Table 1.
Study characteristics and quality assessment using MMAT (n = 23).
| S. No. | Author | Study design | Study setting | State | Study subjects | Sample size | Technology | Intervention | Control | Main findings | MMAT scoring |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Chakraborty A et al. (2021) | Randomized Controlled Trial | Rural | Madhya Pradesh | Parents of Children | 8204 | Kilkari maternal messaging programme | Kilkari (automated voice) calls from the 12th week of pregnancy up until the child’s first birthday for immunization reminders and messaging for immunization benefits | No calls | Kilkari exposure was not associated with improvement of full and timely immunization coverage but it did increase timely immunization at birth. (Probit coefficient: 0.08, 95% CI 0.08–0.24). | ••••○ |
| 2 | Choudhary et al. (2021) | Quasi-experimental study | Rural and urban | Uttar Pradesh | Children eligible under Polio SIA | Variable across different rounds | Community level social mobilization | Social mobilization initiative (mobilisation through community workers and supplementary immunization activities) | Areas with no social mobilization initiative | The adjusted mean of outcome indicators was reported for each outcome. The mean booth coverage of intervention areas was 82.8 (95% CI 82.5–83.2), significantly higher (p < 0.001) by 36.4 percentage points than that of control areas [46.4% (95% CI 45.8–46.9)]. The intervention areas [66.3% (95% CI 65.7–66.9)] had a significantly higher (p < 0.001) conversion rate of ‘unvaccinated houses-to-vaccinated houses’ as compared to controls [54% (95% CI 53.2–54.7)]. Intervention areas had higher conversion rate of ‘Refusal houses-to-Acceptor houses’ [73.7% (95% CI 71.8–75.5)] as compared to control areas [65.5% (95% CI 63.6–67.3)] p < 0.01; there was a significantly lower (p < 0.05) rate of remaining ‘unvaccinated’ houses in intervention areas [4.9 (95% CI 4.8–5.1)] compared to non-intervention areas [5.9% (95% CI 5.8–6.0)]. The intervention areas had a significantly (p < 0.01) higher level of community engagement [89.0% (95% CI 88.9–89.2)], than non-intervention areas [70.8% (95% CI 70.6–71.1)]. | •••○○ |
| 3 | Summan et al. (2021) | Quasi-experimental study | Rural and urban | Select 260 districts from across India | Children | 9674 | Mission Indradhanush | Mission Indradhanush program | Districts with no Mission Indradhanush program | The Difference In Difference (DID) likelihood of receiving full immunization was 27% (95% confidence interval [CI]: 0.11–0.42, p < 0.01, Linear probability models (LPM)) higher among children under 2 years old residing in MI phase 1 and 2 districts (intervention group) as compared with those residing elsewhere (control group). The DID likelihood of children in the intervention groups was also 9% higher for OPV0 (CI: 0.02–0.15, p < 0.05, LPM), 9% higher for OPV1 (CI: 0.04–0.14, p < 0.01, LPM), 11% higher for OPV2 (CI: 0.02–0.19, p < 0.05, LPM), 16% higher for OPV3 (CI: 0.04–0.27, p < 0.01, LPM), 5% higher for BCG (CI: 0.01–0.09, p < 0.05, LPM), and 19% higher for hepatitis B birth dose (CI: 0.11–0.28, p < 0.01, LPM). The DID likelihood in phase 1&2 intervention group to have received age-appropriate vaccines as per recommended schedule was 8% higher (CI: 0.00–0.15, p < 0.05, LPM) than the control group. | ••••• |
| 4 | Chen YJ et al. (2019) | Secondary data analysis | Rural | Gujarat & Maharashtra | Children | 9580 | Jyotigram Yojana (JGY)-rural electrification program | Jyotigram Yojana (JGY)-rural electrification program in Gujarat | Maharashtra with no JGY program | JGY increased the probability of children receiving critical vaccinations. The probit coefficient for BCG was 0.06 (95% CI 0.027–0.102, p < 0.01), for measles it was 0.122 (95% CI 0.057–0.187, p < 0.01), for DPT (all doses) 0.035 (95% CI −0.015 to 0.085) and for Polio (all doses) 0.036 (95% CI −0.005 to 0.077, p < 0.1). The probability of receiving all these vaccines increased significantly post-JGY implementation in Gujarat. | ••••○ |
| 5 | Giduthuri JG (2019) | Quasi-experimental study | Peri/Sub-Urban | Maharashtra | Clinicians providing ANC services | 30 | Sensitization and engagement of clinicians’ for recommending influenza vaccines to pregnant women | Physicians provided with Antenatal influenza vaccination (AIV) recommendations (global, academic and local) intended to motivate clinicians’ influenza vaccination practices for pregnant women coming for ANC. Note: Randomization of clinicians to an intervention and control arm was done separately for middle-class and slum sites. |
Physicians not provided with any intervention | Estimated median rates of antenatal influenza immunization increased from 2.6% in Study Period (SP) 1–12.2% in SP2 (adj OR = 5.2, 95% CI 2.4–11.0) among middle-class active clinicians, but rates remained stable among middle-class controls (0.2% in SP1 and 0.1% in SP2). Among middle-class active clinicians, the median rate of taken opportunities for AIV strongly increased further from SP2 to SP3 (adj OR = 4.4, 95% CI 2.4–7.9). After the second interaction (SP3), middle-class active clinicians were vaccinating at a substantially higher rate of 37.8%, while the rate in middle-class control clinicians remained unchanged (0.2%). | •••○○ |
| 6 | Murthy N et al. (2019) | Quasi-experimental study | Urban | Maharashtra | Pregnant women | 2016 | mMitra voice message | Women in the intervention group received mMitra voice messages two times per week throughout their pregnancy and until their infant turned 1 year of age | Pregnant women who did not receive mMitra voice messages | The intervention group performed significantly better on fully immunizing the infants (Adjusted OR 1.531, 95% CI 1.141–2.055, p = 0.005). | •••○○ |
| 7 | Newtonraj A et al. (2019) | Cross-sectional analytic | Rural | Tamil Nadu | Children | 420 | Measles Rubella (MR) Vaccination Campaign in the rural area of Kanchipuram district, Tamilnadu | Measles Rubella (MR) Vaccination Campaign in the rural area of Kanchipuram district, Tamilnadu | No | Among the total sample of 420 children, 380 children (90.5% (range 87.4%–93.0%)) were found to be vaccinated and 40 children (9.5% (range 7.0%–12.6%)) were found to be unvaccinated immediately after phase 1 of the MR vaccine campaign | ••••• |
| 8 | Vaidyanathan (2019) | Randomized Controlled Trial | Rural and Urban | Maharashtra | Children | 2352 | Information Education Communication (IEC) training through school children of adolescent age (Child to Child/Child to parent) | Standardized structured IEC strategy on immunization in addition to routine propaganda by government of India (GOI), media etc. | Routine propaganda by GOI, media, etc. | Age-appropriate full immunization coverage from birth to 5 years was 51% in rural and 67% in urban experimental groups before IEC, and it was 88% and 85% post-IEC in rural and in urban areas, respectively, KW = 13.5, p = 0.003. BCG to measles dropout rate was initially 22% in experimental and 17% in control groups that were found to be 11% and 17%, respectively, after IEC. | ••••• |
| 9 | Powell-Jackson et al. (2018) | Randomized Controlled Trial | Rural | Uttar Pradesh | Mothers of children aged 0–36 months | 722 | Health education to mothers regarding tetanus and the benefits of DPT vaccine face-to-face through home visits | Mothers were randomly assigned in a ratio of 1:1:1 to 1 of 3 study arms: mothers in the first treatment group received information framed as a gain (e.g., the child is less likely to get tetanus and more likely to be healthy if vaccinated), mothers in the second treatment group received information framed in terms of a loss (e.g., the child is more likely to get tetanus and suffer ill health if not vaccinated) | The third arm acted as a control group, with no information given to the mother. | The proportion of children with DPT3 was 28% in the control group and 43% in the 2 groups receiving information, giving a difference of 14.6 percentage points (95% CI 7.3–21.9, p < 0.001). Children whose mothers received the information were 52% more likely to receive DPT3 than children in the control group. The information intervention increased the rate of measles vaccination by 22 percentage points (risk difference: 22%, 95% CI 14%–30%, p < 0.001; relative risk: 1.53, 95% CI 1.29–1.80) and the rate of full immunization by 14 percentage points (risk difference: 14%, 95% CI 8%–21%, p < 0.001; relative risk: 1.72, 95% CI 1.29–2.29). | ••••○ |
| 10 | Seth R et al. (2018) | Randomized Controlled Trial | Rural | Haryana | Children | 608 | Automated mobile phone reminders, with and without compliance linked incentives like mobile phone talk time | There were two intervention arms: automated mobile phone reminders alone, or automated reminders with compliance-linked incentives in the form of mobile phone talk time | No automated mobile phone reminders or incentives | Immunization coverage at enrolment and End of Study, Control: 33.3 (0–66.7) to 41.7 (23.1–69.2). Automated reminders: 33.3 (0–58.3) to 40.1 (30.8–69.2). Automated reminders with compliance-linked incentives: 33.3 (0–58.3) to 50.0 (30.8–76.9). Overall, 33.3 (0–58.3) to 43.8 (25.0–75.0). Children in the compliance-linked incentive group were significantly more likely to have received timely immunizations (40.8%; p < 0.03) compared with children in the control (31.3%) or automated mobile phone reminder groups (26.7%) | ••••• |
| 11 | Choudhuri, G et al. (2017) | Quasi-experimental study | Urban | Uttar Pradesh | School children | 11,250 | Educational intervention to school children about hepatitis B | Screening of an educational documentary film on HBV in 430 intervention schools | 6 non-intervention schools | The baseline HBV vaccination level among students receiving the intervention was 21%. Two years after the intervention, 45% of students (N = 4284) reported being vaccinated at intervention schools compared to 22% (N = 1264) at non-intervention schools. | •••○○ |
| 12 | Ganguly E et al. (2017) | Cross-sectional analytic | Rural | Rajasthan | Children | 5007 | Rural Effective Affordable Comprehensive Health Care (REACH)-Village mapping by GPS, village household health information data recorded by community volunteers, computerized health data tracking to generate immunization due list | Rural Effective Affordable Comprehensive Health Care (REACH)-Village mapping by GPS, village household health information data recorded by community volunteers, computerized health data tracking to generate immunization due list utilizing government functionaries | No | About 14 months after initiation of the REACH strategy, full immunization coverage increased dramatically to 88.7%, partial immunization declined to 10.3%, and only 1.0% did not receive any immunization, compared with the results of the benchmark IIHMR survey (2008) to represent the pre-intervention rates. The coverage rates of individual vaccines were similar to the percentage of children fully immunized; 97.2% of the children had received BCG, 95.1% of the children had received 3 doses each of DPT and OPV, and immunization against measles had been received by 89.2% of children. | ••••○ |
| 13 | Haenssgen MJ et al. (2017) | Secondary data analysis | Rural and urban | Uttar Pradesh & Bihar | Children | 54,852 | Polio mass immunization high intensity campaign | Polio Mass Immunization Campaign. | No | Children in Bihar exhibit a ‘higher’ (4.3% greater odds of immunization) probability of vaccination uptake when exposed to higher polio campaign intensity. Conversely, high exposure is linked to ‘lower’ (‘decrease’ of 5.45% in the odds of a child to be fully immunized) attainment of full immunization in Uttar Pradesh. | ••••• |
| 14 | More et al. (2017) | Randomized Controlled Trial | Peri/Sub-Urban | Maharashtra | Children | 4544 | “Community Resource Centre” delivered multiple interventions through community organizers educated about health through home visits, group meetings, day care, community events | 20 clusters with Resource Centre offering
|
20 clusters without Community Resource Centre | The proportion of immunized children in the intervention and control group was similar in intention to treat (ITT) group (OR 1.30, 95% CI 0.84–2.01); but were greater in intervention group when assessed per protocol (OR 1.73, 95% CI 1.05–2.86) | •••○○ |
| 15 | Nagar R. et al. (2017) | Randomized Controlled Trial | Rural | Rajasthan | Children | 198 | Digital NFC (Near Field Communication) pendant with and without voice call reminder system | Two intervention groups:
|
NFC enabled sticker stuck on the immunization card. | Neither the NFC necklace nor the necklace with additional voice call reminders directly resulted in an increase in infant immunization timeliness through DTP3. DTP3 completion within two months from the time of registration was higher in the Pendant (37.7%) and Pendant and Voice arms (38.7%) compared to the Control (Sticker) arm (27.4%). | ••••○ |
| 16 | Prinja S et al. (2017) | Quasi-experimental study | Rural | Uttar Pradesh | Pregnant women | 3201 | m-Health application delivered through ASHA workers | Development and implementation of an m-health application used as a job-aid by ASHAs for registering pregnant women and for providing real-time guidance through key counselling points, decision support and simple referral algorithms for various maternal and child health issues and aid early identification, treatment and referral. | Blocks where mHealth application was not introduced | The coverage of maternal ≥2 tetanus toxoid vaccination increased in the intervention area by 4.28%. However, the change was not statistically significant. | ••••• |
| 17 | Sengupta P et al. (2017) | Mixed methods study | Urban | Punjab | Children | 647 | Government funded community-based intervention-outreach clinic, community guardian | A government funded outreach vaccination programme for migrant communities living in slums. | Similar migrant slums with routine services | Uptake of routine vaccines administered in under 1 year of age was significantly (p ≤ 0.05) higher in the intervention clusters than the control. The likelihood of full immunization against 6 vaccine preventable diseases by the age of 1 year was more than twice than the control clusters [OR: 2.27 (95% CI 1.12–4.60); p = 0.023]. | ••••○ |
| 18 | Balakrishnan R et al. (2016) | Quasi-experimental study | Rural | Bihar | Pregnant women | 19,880 | mHealth and community health worker training | An m-health platform used for case management by frontline community health workers. Pregnant women were registered and the child can be followed up till 6 years. Modules include pregnancy registration, birth preparedness, delivery, post-natal care, exclusive breastfeeding, immunization and growth charts. | Rest of Bihar with no mHealth intervention | Pregnant mothers received at least one TT vaccine 79.38% (95% CI 58.90–80.26) compared to 74.12% in the same district the previous year and 80% in the rest of Bihar in the same year. | •••○○ |
| 19 | Jain M et al. (2015) | Mixed methods study | Rural | Jharkhand & Uttar Pradesh | Children | ‘‘My Village Is My Home’’ (MVMH) tool (poster sized record of every infant in the community) | Large Poster Sized record consisting of a table on which every child in the community has a row depicting their immunization status. | No | The immunization coverage rates before and during the use of MVMH tool were available for Uttar Pradesh. In Uttar Pradesh there was an increase in the immunization rates for BCG from 82.3% to 88.5%. Similarly, there were small changes in OPV (54.2%–58.8%), DPT1 (83.6%–86.1%) and DPT3 (68.9%–72.1%), Measles immunization rates decreased from 71.4% to 67%. | •○○○○ | |
| 20 | Scobie HM et al. (2015) | Cross-sectional analytic | Rural and Urban | Jharkhand | Children | 1018 | Measles vaccination campaign | Government run phase 2 of a Measles Campaign. | No | MCV coverage among children aged 9 months to <10 years was 61.0% (95% CI 54.4%–67.7%). At the end of the campaign, 53.7% (95% CI 46.5%–60.9%) of children 12 months to <10 years of age received ≥2 MCV doses, while a large proportion of children remained under-vaccinated (1-dose) (34.0%, 95% CI 28.0%–40.0%) or unvaccinated (12.3%, 95% CI 9.3%–16.2%). | ••••• |
| 21 | Goel S et al. (2012) | Quasi-experimental study | Rural and Urban | Bihar | Children | “Muskaan Ek Abhiyan (Smile)” Campaign (intersectoral coordination, awareness generation by women groups, budgetary support, monitoring and supervision mechanism, tracking beneficiaries, incentives to service providers) run by Government in Bihar | Review and strengthening of microplans Intersectoral Coordination between ICDS and Health Involvement of Mahila Mandals Performance based Incentives. Strengthening Monitoring and Evaluation. Enhanced Political Commitment. |
Other EAG states. | The proportion of fully immunized 12–23-month-old children in Bihar increased significantly from 19% in 2005 to 49% in 2009 (p < 0.001). The coverage of BCG also increased significantly from 52.8% to 82.3% (p < 0.001), DPT-3 from 36.5% to 59.3% (p < 0.001), OPV-3 from 27.1% to 61.6% (p < 0.001) and measles from 28.4% to 58.2% (p < 0.001). | ••••• | |
| 22 | Pradhan N et al. (2012) | Quasi-experimental study | Urban | Bihar | Children | Urban immunization outreach, a multi-pronged strategy (increase in immunization site, plan logistics, community mobilization, supervision, vaccine drives etc.) | Within the framework of existing government drives—Increasing immunization sites, ensuring sufficient, staff for providing injections, planning required logistics, improving community mobilization, providing supervision, using reported data for action and supporting special complementary vaccination drives | No | With the outreach services, vaccination coverage increased from baseline by 121% for BCG, 121% for DPT 1, 148% for DPT-2, 133% for DPT-3, 122% for Measles, 120% for TT-1 and 170% for TT-2. The proportion of both children left out and not completing their DPT vaccination series decreased 47% and 35% respectively. | ••••○ | |
| 23 | Ryman TK et al. (2011) | Quasi-experimental study | Rural | Assam | Children | 800 | Reaching Every District (RED) approach, a multi-pronged intervention (planning, outreach, community mobilization, supervision and monitoring) | 3 districts received strengthening core sub-national routine vaccination program functions by re-establishing outreach services; providing supportive supervision; monitoring and using data for action; improving planning and resource management; and increasing community links with service delivery | 3 comparison districts received no additional intervention except routine services. 8 districts received only training in RED approach but limited oversight. |
During the intervention, coverage significantly increased in both Comprehensive-RED and comparison districts. Children at follow-up were 2.1 times (95% CI 1.5–3.0) more likely to be fully vaccinated compared with baseline in Comprehensive-RED districts, and 2.1 times (95% CI 1.6–2.8) more likely to be fully vaccinated at follow-up compared with baseline in comparison districts. In the 2 Comprehensive-RED districts the DTP1, DTP3, and measles coverage and the percentage of children who were fully vaccinated increased 8, 15, 20, and 18 percentage points, respectively. In comparison districts, coverage increased 16, 16, 20, and 17 percentage points for DTP1, DTP3, measles, and percentage of children fully vaccinated, respectively. | •••○○ |