Experiences integrating delivery of maternal and child health services with childhood immunization programs: systematic review update.
BACKGROUND
The World Health Organization and the United Nations Children's Fund promote integration of maternal and child health (MCH) and immunization services as a strategy to strengthen immunization programs. We updated our previous review of integrated programs and reviewed reports of integration of MCH services with immunization programs at the service delivery level.


METHODS
Published and unpublished reports of interventions integrating MCH and immunization service delivery were reviewed by searching journal databases and Web sites and by contacting organizations.


RESULTS
Among 27 integrated activities, interventions included hearing screening, human immunodeficiency virus services, vitamin A supplementation, deworming tablet administration, malaria treatment, bednet distribution, family planning, growth monitoring, and health education. When reported, linked intervention coverage increased, though not to the level of the corresponding immunization coverage in all cases. Logistical difficulties, time-intensive interventions ill suited for campaign delivery, concern for harming existing services, inadequate overlap of target age groups, and low immunization coverage were identified as challenges.


CONCLUSIONS
Results of this review reinforce our 2005 review findings, including importance of intervention compatibility and focus on immunization program strength. Ensuring proper planning and awareness of compatibility of service delivery requirements were found to be important. The review revealed gaps in information about costs, comparison to vertical delivery, and impact on all integrated interventions that future studies should aim to address.
Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia 30322, USA. awallace@cdc.gov
Aaron S
AS
Wallace
Tove K
TK
Ryman
Vance
V
Dietz
D002662:Child Health Services; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D017589:Immunization Programs; D008427:Maternal Health Services; D011247:Pregnancy