Evidence-based discussion increases childhood vaccination uptake: a randomised cluster controlled trial of knowledge translation in Pakistan
Open accessAbstract
BACKGROUND: Childhood vaccination rates are low in Lasbela, one of the poorest districts in Pakistan's Balochistan province. This randomised cluster controlled trial tested the effect on uptake of informed discussion of vaccination costs and benefits, without relying on improved health services. METHODS: Following a baseline survey of randomly selected representative census enumeration areas, a computer generated random number sequence assigned 18 intervention and 14 control clusters. The intervention comprised three structured discussions separately with male and female groups in each cluster. The first discussion shared findings about vaccine uptake from the baseline study; the second focussed on the costs and benefits of childhood vaccination; the third focussed on local action plans. Field teams encouraged the group participants to spread the dialogue to households in their communities. Both intervention and control clusters received a district-wide health promotion programme emphasizing household hygiene. Interviewers in the household surveys were blind of intervention status of different clusters. A follow-up survey after one year measured impact of the intervention on uptake of measles and full DPT vaccinations of children aged 12-23 months, as reported by the mother or caregiver. RESULTS: In the follow-up survey, measles and DPT vaccination uptake among children aged 12-23 months (536 in intervention clusters, 422 in control clusters) was significantly higher in intervention than in control clusters, where uptake fell over the intervention period. Adjusting for baseline differences between intervention and control clusters with generalized estimating equations, the intervention doubled the odds of measles vaccination in the intervention communities (OR 2.20, 95% CI 1.24-3.88). It trebled the odds of full DPT vaccination (OR 3.36, 95% CI 2.03-5.56). CONCLUSION: The relatively low cost knowledge translation intervention significantly increased vaccine uptake, without relying on improved services, in a poor district with limited access to services. This could have wide relevance in increasing coverage in developing countries. TRIAL REGISTRATION: ISRCTN12421731.
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The highest median effect size was among educational interventions (median = 6.25).
“However, the highest median effect size was among educational interventions (median = 6.25)19,20.”
From Last-mile delivery increases vaccine uptake in Sierra Leone (2024) · cites this paper as [20]
The Results report vaccination outcomes for this trial, not a comparison of effect sizes across intervention types. Searches for “median effect size,” “educational interventions,” and “6.25” found no passage supporting the claimed highest median. (LLM, conf=0.76)
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Strategies for addressing vaccine hesitancy–A systematic review
Jarrett, C., Wilson, R., O’Leary, M., Eckersberger, E., & Larson, H. J. (2015) · Vaccine · doi:10.1016/j.vaccine.2015.04.040 · Cited by 1,066 · see citing works
Can lay health workers increase the uptake of childhood immunisation? Systematic review and typology
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Last-mile delivery increases vaccine uptake in Sierra Leone
Meriggi, N. F., Voors, M., Levine, M., Ramakrishna, V., Kangbai, D. M., Rozelle, M., Tyler, E., Kallon, S., Nabieu, J., Cundy, S., et al. (2024) · Nature · doi:10.1038/s41586-024-07158-w · Cited by 36 · see citing works
“19,20 The intervention we conducted in Sierra Leone – where mobile health teams visit remote communities for 48-72 hours to ease their access burden – produces a larger percentage point effect size than 223 (95”
BackgroundCockcroft, A., Omer, K., Gidado, Y., Baba, M. C., Aziz, A., Ansari, U., Gamawa, A. I., Mohammed, R., Galda, S. A., & Andersson, N. (2022) · Journal of Global Health · doi:10.7189/jogh.12.04003 · Cited by 14 · see citing works
Self-citation
- Authors
- Andersson, N., Cockcroft, A., Ansari, N. M., Omer, K., Baloch, M., Ho Foster, A., Shea, B., Wells, G. A., & Soberanis, J. L.
- Affiliations
- Universidad Autónoma de Guerrero (MX)
- University of Ottawa (CA)
- Ottawa Heart Institute (CA)
- Corresponding author
- Andersson, Neil
- Venue
- BMC International Health and Human Rights
- Published
- 2009-10
- Volume
- 9
- Issue
- S1
- Pages
- S8-S8
- ISSN
- 1472-698X (ISSN-L)
- PMC
- PMC3226240
- OpenAlex
- W2171449678
- Cited by
- 107
- References
- 1
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 9 · 2023: 9 · 2022: 8 · 2021: 12 · 2020: 6 · 2019: 4 · 2018: 8 · 2017: 14 · 2016: 7 · 2015: 5 · 2014: 4 · 2013: 3 · 2012: 4
- FWCI
- 4.49
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC International Health and Human Rights (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- International Development Research Centre
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- knowledge translation, measles vaccination, DPT immunization, community health education, Balochistan, low-income settings, health promotion
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