title: Strategies to increase the demand for childhood vaccination in low- and middle-income countries: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To investigate which strategies to increase demand for vaccination are effective in increasing child vaccine coverage in low- and middle-income countries.
  
  
  METHODS
  We searched MEDLINE, EMBASE, Cochrane library, POPLINE, ECONLIT, CINAHL, LILACS, BDSP, Web of Science and Scopus databases for relevant studies, published in English, French, German, Hindi, Portuguese and Spanish up to 25 March 2014. We included studies of interventions intended to increase demand for routine childhood vaccination. Studies were eligible if conducted in low- and middle-income countries and employing a randomized controlled trial, non-randomized controlled trial, controlled before-and-after or interrupted time series design. We estimated risk of bias using Cochrane collaboration guidelines and performed random-effects meta-analysis.
  
  
  RESULTS
  We identified 11 studies comprising four randomized controlled trials, six cluster randomized controlled trials and one controlled before-and-after study published in English between 1996 and 2013. Participants were generally parents of young children exposed to an eligible intervention. Six studies demonstrated low risk of bias and five studies had moderate to high risk of bias. We conducted a pooled analysis considering all 11 studies, with data from 11,512 participants. Demand-side interventions were associated with significantly higher receipt of vaccines, relative risk (RR): 1.30, (95% confidence interval, CI: 1.17-1.44). Subgroup analyses also demonstrated significant effects of seven education and knowledge translation studies, RR: 1.40 (95% CI: 1.20-1.63) and of four studies which used incentives, RR: 1.28 (95% CI: 1.12-1.45).
  
  
  CONCLUSIONS
  Demand-side interventions lead to significant gains in child vaccination coverage in low- and middle-income countries. Educational approaches and use of incentives were both effective strategies.
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-458, 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada .
authors.forename: Mira
authors.initials: M
authors.lastname: Johri
authors.affiliation: Département d'administration de la santé, Université de Montréal, Montréal, Canada .
authors.forename: Myriam Cielo
authors.initials: MC
authors.lastname: Pérez
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada .
authors.forename: Catherine
authors.initials: C
authors.lastname: Arsenault
authors.affiliation: National Health Systems Resource Centre (NHSRC), Ministry of Health and Family Welfare, New Delhi, India .
authors.forename: Jitendar K
authors.initials: JK
authors.lastname: Sharma
authors.affiliation: Department of Medicine, McGill University, Montréal, Canada .
authors.forename: Nitika Pant
authors.initials: NP
authors.lastname: Pai
authors.affiliation: Pratham Education Foundation (ASER Centre), New Delhi, India .
authors.forename: Smriti
authors.initials: S
authors.lastname: Pahwa
authors.affiliation: Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Tour Saint-Antoine, Porte S03-458, 850 rue St-Denis, Montréal, Québec, H2X 0A9, Canada .
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Sylvestre
mesh_terms: D015982:Bias; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods; D003906:Developing Countries; D005260:Female; D006293:Health Promotion / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D008297:Male; D011203:Poverty; D016032:Randomized Controlled Trials as Topic; D014611:Vaccination / Q000706:statistics & numerical data*