Routine immunisation of children in LMICs: EGM
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Knowledge about immunisation
Caregivers’ knowledge about immunisation in general (i.e., its purpose and role in preventing disease)
Attitudes about immunisation
Caregivers’ attitudes towards immunisation in general (i.e., whether they view it favourably or unfavourably or have high or low confidence in its efficacy)
Attitudes about providers
Caregivers’ attitudes about health providers in general (i.e., whether they generally trust health providers to provide high-quality and appropriate care)
Community norms
Community-level attitudes and beliefs about immunisation, including whether there is social pressure to vaccinate or not vaccinate. This can be measured either objectively through aggregating community-level responses or subjectively by soliciting individual community members’ beliefs about the norms in their community. This includes attitudes and beliefs about immunization of key influencers in the community like traditional or religious leaders.
Household norms
Norms and practices determining who in a household (e.g., mother, father, mother-in-law) provides input to decisions about whether to vaccinate, and how much decision-making power individual household members have. This also covers attitudes towards immunisation of household members other than the primary caregiver.
Readiness to vaccinate
Caregivers’ motivation, intention and plan to vaccinate their children. Note this is more specific than general attitudes towards immunisation covered under "attitudes about immunisation".
Reasons for not vaccinating
Caregivers’ stated reasons for not vaccinating children. This may include factors such as convenience (which would also be coded under “perceived convenience of vaccination”), but only use this code if the factors mentioned are specifically framed as reasons for not vaccinating.
Awareness-place/time/schedule
Caregivers’ knowledge about when and where they should go for vaccinations.
Actual cost of vaccinating
Actual cost of vaccinating the child, including vaccine cost, transportation cost, loss of wage/income due to missed work, and providing gifts/unofficial payments to the health providers.
Convenience of vaccination
Subjective measures (i.e., caregivers’ beliefs) of the convenience of taking the child for vaccination, such as opportunity costs of vaccinating a child (e.g., not able to care for a younger child), long lines at health clinic, and inconvenient day/time of vaccination.
Health service experience
The actual experience of health services in the last visit such as duration of waiting time, availability of vaccine or vaccinator, and behaviour of the health staff (respect, rudeness). This also includes level of satisfaction with the health services, professionals and facilities
Vacc. card availability
Measures of whether caregivers possess vaccination health cards provided by the health system, and/or whether caregivers can show the vaccination health card.
Perception of side effects
Caregivers’ perceptions of the likelihood and severity of side effects from vaccination, and their knowledge of how to recognise and treat normal side effects
CHW motivation & capacity
Any measure of Community Health Worker's (CHW) capacity to deliver quality and timely vaccination services.
Supply of CHWs
The total availability of CHW services in the community, taking into account both the number of CHWs and the time they have available.
Formal HW supply
The total availability of FHW services in the community, taking into account both the number of FHWs and the time they have available.
HW availability for vacc.
Whether vaccinators are present at vaccination point of service (e.g., health clinic) when vaccination services are supposed to be offered. This includes measures of health worker “absenteeism”. This is different from perception or experience of health workers from caregivers’ point of view. The source of information for this outcome can be administrative data or survey of health facilities and staff.
FHW motivation & capacity
Any measure of FHWs’ capacity to deliver quality and timely vaccination services, or of their performance in doing so.
Admin staffing
The number of staff in administrative posts in the health system (i.e., those not directly involved in health service provision).
Capacity of health admin.
The knowledge, skills, and motivation of staff in administrative posts in the health system, including leadership positions.
Immunisation data collection
The health system’s capacity for and success in collecting data about vaccination coverage and service quality for regular monitoring and accountability.
Defaulter tracing
The health system’s capacity for and success in identifying vaccination “defaulters” (i.e., those whose children receive early vaccine doses but do not return for subsequent vaccinations).
Supply chain management
The health system’s capacity to monitor the supply of vaccines at points of service, ensure reliable supply chains, and avoid supply “bottlenecks”.
Vacc. data availability
How easy it is for stakeholders within and beyond the health system to access data about vaccination service quality, coverage and timeliness.
Stockouts
The frequency and duration of incidents when vaccines are out of stock at points of service, or when vaccines are in stock but cannot be administered to children who are brought in (e.g., because health workers are instructed not to open a new vial if there are not enough children to receive all doses in the vial, meaning that some of the vaccine would go to waste). Source of this information is administrative data and/or survey of health facilities and staff.
Quality of cold chain
The availability, quality and upkeep of physical equipment and place for cold chain storage of vaccines.
Vaccine financing
Change in financial resources for national or sub-national vaccination programmes, policies or strategies.
Full routine immunisation
Binary measure of whether or not children have received all routine vaccinations for the relevant country or region.
BCG
Binary measure of whether or not children have received the BCG vaccine. This may be measured by checking whether children have a BCG vaccination scar.
Pentavalent 2
Binary measure of whether or not children have received the second dose of the DPT or pentavalent vaccine.
Pentavalent 3
Binary measure of whether or not children have received the third dose of the DPT or pentavalent vaccine.
OPV0
Binary measure of whether children have received 1st dose of oral polio vaccine (recommended for administration at birth).
OPV1
Binary measure of whether children have received 2nd dose of the oral polio vaccine (recommended for administration at 6 weeks).
OPV2
Binary measure of whether children have received the 3rd dose of the oral polio vaccine (recommended for administration at 10 weeks).
OPV3
Binary measure of whether children have received the 4th and final dose of the oral polio vaccine (recommended for administration at 14 weeks).
IPV
Binary measure of whether children have received inactivated polio vaccine, given as injection. Countries differ in their guidelines/practices regarding IPV, so in the description cell of the codebook, please note the number of doses and age(s) when administered.
Measles
Binary measure of whether or not children have received the measles vaccine.
No/partial immunisation
Proportion of children who receive at least one vaccination versus those who are completely unvaccinated.
Vaccination timeliness
Proportion of vaccinations delivered on time according to the recommended schedule, vs those that are delivered late.
Drop out (multi-dose vacc.)
Proportion of children who fail to receive the complete course of a multi-dose vaccine (DPT/penta, OPV, or in some cases measles) after receiving the first dose.
Unspecified coverage
If an evaluation or SR refers to impacts on routine vaccination coverage for children, but without specifying which vaccines.
Childhood morbidity
Incidence of vaccine-preventable diseases or symptoms associated with those diseases (e.g., diarrhoea) among children under 5.
Infant/Child mortality
Incidence of mortality among children below five years from all causes. Neonatal mortality refers to death of a live-born baby within the first 28 days of life. Infant mortality is the death of young children under the age of 1. Child mortality, refers to the mortality of children under the age of five. This category includes all-cause mortality.
Sustained sensitization and education campaigns
Sustained interventions (i.e., those that are not designed with a fixed end date in mind) that provide targeted caregivers with information about immunisation and its importance, the vaccination schedule, or where and how to access immunisation services. For example, village health and nutrition days (VHNDs) in India in which health education and counselling services are provided to pregnant women and mothers of young children on a regular basis.
One-time sensitization and education campaigns
One-off interventions (i.e., those designed with a fixed end date in mind) that provide targeted caregivers with information about immunisation and its importance, the vaccination schedule, or where and how to access immunisation services.
Public information campaigns
Mass media campaigns through newspapers, radio and TV which provide caregivers with information about immunisation and its importance, the vaccination schedule, or where and how to access immunisation services. Because of the nature of communication mediums they cannot be targeted to a specific audience.
Material/monetary incentives for caregivers
Interventions that incentivise caregivers to vaccinate through items with monetary value. This could be cash transfers or material goods like food or home goods.
Non-material incentives for caregivers
Interventions that seek to motivate caregivers to vaccinate through non-material incentives like social recognition. Unlike reminder messages, interventions in this category should seek to create or strengthen a desire to vaccinate, rather than activating a standing intention to vaccinate.
Automated voice messages to caregivers
Use of automatically-generated voice messages (usually delivered to a mobile phone) that remind caregivers about upcoming vaccinations, provide them information on place and time of vaccination and encourage them to vaccinate. While these messages may contain some motivational component (e.g., stressing the importance of vaccination in addition to reminding caregivers about an upcoming appointment), voice messages should be categorised only here and not also under “non-material incentives”, unless they rely on a substantive motivational factor like social recognition.
Written or pictorial messages to caregivers
Use of written messages/pictorial that remind caregivers about upcoming vaccinations, provide them information on place and time of vaccination and encourage them to vaccinate. While these messages may contain some motivational component (e.g., stressing the importance of vaccination in addition to reminding caregivers about an upcoming appointment), messages should be categorised only here and not also under “non-material incentives”, unless they rely on a substantive motivational factor like social recognition.
Changes to health system user fees
Any change to the monetary costs to users for accessing the health system. This can include introduction or elimination of fees at the point of service, or pre-payment or insurance schemes.
Formal health worker training and education
Programmes that train or educate formal health workers (FHWs). FHWs are typically vaccinators (and they tend to provide/prescribe medication or administer tests such as recording blood glucose level, etc.). (The only likely exception to this would be oral polio vaccination (OPV), especially supplementary polio campaigns, where CHWs or community volunteers may be enlisted to administer the vaccination.)
Community health worker training and education
Programmes that train or educate community health workers (CHWs). CHWs are defined as "paraprofessionals or lay individuals with an in-depth understanding of the community culture and language, have received standardised job-related training of a shorter duration than health professionals, and their primary goal is to provide culturally appropriate health services to the community (Olaniran et al. 2017).”
Formal health worker involvement in planning & monitoring
Interventions that give FHWs substantive roles in creating plans/strategies to deliver vaccination services and/or monitor vaccination coverage in the community.
Community health worker involvement in planning & monitoring
Interventions that give CHWs substantive roles in creating plans/strategies to deliver vaccination services and/or monitor vaccination coverage in the community.
Paper-based tracking
Paper-based systems (e.g., logbooks) used by health workers to keep track of children in the community who are due for upcoming vaccinations or have not received scheduled vaccinations. Note that if a study merely mentions the existence of logbooks, that is not sufficient to code it as this intervention. The logbooks must be specifically used for tracking upcoming and missed vaccinations.
Promoting outreach to vaccine-hesitant groups
Outreach to groups that, because of religious, cultural, or other reasons, are suspicious of vaccination or have specific fears about it (e.g., that vaccinations cause infertility or spread disease).
Outreach to vulnerable populations
Outreach to groups that are vulnerable in a way that affects their access to vaccination services. They may be in hard-to-reach geographical areas, have low socioeconomic status (including wealth and education), or be from groups marginalised based on caste, ethnicity, etc. This also includes interventions that set up temporary and mobile clinics to deliver vaccines, to make vaccination services more accessible.
Outreach to migrant populations
Outreach to populations who have migrated temporarily or seasonally because of cultural or employment reasons.
Home visits
Use of visits to caregivers’ homes by health workers. This includes both visits to encourage caregivers to vaccinate their children, and visits to deliver vaccines, provided they are targeted visits to specific households for routine immunisation.
Campaigns to vaccinate refugee populations
Interventions that make a special effort to vaccinate populations which have been displaced temporarily or permanently because of conflict, war or famine.
National/sub-national immunisation days
Supplementary immunisation activities (SIA) are mass immunization campaigns which complement routine immunisation activities whereby a vaccine is taken simultaneously to many residents of a community within a defined short space of time. They have generally been conducted for polio and measles. They may be called national or sub-national immunization days. They may happen through booth days or door to door vaccination campaigns. On a booth day a large number of fixed site booths are set up throughout the target area for children to be brought to receive a specific vaccine like polio. In door to door campaigns vaccination teams go door to door to every house, checking each child under five to see if they have received the specific vaccine, and if they have not that vaccination is provided.
Material/monetary incentives for health workers
Interventions that incentivise formal or community health workers to deliver vaccination services through items with monetary value. This could be cash transfers or material goods like food or home goods.
Non-material incentives for health workers
Interventions that use non-material incentives like social recognition to incentivise formal or community health workers to deliver vaccination services.
Automated voice messages to health workers
Use of automatically-generated voice messages (usually delivered to a mobile phone) that remind health workers about upcoming vaccinations for community members, provide them information to help plan their work, and encourage them to conduct outreach to those community members.
Written or pictorial messages to health workers
Use of written/pictorial messages that remind health workers about upcoming vaccinations for community members, provide them information to help plan their work, and encourage them to conduct outreach to those community members.
Pay-for-performance schemes
Schemes whereby health centres or districts receive funding based on their performance in delivering health services (e.g., they receive a given amount of funding for each child vaccinated or each antenatal care visit completed). Also known as “results-based financing”.
Building & upgrading health clinics
Projects that build new permanent health clinics, or provide physical upgrades to existing clinics.
Cold chain infrastructure improvements
Interventions that improve the ability of health systems to maintain vaccine cold chains.
Health system strategic planning
Initiatives at the national or sub-national level to develop plans and governance structures designed to improve vaccination services. This also includes interventions that improve the human resource availability, strategies, policies and plans in existing health governance and delivery structures that may or may not be directly related to immunization services.
Vaccination guidelines
Changes to official national or sub-national guidelines about when and how vaccinations should be administered. This includes studies comparing two different approaches to administering vaccines (e.g., one measles dose vs. two), which could be made into guidelines.
Changes to broader governance systems (beyond health systems)
Interventions that modify general governance systems not directly related to health. An example would be a policy dictating a certain level of representation for women in local or national governing bodies.
Health system financing
Interventions that increase the national or sub-national financing of health or specifically for vaccination in absolute terms or as a proportion of GDP. This also includes results- or performance-based financing.
New HMIS/Dashboard systems
New digital tools and systems designed to improve health system capacity to monitor and deliver vaccination services. This includes apps for mobile phones or tablets, as well as desktop-based software and setting up online dashboards. A common type of intervention in this category is giving health workers tablets with an app that allows them to register vaccination information (and for other health services) for community members, track their vaccination schedules and provide them readily-accessible information about vaccination.
Capacity building for existing systems
Initiatives to train people working in the health system (including frontline health workers and administrative personnel) to improve their ability to use existing digital tools and systems more effectively.
Faith-based outreach/outreach using local leaders
Interventions that enlist influential community members (often religious or other traditional leaders) to promote vaccination in the community.
Collaborating with whole community
Interventions that involve or plan to involve ALL community members beyond health workers in various aspects of the intervention, such as developing plans and solutions to improve immunisation outcomes in the community.
Collaborating with selected community groups and networks
Interventions that involve selected groups or networks of community members beyond health workers (other than the traditional or religious leaders) in developing plans and solutions to improve immunization outcomes in the community.. This includes interventions focusing on mother’s groups, father clubs, self-help groups, etc.
Community tracking and registering
Interventions that involve community members beyond health workers (e.g., caregivers or any other community members other than the traditional leaders) in registering children with the health system so their vaccination status can be tracked, and/or tracking which children are due for vaccinations.
Education policy and infrastructure
Policy interventions that affect education levels of people in a country or region. An example would be an intervention that makes education mandatory for a particular population where it had previously been optional.
Non-health/education infrastructure
General improvements in physical infrastructure beyond the health system. This may include electrification, roads, sanitation improvements, etc.
