Integrated Approaches for the Delivery of Maternal and Child Health Services with Childhood Immunization Programs in Low- and Middle-Income Countries: Systematic Review Update 2011–2020
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Methods
2.2. Criteria for Inclusion and Exclusion
2.3. Selection of Studies
2.4. Data Extraction
2.5. Data Synthesis
3. Results
3.1. Results of Search
3.2. Description of Included Studies
Study a | Country (Study Year(s)) | Immunization Delivery Platform | Linked Maternal and Child Health Service(s) | Integration Strategy | Description of Integration Strategy | Study Design: Outcome Comparison | Immunization Outcomes Measured (Primary Outcome in Bold) | Linked Health Service Outcomes Measured (Primary Outcome in Bold) |
---|---|---|---|---|---|---|---|---|
Goodson (2012) and Kulkarni (2010) [25,26] | Madagascar [2007–2008] | Campaign—mixed | Malaria | a. Extra services by immunization staff c. Co-location | Integrated delivery of ITNs, deworming tablets, vit A and measles vaccine to <5-year-olds during a national health campaign. | Post only; two groups [integration = ITNs distributed in campaign package of services; comparison = ITNs were not included] | Measles vaccination coverage (higher in integration group compared to non-ITN control group, including in poorest households) | Proportion of households with at least one ITN (higher in integration compared to non-integration areas) |
Habib (2017) [23] | Pakistan [2013–2014] | Campaign—mixed (fixed and mobile camps) | Nutrition, PHC | b. Extra information and/or counseling by immunization staff c. Co-location | MCH camps alongside polio campaign, offered counseling on hygiene and nutrition, routine immunizations, micronutrient supplements, and general MCH assessments. | Pre/post; three groups: comparison = OPV with routine immunizations; integration 1 = OPV with routine immunizations and other interventions; integration 2 = OPV with routine immunizations, other interventions, and IPV | -OPV coverage (higher in integration groups versus comparison) -Other routine immunization coverage (higher in integration groups versus comparison) | Updates of PHC services noted but were not quantifiable due to lack of comparison data. |
Boselli (2011) [27] | Lao PDR [2007] | Campaign—mixed | Nutrition | a. Extra services by immunization staff | Integrated deworming tablets, vit A and polio vaccine to <5-year-olds. Deworming tablets with tetanus toxoid vaccine to women | Only examined cost effectiveness of integrated vit A and deworming tablet delivery compared to non-integrated delivery | Not measured | Not measured |
Birukila (2017) [28] | Nigeria [2013] | Campaign—mixed (fixed and temporary sites) | PHC | c. Co-location | During polio campaigns, health camps were organized for settlements with high vaccine refusal rates in which other health services were offered with OPV. | Historical comparison 2013 with 2014; integration group = settlements with integrated health camps (polio and other primary healthcare services) in 2013. | Number of children who received OPV (14,000 in 2013 round with integrated health camps and 7000 in 2014 round without integrated health camps) | Not measured |
Study a | Country (Study Year(s)) | Immunization Delivery Platform | Linked Maternal and Child Health Service(s) | Integration Strategy | Description of Integration Strategy | Study Design: Outcome Comparison | Immunization Outcomes Measured (Primary Outcome in Bold) | Linked Health Service Outcomes Measured (Primary Outcome in Bold) |
---|---|---|---|---|---|---|---|---|
Integration into routine immunization—child hearing screening | ||||||||
Friderichs (2012) [29] | South Africa [2008–2010] | Routine—facility | Child health (hearing screening) | a. Extra services by immunization staff | EPI staff administered a hearing screening test; no non-integration comparison. | Not applicable/no relevant outcomes compared: feasibility study only. | Not measured | Proportion of infants that underwent hearing screening. No comparator. |
Jac-Okereke (2020) [30] | Nigeria [ND] | Routine—facility | Child health (vision screening) | c. Co-location | Infants attending immunization clinics randomly selected for vision screening. | Not applicable/no relevant outcomes compared: descriptive study only. | Not measured | Not measured |
Integration into routine immunization—family planning (FP) advice and services | ||||||||
Balasubramaniam (2018) [31] | India [2012] | Routine—outreach | FP | b. Extra information and/or counseling by immunization staff | Providers applied a screening tool to assess for FP; both intervention and control areas updated in post-partum FP. | Mid-point/end-line; two groups [integration group = use of FP screening tool in intervention areas] | DTP3 coverage (similar increases in intervention and control) | Percentage of women receiving FP services (no change in intervention, control decreased). FP methods (increased in intervention, but no change in control) |
Cooper (2015) [32] | Liberia [2012] | Routine—facility | FP | b. Extra information and/or counseling by immunization staff c. Co-location | Pilot of FP counseling by immunization staff at routine immunization visits and same-day referral to a co-located FP service. | Pre/post; two groups [integration group = pilot facilities comparator non-pilot facilities and pre-intervention data] | -Provision of DTP1 and DTP3 (increase from pre to post and higher in pilot vs non-pilot in one site, but no differences in other sites) -DTP1—3 drop-out rate (increased from pre to post and higher in pilot facilities compared to non-pilot at both sites). | -New contraceptive users (increased from pre- to post-intervention in both sites) |
Cooper (2020) [33] | Malawi [2016–2017] | Routine—mixed (facility and outreach) | FP | a. Extra services by immunization staff c. Co-location e. Extra information and/or counseling by non-immunization staff | Same-day family planning services offered by nurses and health surveillance assistants to mothers seeking routine immunization services; screening of vaccination status for infants of family planning clients. | Pre/post; one group | -Number of DTP1 doses (no change) -Number of DTP3 doses (increase from pre to post) | Number of women accessing FP services (increase from pre to post) |
Dulli (2016) [34] | Rwanda [2010–2011] | Routine—facility | FP | b. Extra information and/or counseling by immunization staff c. Co-location | Immunization staff provided information on FP and referral for counseling to co-located services. Compared to health facilities not using integrated approach. | Pre/post; two groups [integration group = health facilities implementing integrated family planning and immunization services] | -Monthly trends in measles vaccinations (similar in integration and non-integration health facilities) -Monthly trends in DTP1, 2, and 3 collected but not reported | Proportion of women using a modern contraceptive method (higher in integration health facilities compared to non-integration group) |
Erhardt-Ohren (2020) [35] | Benin [2016–2017] | Routine—facility | FP | b. Extra information and/or counseling by immunization staff | Immunization staff provided information on FP and referral for FP counseling. | Not applicable/no relevant outcomes compared: qualitative process evaluation. | Not measured | Not measured |
Nelson (2019) [36] | Liberia [2016–2017] | Routine—facility | FP | b. Extra information and/or counseling by immunization staff c. Co-location e. Immunization counselling by non-immunization staff | Immunization staff provided information on FP and referral for counseling to co-located services. Compared to matched facilities not using integration. | Pre/post; two groups [integration group = health facilities implementing integrated family planning and immunization services] | -DTP1–3 drop-out rates (similar in integration and non-integration health facilities) | -FP referral (increased over time, higher in integration than non-integration) -Contraceptive acceptance (higher in integration than non-integration facilities) |
Vance (2014) [37] | Ghana and Zambia [2009–2010] | Routine—facility | FP | b. Extra information and/or counseling by immunization staff c. Co-location | Immunization staff provided information on FP and referral for services at nine-month visit at intervention health facilities. Outcomes compared to non-intervention (control) facilities. | Pre/post; two groups [integration group = health facilities where vaccinators were trained to provide FP messages and referrals to women presenting for child immunization services] | Not measured | -Non-condom contraceptive use (no changes in intervention compared to control) -Women’s knowledge of LAM (no differences) -Referrals for FP services (non-significant changes across groups) |
Yugbare Belemsaga (2018) [38,39,40] | Burkina Faso [2013–2015] | Routine—facility | FP | a. Extra services by immunization staff b. Extra information and/or counseling by immunization staff c. Co-location | Provision of maternal-infant post-partum care checks and FP counseling at same time as immunization visits, by co-located staff. | Pre/post; one group | -Monthly number of doses of DTP administered (no change over time) | -Uptake of post-partum care at immunization visits (no pre–post changes overall, some increase during the early post-natal period) |
Study a | Country (Study Year(s)) | Immunization Delivery Platform | Linked Maternal and Child Health Service(s) | Integration Strategy(ies) | Description of Integration Strategy | Study Design: Outcome Comparison | Immunization Outcomes Measured (Primary Outcome in Bold) | Linked Health Service Outcomes Measured (Primary Outcome in Bold) |
---|---|---|---|---|---|---|---|---|
Integration into routine immunization—HIV services | ||||||||
Dube 2012 [41] | Malawi [2008–2010] | Routine—facility | HIV | c. Co-location | Testing, counseling, and treatment for EID of HIV offered at 6-week EPI visit. | Not applicable/no relevant outcomes compared: feasibility study to describe completion of EID process during routine EPI visits. | Not measured | -Measured, but no non-integration comparator -71.6% of HEIs had early diagnosis, 87.3% of mothers informed of infants’ results, ART started in 58% of infants with confirmed infection. |
Goodson (2013) and Wallace (2014) [42,43] | Tanzania [2009–2010] | Routine—facility | HIV | a. Extra services by immunization staff b. Extra information and/or counseling by immunization staff c. Co-location | EPI staff identified HEIs offered testing, counseling and care in selected sites. Compared to remaining sites in district (control). | For immunization outcome: pre/post; two groups [integration group] For linked service: not applicable/no relevant outcomes compared—feasibility study only. | -Monthly vaccine doses [OPV1, OPV3, Penta1, Penta3, Measles] (results differed by urban/rural and by antigen; overall either no change or a decrease in monthly doses) | -Measured, but no non-integration comparator -HIV service uptake increased in all sites |
McCollum (2012) [44] | Malawi [2011] | Routine—facility | HIV | b. Extra information and/or counseling by immunization staff c. Co-location | Testing and counseling for EID of HIV offered at EPI clinic. Compared to EID offered at pediatric clinic. | Post only; two groups [integration group = infants attending EPI clinic where EID service was co-located] | Not measured | -Proportion of infants receiving provider initiated HIV testing and counseling for EID (higher in EPI than pediatric clinic) |
Odafe (2020) [45] | Nigeria [2016–2017] | Routine—facility | HIV | c. Co-location | Targeted HIV testing of infants in immunization clinics compared to in TB clinics, inpatient wards, outpatient clinics, and through a family registry system. | Post only; five platforms/groups [integration group = immunization clinics] | Not measured | -Proportion of all tests by platform (testing at immunization clinics low [0.9%] compared to others: pediatric outpatients [49.7%], family registry [38.0%], pediatric inpatient [10.5%], or tuberculosis [0.8%] clinics) |
Ong’ech (2012) [46] | Kenya [2008–2010] | Routine—facility | HIV | c. Co-location | Services for HEIs (infant feeding support, prophylactic medicines, and HIV diagnosis) offered at MCH clinics with EPI services co-located compared to specialized HIV clinic. | Post only; two groups [integration group = infants seeking care at MCH clinic offering EPI and HEI services] | -Measles vaccine coverage at 9 months (higher in integrated MCH clinic than specialized HIV clinic) -Completion of vaccinations by 12 months (higher in integrated MCH clinic than specialized HIV clinic) | -Odds of attending scheduled post-natal visits (higher in integrated MCH clinic than specialized HIV clinic) -Proportion of infants attending follow-up (higher in integrated MCH clinic than specialized HIV clinic) |
Tejiokem (2011) [47] | Cameroon [2007–2009] | Routine—facility | HIV | c. Co-location | Testing, counseling, and treatment for EID of HIV offered at 6-, 10-, and 14-week EPI visit and linkage to HAART. | Not applicable/no relevant outcomes compared: feasibility study only. | Not measured | -Measured, but no non-integration comparator -Completeness of follow-up of HEIs (83.9% completed) |
Wang (2015) [48] | Zambia [2012–2014] | Routine—facility | HIV | a. Extra services by immunization staff b. Extra information and/or counseling by immunization staff c. Co-location | EPI and co-located staff, with commodity support, offered HIV testing and counseling. | Pre/post; three groups [control, simple intervention = re-supply of HIV commodities, integration group = integration of HIV testing with routine immunization] | -Monthly DTP1 doses (similar change in both intervention arms and matched control sites) -Qualitative finding: HIV services did not deter families from immunization. | -Monthly HIV tests administered (higher in integration compared to simple intervention and control) |
Integration into routine immunization—malaria prevention | ||||||||
Bojang (2011) [49] | Gambia [2006] | Routine—outreach | Malaria | a. Extra services by immunization staff | IPTc during outreach by community-based VHWs) compared to outreach by reproductive and child health trekking teams (EPI staff). | Post only; two groups [integration group = RCH teams (EPI staff) delivery] | % children ≥ 12 months who were fully vaccinated (lower in RCH teams compared to non-integrated VHW delivery) | -Coverage of three courses of IPTc (lower in RCH teams delivery compared to non-integrated VHW) -Cost of delivery at least first dose of IPTc (more expensive to deliver by RCH teams compared to VHWs) |
Dicko (2011) [50,51] | Mali [2006–2007] | Routine—facility | Malaria | a. Extra services by immunization staff | IPTi services and counseling by staff at EPI clinics in intervention sites. Compared to sites not offering IPTi. | Pre/post; two groups [integration group = randomized areas where IPTi was delivered with routine vaccinations] | Coverage of fully vaccinated children 9–23 months [BCG, 3 doses of DTP, 3 doses of polio, measles, and yellow fever vaccines] (increase in coverage in intervention compared to control and baseline) | -Coverage of IPTi (higher in intervention compared to control) -Coverage of vitamin A (higher in intervention compared to control) -ITN use (similar in intervention compared to control) |
Patouillard (2011) [52] | Ghana [2006] | Routine—outreach | Malaria | a. Extra services by immunization staff b. Extra information and/or counseling by immunization staff | IPTc delivery by VHWs compared to facility-based staff (at outpatient departments or EPI outreach clinics). | Post only; two groups [integration group = facility-based delivery] | Not measured | -Coverage of IPTc (similar in VHW delivery and facility-based delivery) -Cost of delivering full course of IPTc (more expensive to deliver by EPI nurses compared to VHWs) |
Scates 2020 [53] | Ghana, Mali, Tanzania [2015–2016] | Routine—mixed (facility in Ghana, Tanzania, and Mali; community and facility in Zanzibar) | Malaria | a. Extra services by immunization staff | Continuous distribution of insecticide-treated bednets (ITNs) by immunization staff through ANC, EPI, schools, and mass distribution campaign. | Not applicable/no relevant outcomes compared: descriptive study of costs associated with various ITN continuous distribution delivery platforms. | Not measured | Not measured |
Schellenberg (2011) and Willey (2011) [54,55] | Tanzania [2005–2007] | Routine—facility | Malaria | a. Extra services by immunization staff | IPTi services and counseling by staff at EPI clinics in intervention sites. Compared to no IPTi control sites. | Pre/post for infant survival and post only for other outcomes; two groups [integration group = randomized areas where IPTi was delivered with routine vaccinations compared to no IPTi control] | -DTP3 and measles vaccination coverage (similar in IPTi vs no IPTi groups) | -Coverage of three doses of IPTi (higher in intervention compared to control) -Infant mortality (decrease over time, but no difference between intervention and control groups) |
Theiss-Nyland (2016b) and (2017) [56,57] | Kenya, Malawi, Mali, Rwanda [2014] | Routine—mixed | Malaria | a. Extra services by immunization staff | Continuous distribution of LLINs through ANC and EPI | Not applicable/no relevant outcomes compared: feasibility study of continuous distribution. | Not measured | Not measured |
Study a | Country (Study Year(s)) | Immunization Delivery Platform | Linked Maternal and Child Health Service(s) | Integration Strategy | Description of Integration Strategy | Study Design: Outcome Comparison | Immunization Outcomes Measured (Primary Outcome in Bold) | Linked Health Service Outcomes Measured (Primary Outcome in Bold) |
---|---|---|---|---|---|---|---|---|
Integration into routine immunization—maternal depression screening | ||||||||
Bakare (2014) and (2017) [58,59] | Nigeria [2012] | Routine—facility | PHC—maternal depression | c. Co-location | Depression screening service co-located with EPI clinic visits. | Not applicable/no relevant outcomes compared: feasibility study only. | Not measured | Not measured |
Integration into routine immunization—nutrition activities | ||||||||
Monterrosa (2013) [60] | Mexico [2011] | Routine—mixed | Nutrition | b. Extra information and/or counseling by immunization staff | EPI nurses and radio communications delivered scripted nutrition counseling messages. Behavior change among women with children 6–24 months compared between with and without messages. | Pre/post; two groups [integration group = sites receiving nutrition communications from EPI nurses and via radio] | Not measured | -Frequency of breast feeding (higher in integration group compared to sites not receiving nutrition communications) -Self-reported feeding (mixed results but some healthier consumption in integration group) |
Oladeji (2019) [61] | South Sudan [2017] | Routine—mixed (nutrition treatment centers and community outreach) | Nutrition | c. Co-location e. Extra information and/or counseling by non-immunization staff | Immunization services offered to children visiting nutrition treatment clinics and nutrition community outreach. Nutrition volunteers provide messages on immunization, screen vaccination status and track children. Compared to immunization atPHCs. | Post only; two groups [integration group = immunization delivery at nutrition treatment clinics and community outreach] | -Proportion of children vaccinated in nutrition treatment clinics compared to standard PHC clinics [BCG, OPV 0–3, Penta 1–3, IPV, and measles] (data insufficient for comparison) -Drop-out Penta1 to Penta3 (lower drop-out in nutrition treatment clinics compared to PHCs) | Not measured |
Integration into routine immunization—water, sanitation, and hygiene interventions (WASH) | ||||||||
Briere (2012) and (Ryman) 2012 [62,63] | Kenya [2009] | Routine—facility | WASH | a. Extra services by immunization staff b. Extra information and/or counseling by immunization staff c. Co-location | During routine immunization visits, health workers offered water treatment, soap and related education to caregivers children aged <1 yr old. | Pre/post; two groups [integration group = district randomly selected to integrate WASH interventions at routine immunization visits] | -Percent of children 2–20 months who received all vaccine doses [penta, OPV, and measles] (higher in intervention compared to control) -Percent of children 2–20 months who received all age-appropriate vaccines (higher in intervention compared to control) | -Awareness of water treatment options (increase in both intervention and control from pre to post) -Uptake of water treatment (significant pre–post increase in intervention, not control) -Percentage of households with soap (pre–post increase in intervention, not control) |
Integration into routine immunization—multiple primary healthcare and disease control interventions | ||||||||
Bawa (2019) [20,21] | Nigeria [2014–2015] | Routine—mobile | Malaria, PHC, Nutrition, WASH | c. Co-location | Package of MCH services (antenatal care, malaria prevention, iron folate, deworming, child health, WASH, vitamin A, nutrition screening, and routine immunizations) delivered to women and children during mobile outreach visits. | Pre/post; one group | -Coverage of measles vaccination (increased from pre to post) | -Provision of multiple MCH interventions (increase from pre to post) |
Edmond (2020) [22] | Afghanistan [2013] | Routine—mobile | PHC, Nutrition | c. Co-location | Integrated outreach services for ANC, PNC, and immunization by mobile health teams (MHTs). | Post only; two groups [integration group = recent MHT integrated outreach delivery, comparator = areas without recent visits] | -Measles first dose coverage (higher in areas with recent MHT integrated outreach compared to non-recent) -Penta 3 coverage (higher in areas with recent MHT integrated outreach, but not statistically significant) | -Coverage of at least one ANC visit (higher in areas with recent MHT integrated outreach) -Coverage of at least one PNC visit (no difference) -Coverage of facility-based delivery (no difference) -Coverage of at least one IMCI visit (higher in areas with recent MHT integrated outreach) |
Hodges (2015) [24] | Sierra Leone [2012–2013] | Routine—facility | Family planning, Nutrition | c. Co-location e. Extra information and/or counseling by non-immunization staff | Extra co-located staff provided vit A and either IYCF counseling or IYCF and FP services, alongside routine and catch-up vaccination, during visits from 6 months of age onwards. Extra staff also gave information on catch-up vaccination. | Post only; three groups [integration group 1 = revised vaccination card with vit A + IYCF + FP counseling, integration group 2 revised vaccination card with vit A, control group = revised vaccination card with vit A] | -Proportion of fully vaccinated children (similar in all groups) -Proportion of infants receiving catch-up vaccination [OPV 2 or 3, penta and/or PCV] (higher in both integration groups compared to control) | -Coverage of vit A supplement (higher in both integration groups compared to control) -Provision of FP counseling and commodities (higher in both integration groups compared to control) |
3.3. Integration Strategies
3.4. Effect of Integration on Outcomes for Immunization and Linked Service
3.5. Implementation Considerations
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Qualitative Summary 1 of the Effect of Integrated Service Delivery | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Immunization Outcome 2,3 | Linked MCH Service Outcome 2,3 | ||||||||||||||
Study | Country | EPI Platform | Linked Health Service(s) | NOT MEASURED | NEG | M-NEG | STATIC | M-POS | POS | NOT MEASURED | NEG | M-NEG | STATIC | M-POS | POS |
Goodson 2012 & Kulkarni 2010 [25,26] | Madagascar | Campaign—mixed | Malaria | A C | A C | ||||||||||
Birukila 2017 [23] | Nigeria | Campaign—mixed | PHC | C | C | ||||||||||
Habib 2017 [26] | Pakistan | Campaign—mixed | Nutrition, PHC | B C | B C | ||||||||||
Balasubramaniam 2018 [31] | India | Routine—outreach | FP | B | B | ||||||||||
Cooper 2015 [32] | Liberia | Routine—facility | FP | B C | B C | ||||||||||
Dulli 2016 [34] | Rwanda | Routine—facility | FP | B C | B C | ||||||||||
Vance 2014 [37] | Ghana, Zambia | Routine—facility | FP | B C | B C | ||||||||||
Cooper 2020 [33] | Malawi | Routine- mixed | FP | A C E | A C E | ||||||||||
Nelson 2019 [36] | Liberia | Routine—facility | FP | B C E | B C E | ||||||||||
Yugbare Belemsaga 2018 [38] | Burkina Faso | Routine—facility | FP | A B C | A B C | ||||||||||
Odafe 2020 [45] | Nigeria | Routine—facility | HIV | C | C | ||||||||||
Ong’ech 2012 [46] | Kenya | Routine—facility | HIV | C | C | ||||||||||
McCollum 2012 [44] | Malawi | Routine—facility | HIV | B C | B C | ||||||||||
Goodson 2013 &Wallace 2014 [42,43] | Tanzania | Routine—facility | HIV | A B C | A B C | ||||||||||
Wang 2015 [48] | Zambia | Routine—facility | HIV | A B C | A B C | ||||||||||
Bojang 2011 [49] | Gambia | Routine—outreach | Malaria | A | A | ||||||||||
Dicko 2011 [50] | Mali | Routine—facility | Malaria | A | A | ||||||||||
Schellenberg 2011 & Willey 2011 [54,55] | Tanzania | Routine—facility | Malaria | A | A | ||||||||||
Patouillard 2011 [52] | Ghana | Routine—outreach | Malaria | A B | A B | ||||||||||
Monterrosa 2013 [60] | Mexico | Routine—mixed | Nutrition | B | B | ||||||||||
Oladeji 2019 [61] | South Sudan | Routine—mixed | Nutrition | C E | C E | ||||||||||
Briere 2012& Ryman 2012 [62,63] | Kenya | Routine—facility | WASH | A B C | A B C | ||||||||||
Bawa 2019 [21] | Nigeria | Routine—mobile | Malaria, PHC, Nutrition, WASH | C | C | ||||||||||
Edmond 2020 [22] | Afghanistan | Routine—mobile | Nutrition, PHC | C | C | ||||||||||
Hodges 2015 [25] | Sierra Leone | Routine—facility | FP, Nutrition | C E | C E |
Category | Processes, Enablers, and Barriers Affecting Service Integration | References |
---|---|---|
Policy and governance topics | Consistency of leadership support | [25,26,28,34,37,48] |
Governments and donors seeking efficiency amidst multiple priorities | [23,33] | |
Reducing financial access barriers to the integration of other primary healthcare services with immunization | [23,33,38,39,40] | |
Design of integrated service delivery | Optimize co-location of additional staff, especially if extra tasks require more time (e.g., counseling) or skills | [32,33,36,37,61] |
Ensure good matches in terms of of cadence, target groups, and types of services (e.g., preventive rather than curative services may more amenable to integration with immunization) | [38,39,40,44] | |
Ensure additional service requirements do not compromise uptake or quality | [41,42,43] | |
Use integration as an opportunity to provide services to areas/populations that are difficult to reach | [20,21,23,25,26,61] | |
Human resources for health | Managing workload and time demands for extra tasks | [22,29,36,37,38,39,40,49,50,51,52,53,56,57,60,62,63] |
Additional and skilled staff may be needed (e.g., counseling) | [20,21,22,28,35,36,37,38,39,40,44,49,52] | |
Motivation and empowerment of healthcare staff to provide expanded care, which healthcare workers generally perceive as better in quality and responsiveness | [32,33,36,48,50,51] | |
Training that is (a) harmonized for vaccinators and for providers of linked health service; (b) includes client communications/mobilization; and (c) includes integration processes and tools | [20,21,23,24,27,29,32,33,34,36,37,38,39,40,45,46,49,50,51,54,55,56,61,62,63] | |
Involving community-based health workers to support integrated service delivery | [20,21,24,33,44,45,46,48,49,52,61,62,63] | |
Ensuring that staff are willing to collaborate in providing additional services | [37,38,39,40] | |
Management, logistics, and costs | Coordinated program planning across program managers and between staff | [32,33,44,48,49] |
Consistency of supplies (particularly for linked service) and coordinated logistics | [20,21,30,32,35,36,46,48,49,50,51,52,56,57,62,63] | |
Efficiency may lower costs of integrated service | [27,34,38,39,40,52,62,63] | |
Integrating professional staff may increase costs | [49] | |
Ensuring infrastructure is supportive (e.g., privacy) | [29,32,35,36,42,43] | |
Operational tools, reporting and recording | Consolidation of information systems and reporting, including home-based records | [20,21,31,32,33,34,36,56,57] |
Ensuring time for documentation of extra services | [36,56,57] | |
Job aids and other tools to support implementation of linked service and referral between programs | [29,31,32,33,34,36,37,38,39,40,45,57] | |
Community and client topics | Promote care seeking, with perceptions of integrated services as more responsive and client-focused | [23,24,27,28,31,36,49,50,51,57,61,62,63] |
Ensuring stigma/sensitivity does not hamper uptake | [23,32,33,34,35,36,41,42,43,46,58,59] | |
Ensuring family time and travel costs do not increase | [22,38,39,40,41,42,43,46,62,63] | |
Account for need to involve spouse in care decisions | [32,35,41] | |
Ensuring integrated services address common barriers to uptake | [22,27,28,32,33,34,35,36,38,39,40,41,42,43,44,46,61,62,63] | |
Ensuring multiple channels of communication on integrated health services | [25,26,33,38,39,40] |
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Shah, M.P.; Morgan, C.J.; Beeson, J.G.; Peach, E.; Davis, J.; McPake, B.; Wallace, A.S. Integrated Approaches for the Delivery of Maternal and Child Health Services with Childhood Immunization Programs in Low- and Middle-Income Countries: Systematic Review Update 2011–2020. Vaccines 2024, 12, 1313. https://doi.org/10.3390/vaccines12121313
Shah MP, Morgan CJ, Beeson JG, Peach E, Davis J, McPake B, Wallace AS. Integrated Approaches for the Delivery of Maternal and Child Health Services with Childhood Immunization Programs in Low- and Middle-Income Countries: Systematic Review Update 2011–2020. Vaccines. 2024; 12(12):1313. https://doi.org/10.3390/vaccines12121313
Chicago/Turabian StyleShah, Monica P., Christopher J. Morgan, James G. Beeson, Elizabeth Peach, Jessica Davis, Barbara McPake, and Aaron S. Wallace. 2024. "Integrated Approaches for the Delivery of Maternal and Child Health Services with Childhood Immunization Programs in Low- and Middle-Income Countries: Systematic Review Update 2011–2020" Vaccines 12, no. 12: 1313. https://doi.org/10.3390/vaccines12121313
APA StyleShah, M. P., Morgan, C. J., Beeson, J. G., Peach, E., Davis, J., McPake, B., & Wallace, A. S. (2024). Integrated Approaches for the Delivery of Maternal and Child Health Services with Childhood Immunization Programs in Low- and Middle-Income Countries: Systematic Review Update 2011–2020. Vaccines, 12(12), 1313. https://doi.org/10.3390/vaccines12121313