directly impacts Effectiveness | 82 | ||
Acute Infection | Acute child health issues that may interfere with immune response | Directly impacts Effectiveness | 83 | ||
Nutrition | Nutritional status of child | Directly impacts Effectiveness | 84 | ||
Maternal Antibodies | Presence of maternal antibodies in child | Directly impacts Effectiveness | 85 | ||
Breast Feeding | Breast feeding practices | Directly impacts Maternal Antibodies, Nutrition | 86 | ||
Genetics | Genetic factors in child that may influence immune response | Directly impacts Effectiveness | [122] | 87 |
Synthesis of results
Thematic analysis
Interpretive synthesis
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Intent to Vaccinate - Demand for vaccines on the part of the mother that would result in vaccination in the absence of other barriers.
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Facility Readiness - Supply (by the health system) of vaccine services to adequately meet demand. Incorporates supplies (vials, syringes etc.), human resources and the consistency of their availability.
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Community Access - The ability (or inability) to successfully carry out the transaction of vaccine utilization, i.e. barriers and facilitators between Intent and Readiness.