Peer-reviewed article
The impact of information and communication technology on immunisation and immunisation programmes in low-income and middle-income countries: a systematic review and meta-analysis
Mohini Zarekar, Hussein Al-Shehabi, Rita Dörner, Heide Weishaar, Tessa Lennemann et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review and meta-analysis examined how information and communication technology (ICT) affects vaccine delivery in low- and middle-income countries between 2010 and 2023. The review included 27 studies covering nearly 355,000 children and found that ICT interventions, especially reminder systems, improved immunisation coverage and vaccine programme efficiency. Reminders more than doubled the likelihood of children receiving the third pentavalent dose and completing full immunisation by age one. The evidence shows consistent benefits across vaccine delivery stages, from reducing stockouts to improving record accuracy.
Key points
- ICT interventions, particularly reminders, increased the odds of receiving the third pentavalent dose by 2.32 times (95% CI 1.34–4.03)
- Full immunisation coverage at one year increased with ICT use (OR 2.61, 95% CI 1.2–5.67)
- 26 of 27 included studies demonstrated positive impacts on immunisation coverage, timeliness, record accuracy, adverse event reporting, vaccine stockouts, and cold chain management
- Studies were heterogeneous with significant variation (I² 82% and 89%), suggesting results vary across contexts
- Quality concerns included unblinded assessors in RCTs and baseline differences between study arms in quasi-experimental designs
Limitations
The review could not fully determine which specific ICT approaches work best in which contexts due to high heterogeneity across studies. The quality of evidence was compromised by methodological limitations in the included studies, particularly around blinding and baseline comparability.
Abstract
Background Low-income and Middle-income Countries (LMIC) are continually working to ensure everyone can access life-saving vaccines. Recognising the considerable impact of Information and Communication Technology (ICT) in healthcare, we performed a systematic review and meta-analysis to summarise ICT effectiveness in improving vaccine delivery in LMICs. Methods A systematic search from January 2010 to August 2023 in MEDLINE, EMBASE, Cochrane Library, BMJ Health & Care Informatics, and grey literature was performed. This search focused on randomised controlled trials (RCTs), non-RCTs, observational, and mixed-methods studies in English, examining ICT's effects on childhood immunisation in LMICs. Risk of bias in RCTs and non-RCTs was assessed using the Joanna Briggs Institute tool, and mixed-methods studies were evaluated with the Mixed Methods Appraisal Tool. A meta-analysis summarised ICT's impact on third pentavalent dose coverage and full immunisation by age one. The study is registered with PROSPERO (CRD42023446062). Findings Of 6535 screened studies, 27 involving 354,979 children were included. All apart from one study demonstrated a positive impact on immunisation coverage and timeliness, completeness and accuracy of records, number of adverse events reporting, vaccine stockouts, and cold chain expansion. The meta-analysis demonstrated that reminders effectively improved coverage rate of the third dose of the pentavalent vaccine (OR 2.32, 95% CI 1.34–4.03) and the full immunisation at one year of age (OR 2.61, 95% CI 1.2–5.67) with significant degrees of heterogeneity, respectively I 2 82% and I 2 89%. Main concerns for bias in RCTs included unblinded outcome assessors and intervention providers. Interpreting quasi-experimental studies was more challenging due to the higher risk of baseline differences between study arms, statistical methods, and dropouts. Mixed-methods studies often lacked clarity in integrating qualitative and quantitative data. Interpretation This systematic review confirms the benefits of ICT in immunisation programmes by enhancing various stages of vaccine delivery. Specifically, reminders have been shown to enhance childhood immunisation coverage rates. Funding Deutsche Gesellschaft für Internationale Zusammenarbeit (German Corporation for International Cooperation, GIZ) as part of the Digital Innovation in Pandemic Control (DIPC) Initiative, financed by the Bundesministerium für Wirtschaftliche Zusammenarbeit (Federal Ministry for Economic Cooperation and Development, BMZ).
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Information and communication technology (ICT) applications, primarily reminder systems for caregivers and healthcare workers
- Population
- Children in low- and middle-income countries (27 studies, 354,979 children)
Key finding
ICT reminders increased odds of third pentavalent dose coverage by 2.32 times (95% CI 1.34–4.03)