Assessing Interventions for Declining Childhood Immunization Dropout - A Systematic Review


  • Jaleha Jaleha Doctoral Program of Medicine and Health Sciences, Faculty of Medicine, University of Diponegoro, Semarang, Central Java, Indonesia
  • Bagoes Widjarnarko Faculty of Public Health, University of Diponegoro, Semarang, Central Java, Indonesia
  • Henry Setyawan Susanto Faculty of Public Health, University of Diponegoro, Semarang, Central Java, Indonesia
  • Ani Margawati Faculty of Medicine, University of Diponegoro, Semarang, Central Java, Indonesia
  • Suharyo Hadisaputro Faculty of Medicine, University of Diponegoro, Semarang, Central Java, Indonesia
  • Kholisotul Hikmah Department of Epidemiology, Faculty of Public Health, University of Indonesia, Depok, West Java, Indonesia



Intervention, Immunization Dropout, Immunization Uptake Coverage


Childhood routine immunization is a critical stage to ensure the health of infants and protect against serious diseases. Therefore, adequate strategies are urgently needed to increase childhood immunization coverage to prevent global disease and death. This review has identified the effect of interventions to increase immunization coverage among children in developing countries. A review included published studies from 2013 to 2023 on randomized controlled trials (RCT) and pre-post intervention that met eligible criteria. All included studies had been conducted in English-published articles on Pub Med and Google Scholar, without being limited to geographical sites. A total of 1107 published articles were accessed and 12 final eligible articles were reviewed. 66.67% of the included studies were conducted in Africa, 16.67% in South East Asia countries, and others were conducted in East Asia and America. These studies demonstrated that different interventions (SMS and call reminders, sticker reminders, immunization education, home-based records, and community-centered) had significant increases in immunization coverage for childhood compared to the control group with standard care or without any interventions. The present findings suggest that interventions including implementing SMS and call reminders, sticker reminders, education both from health workers and local leaders, and home-based records can potentially reduce immunization dropout. However, strategies to improve coverage for immunization uptake should also be considered preferred community-based to extend the marginal groups.


Download data is not yet available.


Bangure, D., Chirundu, D., Gombe, N., Marufu, T., Mandozana, G., Tshimanga, M., & Takundwa, L. (2015). Effectiveness of short message services reminder on childhood immunization programme in Kadoma, Zimbabwe-a randomized controlled trial, 2013. BMC Public Health, 15, 1-8.

Brown, S. E., Krishnan, A., Ranjit, Y. S., Marcus, R., & Altice, F. L. (2020). Assessing mobile health feasibility and acceptability among HIV-infected cocaine users and their healthcare providers: guidance for implementing an intervention. Mhealth, 6.

Brown, V. B., Oluwatosin, O. A., Akinyemi, J. O., & Adeyemo, A. A. (2016). Effects of Community Health Nurse-Led Intervention on Childhood Routine Immunization Completion in Primary Health Care Centers in Ibadan, Nigeria. Journal of Community Health, 41(2), 265–273.

Chandler, J., Cumpston, M., Li, T., Page, M., & Welch, V. (2019). Cochrane Handbook for Systematic Reviews of Interventions: Vol. Version 6 (J. Higgins & J. Thomas, Eds.). Cochrane Training.

Chanie, M. G., Ewunetie, G. E., Molla, A., & Muche, A. (2021). Determinants of vaccination dropout among children 12-23 months age in north Gondar zone, northwest Ethiopia, 2019. Plos one, 16(2), e0246018.

Dissieka, R., Soohoo, M., Janmohamed, A., & Doledec, D. (2019). Providing mothers with mobile phone message reminders increases childhood immunization and vitamin A supplementation coverage in Cäte d’Ivoire: A randomized controlled trial. Journal of Public Health in Africa, 10(1), 56–60.

Ekhaguere, O. A., Oluwafemi, R. O., Badejoko, B., Oyeneyin, L. O., Butali, A., Lowenthal, E. D., & Steenhoff, A. P. (2019). Automated phone call and text reminders for childhood immunisations (PRIMM): a randomised controlled trial in Nigeria. BMJ global health, 4(2), e001232.

Eze, G. U., & Adeleye, A. O. (2015). Enhancing Routine Immunization Performance using Innovative Technology in an Urban Area of Nigeria. West African Journal of Medicine, 34(1), 3-10.

Haji, A., Lowther, S., Ngan’Ga, Z., Gura, Z., Tabu, C., Sandhu, H., & Arvelo, W. (2016). Reducing routine vaccination dropout rates: evaluating two interventions in three Kenyan districts, 2014. BMC public health, 16(1), 1-8.

Haldane, V., Chuah, F. L., Srivastava, A., Singh, S. R., Koh, G. C., Seng, C. K., & Legido-Quigley, H. (2019). Community participation in health services development, implementation, and evaluation: A systematic review of empowerment, health, community, and process outcomes. PloS one, 14(5), e0216112.

Higgins, J. P., Savović, J., Page, M. J., Elbers, R. G., & Sterne, J. A. (2019). Assessing risk of bias in a randomized trial. Cochrane handbook for systematic reviews of interventions, 205-228.

Hu, Y., Chen, Y., Wang, Y., Song, Q., & Li, Q. (2017). Prenatal vaccination education intervention improves both the mothers’ knowledge and children’s vaccination coverage: Evidence from randomized controlled trial from eastern China. Human Vaccines and Immunotherapeutics, 13(6), 1477–1484.

Ijeoma, N. H., Uloaku, E. U., Eno, A., Damaris, O., & Adanze, A. (2015). Use of Telephone Calls in Reduction of Dropout Rate of Routine Immunization in a Tertiary Health Facility in South Eastern Nigeria. European Journal of Preventive Medicine, 3(3), 39-43.

Ibraheem, R., Akintola, M., Abdulkadir, M., Ameen, H., Bolarinwa, O., & Adeboye, M. (2021). Effects of call reminders, short message services (SMS) reminders, and sms immunization facts on childhood routine vaccination timing and completion in Ilorin, Nigeria. African Health Sciences, 21(2), 951–959.

Kayembe-Ntumba, H. C., Vangola, F., Ansobi, P., Kapour, G., Bokabo, E., Mandja, B. A., & Bompangue, D. (2022). Vaccination dropout rates among children aged 12-23 months in Democratic Republic of the Congo: a cross-sectional study. Archives of Public Health, 80(18).

Kementerian Kesehatan Republik Indonesia. (2018). Laporan Riset Kesehatan Dasar 2018. Kementerian Kesehatan Republik Indonesia.

Mahachi, K., Kessels, J., Boateng, K., Baptiste, A. E. J., Mitula, P., Ekeman, E., ... & Gabrielli, A. F. (2022). Zero-or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges. Vaccine, 40(37), 5433-5444.

Mekonnen, Z. A., Gelaye, K. A., Were, M. C., Gashu, K. D., & Tilahun, B. C. (2019). Effect of mobile text message reminders on routine childhood vaccination: a systematic review and meta-analysis. Systematic reviews, 8(154).

Nguyen, N. T., Vu, H. M., Dao, S. D., Tran, H. T., & Nguyen, T. X. C. (2017). Digital immunization registry: evidence for the impact of mHealth on enhancing the immunization system and improving immunization coverage for children under one year old in Vietnam. MHealth, 3, 26–26.

Obi-Jeff, C., Garcia, C., Adewumi, F., Bamiduro, T., David, W., Labrique, A., & Wonodi, C. (2022). Implementing SMS reminders for routine immunization in Northern Nigeria: a qualitative evaluation using the RE-AIM framework. BMC Public Health, 22(2370).

Oyo-Ita, A., Bosch-Capblanch, X., Ross, A., Oku, A., Esu, E., Ameh, S., ... & Meremikwu, M. (2021). Effects of engaging communities in decision-making and action through traditional and religious leaders on vaccination coverage in Cross River State, Nigeria: A cluster-randomised control trial. Plos one, 16(4), e0248236.

Powelson, J., Magadzire, B. P., Draiva, A., Denno, D., Ibraimo, A., Benate, B. B. L., ... & Lawrence, E. (2022). Determinants of immunisation dropout among children under the age of 2 in Zambézia province, Mozambique: a community-based participatory research study using Photovoice. BMJ open, 12(3), e057245.

Rachlin, A., Danovaro-Holliday, M. C., Murphy, P., Sodha, S. V., & Wallace, A. S. (2022). Routine vaccination coverage—worldwide, 2021. Morbidity and Mortality Weekly Report, 71(44), 1396-1400.

Sabarwal, S., Bhatia, R., Dhody, B., Perumal, S., White, H., & Health, J. P. (2015). Engaging communities for increasing immunisation coverage What do we know?. International Initiative Impact Evaluation.

Shen, A. K., Fields, R., & Mcquestion, M. (2014). The future of routine immunization in the developing world: challenges and opportunities. Global Health: Science and Practice, 2(4), 381–394.

Syed, U., Kapera, O., Chandrasekhar, A., Baylor, B. T., Hassan, A., Magalhães, M., ... & Bhatti, A. (2023). The Role of Faith-Based Organizations in Improving Vaccination Confidence & Addressing Vaccination Disparities to Help Improve Vaccine Uptake: A Systematic Review. Vaccines, 11(2), 449.

Wallace, A. S., Peetosutan, K., Untung, A., Ricardo, M., Yosephine, P., Wannemuehler, K., Brown, D. W., McFarland, D. A., Orenstein, W. A., Rosenberg, E. S., Omer, S. B., & Daniels, D. (2019). Home-based records and vaccination appointment stickers as parental reminders to reduce vaccination dropout in Indonesia: A cluster-randomized controlled trial. Vaccine, 37(45), 6814–6823.

World Health Organization. (2015). Practical guide for the design, use and promotion of home-based records in immunization programmes (No. WHO/IVB/15.05). World Health Organization.

WHO. (2023). Immunization coverage. World Health Organization.

Wightman, P., McCue, K., Sabo, S., Annorbah, R., Jiménez, D., Pilling, V., ... & Rumann, S. (2022). Community health worker intervention improves early childhood vaccination rates: Results from a propensity-score matching evaluation. BMC Public Health, 22(1), 1854.




How to Cite

Jaleha, J., Widjarnarko, B., Susanto, H. S., Margawati, A., Hadisaputro, S., & Hikmah, K. (2023). Assessing Interventions for Declining Childhood Immunization Dropout - A Systematic Review . JURNAL INFO KESEHATAN, 21(3), 438–453.
Abstract viewed = 37 times