Bulletin of the World Health Organization
Volume 93, Number 5, May 2015, 285-360
http://www.who.int/bulletin/volumes/93/5/en/

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EDITORIALS
Knowledge for effective action to improve the health of women, children and adolescents in the post-2015 era: a call for papers
Flavia Bustreo & Robin Gorna
doi: 10.2471/BLT.15.156521

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Research
Surveys of measles vaccination coverage in eastern and southern Africa: a review of quality and methods used
Reinhard Kaiser, Messeret E Shibeshi, Jethro M Chakauya, Emelda Dzeka, Balcha G Masresha, Fussum Daniel & Nestor Shivute
Abstract
Objective
To assess the methods used in the evaluation of measles vaccination coverage, identify quality concerns and provide recommendations for improvement.
Methods
We reviewed surveys that were conducted to evaluate supplementary measles immunization activities in eastern and southern Africa during 2012 and 2013. We investigated the organization(s) undertaking each survey, survey design, sample size, the numbers of study clusters and children per study cluster, recording of immunizations and methods of analysis. We documented sampling methods at the level of clusters, households and individual children. We also assessed the length of training for field teams at national and regional levels, the composition of teams and the supervision provided.
Findings
The surveys were conducted in Comoros, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Uganda, Zambia and Zimbabwe. Of the 13 reports we reviewed, there were weaknesses in 10 of them for ethical clearance, 9 for sample size calculation, 6 for sampling methods, 12 for training structures, 13 for supervision structures and 11 for data analysis.
Conclusion
We recommend improvements in the documentation of routine and supplementary immunization, via home-based vaccination cards or other records. For surveys conducted after supplementary immunization, a standard protocol is required. Finally, we recommend that standards be developed for report templates and for the technical review of protocols and reports. This would ensure that the results of vaccination coverage surveys are accurate, comparable, reliable and valuable for programme improvement.

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Research
A multimedia consent tool for research participants in the Gambia: a randomized controlled trial
Muhammed Olanrewaju Afolabi, Nuala McGrath, Umberto D’Alessandro, Beate Kampmann, Egeruan B Imoukhuede, Raffaella M Ravinetto, Neal Alexander, Heidi J Larson, Daniel Chandramohan & Kalifa Bojang
Abstract
Objective
To assess the effectiveness of a multimedia informed consent tool for adults participating in a clinical trial in the Gambia.
Methods
Adults eligible for inclusion in a malaria treatment trial (n = 311) were randomized to receive information needed for informed consent using either a multimedia tool (intervention arm) or a standard procedure (control arm). A computerized, audio questionnaire was used to assess participants’ comprehension of informed consent. This was done immediately after consent had been obtained (at day 0) and at subsequent follow-up visits (days 7, 14, 21 and 28). The acceptability and ease of use of the multimedia tool were assessed in focus groups.
Findings
On day 0, the median comprehension score in the intervention arm was 64% compared with 40% in the control arm (P = 0.042). The difference remained significant at all follow-up visits. Poorer comprehension was independently associated with female sex (odds ratio, OR: 0.29; 95% confidence interval, CI: 0.12–0.70) and residing in Jahaly rather than Basse province (OR: 0.33; 95% CI: 0.13–0.82). There was no significant independent association with educational level. The risk that a participant’s comprehension score would drop to half of the initial value was lower in the intervention arm (hazard ratio 0.22, 95% CI: 0.16–0.31). Overall, 70% (42/60) of focus group participants from the intervention arm found the multimedia tool clear and easy to understand.
Conclusion
A multimedia informed consent tool significantly improved comprehension and retention of consent information by research participants with low levels of literacy.

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Systematic Reviews
Strategies to increase the demand for childhood vaccination in low- and middle-income countries: a systematic review and meta-analysis
Mira Johri, Myriam Cielo Pérez, Catherine Arsenault, Jitendar K Sharma, Nitika Pant Pai, Smriti Pahwa & Marie-Pierre Sylvestre
Abstract
Objective
To investigate which strategies to increase demand for vaccination are effective in increasing child vaccine coverage in low- and middle-income countries.
Methods
We searched MEDLINE, EMBASE, Cochrane library, POPLINE, ECONLIT, CINAHL, LILACS, BDSP, Web of Science and Scopus databases for relevant studies, published in English, French, German, Hindi, Portuguese and Spanish up to 25 March 2014. We included studies of interventions intended to increase demand for routine childhood vaccination. Studies were eligible if conducted in low- and middle-income countries and employing a randomized controlled trial, non-randomized controlled trial, controlled before-and-after or interrupted time series design. We estimated risk of bias using Cochrane collaboration guidelines and performed random-effects meta-analysis.
Findings
We identified 11 studies comprising four randomized controlled trials, six cluster randomized controlled trials and one controlled before-and-after study published in English between 1996 and 2013. Participants were generally parents of young children exposed to an eligible intervention. Six studies demonstrated low risk of bias and five studies had moderate to high risk of bias. We conducted a pooled analysis considering all 11 studies, with data from 11 512 participants. Demand-side interventions were associated with significantly higher receipt of vaccines, relative risk (RR): 1.30, (95% confidence interval, CI: 1.17–1.44). Subgroup analyses also demonstrated significant effects of seven education and knowledge translation studies, RR: 1.40 (95% CI: 1.20–1.63) and of four studies which used incentives, RR: 1.28 (95% CI: 1.12–1.45).
Conclusion
Demand-side interventions lead to significant gains in child vaccination coverage in low- and middle-income countries. Educational approaches and use of incentives were both effective strategies.