title: Exposing concerns about vaccination in low- and middle-income countries: a systematic review.
abstract: OBJECTIVE
  Concerns about vaccination lead to under- and no-vaccination. Our objective is to synthesise and expose evidence on individuals' and communities' concerns about vaccination to influence current debates on strategies to improve vaccination coverage in low- and middle-income countries.
  
  
  METHODS
  Systematic literature review till February 2014, following standard methods. Published and grey literature that focused on individuals and community concerns on childhood vaccinations were selected.
  
  
  RESULTS
  44 quantitative, qualitative and mixed-methods studies were included. Main reported concerns referred to perceptions of vaccine harms (e.g. attribution of fatal events). Other concerns included programme distrust (mainly due to rumours and conspiracies) and health system unfriendliness.
  
  
  CONCLUSIONS
  Concerns about vaccination are widespread and further worsen the challenges related to programmatic and health system barriers to vaccination. There is a disconnection between qualitative and quantitative research which misses the opportunity to quantify what is reported in the former. Strikingly, there is a wealth of evidence on concerns but much lesser evidence on interventions to address them. We welcome World Health Organization initiative to tackle vaccine hesitancy and call for the synthesis of evidence and production of guidance on strategies to address concerns on vaccination.
authors: Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.|Universität Basel, Petersplatz 1, 4003, Basel, Switzerland.
authors: Daniel
authors: D
authors: Cobos Muñoz
authors: Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.|Universität Basel, Petersplatz 1, 4003, Basel, Switzerland.
authors: Laura
authors: L
authors: Monzón Llamas
authors: Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland. x.bosch@unibas.ch.|Universität Basel, Petersplatz 1, 4003, Basel, Switzerland. x.bosch@unibas.ch.
authors: Xavier
authors: X
authors: Bosch-Capblanch
mesh_terms: D003258:Consumer Behavior; D003695:Delivery of Health Care; D003906:Developing Countries; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods; D006801:Humans; D038622:Internationality; D010342:Patient Acceptance of Health Care; D014611:Vaccination / Q000009:adverse effects / Q000706:statistics & numerical data*; D014612:Vaccines / Q000600:supply & distribution
chemical_list: D014612:Vaccines
keywords: Concerns; Hesitancy; Immunisation; Low- and middle-income countries; Systematic review; Vaccination