The impact of information and communication technology on immunisation and immunisation programmes in low-income and middle-income countries: a systematic review and meta-analysis

Mohini Zarekar; Hussein Al-Shehabi; Rita Dörner; Heide Weishaar; Tessa Lennemann; Charbel El Bcheraoui; Andrea Bernasconi

doi:10.1016/j.ebiom.2024.105520

The impact of information and communication technology on immunisation and immunisation programmes in low-income and middle-income countries: a systematic review and meta-analysis

EBioMedicine. 2024 Dec 21:111:105520. doi: 10.1016/j.ebiom.2024.105520. Online ahead of print.

Authors

Mohini Zarekar¹, Hussein Al-Shehabi², Rita Dörner², Heide Weishaar², Tessa Lennemann³, Charbel El Bcheraoui⁴, Andrea Bernasconi⁵

Affiliations

¹ Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany; Institute of International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
² Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany.
³ Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Bonn, Germany.
⁴ Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany. Electronic address: El-BcheraouiC@rki.de.
⁵ Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany; Unité Epidémiologie et Recherche Clinique, Réseau de l'Arc, Saint-Imier, Switzerland.

PMID: 39709769
DOI: 10.1016/j.ebiom.2024.105520

Abstract

Background: Low-income and Middle-income Countries (LMIC) are continually working to ensure everyone can access life-saving vaccines. Recognising the considerable impact of Information and Communication Technology (ICT) in healthcare, we performed a systematic review and meta-analysis to summarise ICT effectiveness in improving vaccine delivery in LMICs.

Methods: A systematic search from January 2010 to August 2023 in MEDLINE, EMBASE, Cochrane Library, BMJ Health & Care Informatics, and grey literature was performed. This search focused on randomised controlled trials (RCTs), non-RCTs, observational, and mixed-methods studies in English, examining ICT's effects on childhood immunisation in LMICs. Risk of bias in RCTs and non-RCTs was assessed using the Joanna Briggs Institute tool, and mixed-methods studies were evaluated with the Mixed Methods Appraisal Tool. A meta-analysis summarised ICT's impact on third pentavalent dose coverage and full immunisation by age one. The study is registered with PROSPERO (CRD42023446062).

Findings: Of 6535 screened studies, 27 involving 354,979 children were included. All apart from one study demonstrated a positive impact on immunisation coverage and timeliness, completeness and accuracy of records, number of adverse events reporting, vaccine stockouts, and cold chain expansion. The meta-analysis demonstrated that reminders effectively improved coverage rate of the third dose of the pentavalent vaccine (OR 2.32, 95% CI 1.34-4.03) and the full immunisation at one year of age (OR 2.61, 95% CI 1.2-5.67) with significant degrees of heterogeneity, respectively I² 82% and I² 89%. Main concerns for bias in RCTs included unblinded outcome assessors and intervention providers. Interpreting quasi-experimental studies was more challenging due to the higher risk of baseline differences between study arms, statistical methods, and dropouts. Mixed-methods studies often lacked clarity in integrating qualitative and quantitative data.

Interpretation: This systematic review confirms the benefits of ICT in immunisation programmes by enhancing various stages of vaccine delivery. Specifically, reminders have been shown to enhance childhood immunisation coverage rates.

Funding: Deutsche Gesellschaft für Internationale Zusammenarbeit (German Corporation for International Cooperation, GIZ) as part of the Digital Innovation in Pandemic Control (DIPC) Initiative, financed by the Bundesministerium für Wirtschaftliche Zusammenarbeit (Federal Ministry for Economic Cooperation and Development, BMZ).

Keywords: Childhood vaccination; Digital health interventions; Health information technology; Immunisation equity; Low-income and middle-income countries (LMICs); Vaccine delivery systems.