Equity, vulnerability and childhood immunization in Kenya and Uganda. A review of policy documents protocol.

Esther Awuor Owino; David Mafigiri; Dorcas Kamuya; Caroline Jones; Primus Chi

doi:10.3310/nihropenres.13449.1

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Equity, vulnerability and childhood immunization in Kenya and Uganda. A review of policy documents protocol.

[version 1; peer review: 2 approved with reservations]

Esther Awuor Owino ¹, David Mafigiri², Dorcas Kamuya^1,3, Caroline Jones^1,3, Primus Chi¹

Esther Awuor Owino ¹, David Mafigiri², [...] Dorcas Kamuya^1,3, Caroline Jones^1,3, Primus Chi¹

PUBLISHED 24 Nov 2023

Author details Author details

¹ Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
² Makerere University, Kampala, Central Region, Uganda
³ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK

Esther Awuor Owino
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

David Mafigiri
Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing

Dorcas Kamuya
Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing

Caroline Jones
Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing

Primus Chi
Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Introduction

Inequities in access and uptake of vaccines remains to be a challenge to the full realization of benefits they stand to offer. In the case of childhood immunization, improved full immunization coverage has been witnessed globally in the past decades but countries in sub-Saharan Africa have registered slow progress, with variations between/within countries. This has been attributed to several challenges/vulnerability factors. Consequently, current global efforts to promote access to immunization have focused on the issue of equity, which is now a strategic priority in key international policy documents such as the World Health Organization immunization agenda 2030 among others. It is therefore important to understand the context and efforts being made by individual countries to realize equity. We plan to undertake a systematic policy document review to understand the immunization context in Kenya and Uganda by examining the extent to which equity and vulnerability issues are framed and addressed in key health sector and policy documents in both countries.

Methods

The systematic review will focus on key health sector and immunization policy documents in Uganda and Kenya between 2000 and 2023. Documents in the English language will be reviewed. Data sources will include official ministry of health websites for each country, websites of key international organizations working on immunization, general google searches and requesting for relevant documents from immunization stakeholders and officials in both countries. Data synthesis will follow a deductive and inductive approach. Findings will be presented in a descriptive format and in line with review objectives.

Discussion

We will assess the extent to which equity and vulnerability issues are included and how they are defined in the health sector and immunization policy documents. In addition, the review will examine strategies proposed, planned and/or implemented to promote equitable access and uptake of immunization services in the two countries.

Plain Language Summary

Plain English Summary

Vaccines offer several benefits key among them being prevention of infectious disease outbreaks and deaths. Unfortunately, not everyone enjoys these benefits partly due to avoidable differences in reaching and using vaccines. In most African countries, there have been an increase in the number of those using vaccines over the years even though there are still differences between and within countries. In a bid to ensure that no one is left behind in reaching and using vaccines, most international organizations working around vaccines have now prioritized attaining fairness in use of vaccines and this commitment is reflected in international immunization policy documents. It is therefore important to examine how this is working out at country level. That is whether countries are also working towards ensuring that everyone is vaccinated and whether this is captured in their policy documents. This review therefore seeks to understand what is being done in Kenya and Uganda to ensure that everyone is reached with vaccines by examining key health sector and immunization policy documents.

The review will focus on key health sector and immunization policy documents published in the English language from 2000 to 2023. An online search will be conducted through relevant websites such as ministry of health websites for each country. In addition, documents that cannot be accessed via online sources will be requested from relevant stakeholders in the two countries. The documents will then be screened to determine those appropriate to the review objective. Data from selected documents will be extracted using a data extraction tool, analysed and presented in a descriptive format and in line with the objectives of the review.

Keywords

Equity, immunization, vulnerability, vaccine, vaccination, Kenya, Uganda, policy document review

Corresponding author: Esther Awuor Owino

Competing interests: No competing interests were disclosed.

Grant information: This project is funded by the National Institute for Health and Care Research (NIHR) under its [Global Health Research Units and Groups (GHRUG) Programme (Grant Reference Number NIHR134531)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2023 Owino EA et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Owino EA, Mafigiri D, Kamuya D et al. Equity, vulnerability and childhood immunization in Kenya and Uganda. A review of policy documents protocol. [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2023, 3:64 (https://doi.org/10.3310/nihropenres.13449.1) First published: 24 Nov 2023, 3:64 (https://doi.org/10.3310/nihropenres.13449.1) Latest published: 27 May 2025, 3:64 (https://doi.org/10.3310/nihropenres.13449.2)

Introduction

Vaccines are some of the most effective public health interventions with a demonstrated capacity to prevent and/or control the outbreak and spread of infectious diseases^1,2. Improved health outcomes globally can partly be attributed to the use of vaccines which have played a significant role in the reduction of morbidity and mortality arising from life threatening infectious diseases. According to the WHO, immunization against different infectious diseases contributes to the prevention of approximately four million deaths per year globally, hence increase in life expectancy. Moreover, disease prevention using vaccines can help to avert medical expenditures and other related costs such as loss of wages by caregivers during sickness episodes, travel time and transportation cost to seek treatment.

In the past decades, several concerted efforts have been put in place internationally to promote access and uptake of vaccines targeting different age groups. Key among these was the establishment of the Expanded Programme on Immunization (EPI) by WHO in 1974 and the Global Alliance for Vaccines and Immunization (GAVI) in 1999. These initiatives have so far led to improved childhood vaccine coverage across the globe. However, access and uptake between countries is still characterized by inequities especially in sub-Saharan African countries where majority of vaccine preventable diseases are experienced. Additionally, immunization coverage at national and sub-national levels in most African countries have stagnated and are disparate^2–6. WHO estimates that more than 30 million of under five years children in Africa suffer from vaccine preventable diseases annually out of which 500,000 die from these diseases. This is almost equivalent to 58% of the global vaccine preventable diseases⁴. Moreover, many of these children are those who haven’t received any dose of the recommended childhood vaccines (zero-dose children).

Current global efforts to promote immunization have focused on the issue of equity^5,7. Equitable access to childhood vaccines is important since population groups or children who are unvaccinated or partially vaccinated are more vulnerable to outbreaks or re-emergence of infectious diseases⁵. Equity in immunization has therefore been captured as a strategic priority in key international policy documents including the WHO immunization agenda 2021–2030 which aims at leaving no one behind, global vaccine action plan, Gavi’s 2021–2025 high-level strategy and the United Nations Children’s Fund (UNICEF) equity reference group for immunization^5,8. It is therefore important to understand efforts being made by individual countries to reach vulnerable communities/ population groups and realize equity in immunization.

This policy analysis/document review therefore aims at understanding the immunization context in Kenya and Uganda by examining the extent to which equity and vulnerability issues are framed and addressed in health sector and immunization policy documents in the two countries. Specifically, the review will:

1. Examine the extent to which key health and immunization policy documents in Kenya and Uganda have included issues of vulnerability and (in)equity, how they are defined and proposed strategies to addressed them and promote uptake of vaccines.
2. Identify gaps and opportunities in the health sector and immunization policy documents.
3. Compare how issues of equity and vulnerability in the reviewed documents vary between Kenya and Uganda.

Methods

Eligibility criteria

The documents to be reviewed will include immunization policies, health sector strategies and guidelines, implementation and working documents such as annual and midterm reports, training manuals, government speeches among others. Only documents in English language will be included. Publication date for inclusion will be from 2000 (to correspond with the establishment of GAVI which has played a key role in promoting access to vaccines in most of the developing countries like Kenya and Uganda) to 2023. This will also help to provide a better understanding of the immunization context in both countries over the years as well as the efforts made to ensure that all children are vaccinated.

Information sources

Documents to be reviewed will be retrieved from the following sources:

i. The official Kenyan and Ugandan Ministry of Health websites (https://www.health.go.ke/
https://www.health.go.ug/)
ii. Websites of international and local organizations working around childhood immunization in Kenya and Uganda e.g., UNICEF, GAVI, WHO, Save the Children etc (https://www.unicef.org/
https://www.gavi.org/;
https://www.who.int/;
https://kenya.savethechildren.net/)
iii. Requesting for relevant documents from the relevant stakeholders at MOH, Kilifi County department of health and donor and partner organizations.
iv. General google search

Search strategy

The following key words will be used for general google searches as well as the specific websites listed above: Vaccin* and/or immuniz* AND/OR routine vaccin* and/or immuniz* and/or (In)equit* and/or vulnerab* AND/OR Expanded programme on immunization or EPI OR Kenya expanded programme on immunization or KEPI OR Uganda national expanded programme on immunization (UNEPI). In addition to the search terms listed above, documents will also be identified through the reference list of identified documents.

Study records

Data management and selection process. All documents retrieved from online sources will be exported and managed in Endnote v20 or Mendeley where duplicates will also be identified. The reviewer (EO) will manually screen the documents to identify those relevant to the review questions and meets the eligibility criteria. The screening will be based on the title of the document, a search of terms, including vulnerability, equity, immunization, and vaccination within the documents, and by reading through the executive summary of a document. The list of documents identified to be eligible for review will then be shared with the other reviewers (PC, CJ, DM and DK). The team will then meet to discuss about the appropriateness of the documents identified as eligible and a consensus reached on documents to be included for final review.

Data collection process and data items. Data collection will be performed by EO using a data extraction template⁹. Extracted data will then be shared with co-reviewers who will independently review it after which the team will meet to discuss and resolve any disagreement. The data extraction tool will be developed using an Excel spreadsheet. Each row of the tool will capture documents identified while the individual columns will capture the type of information to extract from the documents. Information to be extracted will include general information about the documents e.g., the full title of the document, author(s), date of publication, purpose of the document, intended users/audience and a summary of issues addressed in the document. For documents about a specific policy, aspects of the policy analysis triangle will be captured. These will include context (why was the policy developed), content (what the policy is about), process (how the policy was brought forward and implemented), and actors (who are the persons involved in and influences the formulation and implementation of the policy). The second category of information to be extracted will include explicit and implicit information about equity, vulnerability, access, and uptake of immunization. To extract this type of data, full text review of documents that are entirely focused on immunization will be conducted while for documents that contain other information apart from immunization, only relevant sections will be read and data extracted in addition to the general information about the document.

Review outcomes

The key outcomes for this review will be a description of how equity and vulnerability issues have been framed in immunization and health sector policy documents in Kenya and Uganda, strategies planned and/or implemented by each government with the aim of addressing vulnerabilities and promoting equity in access and uptake of vaccines, gaps and opportunities in the policy documents reviewed and how they compare between Kenya and Uganda.

Risk of bias in individual studies

Not applicable

Data synthesis

Data synthesis will follow a deductive and inductive approach. A modified version of UNICEF journey to health and immunization framework (JHIF) will be used to analyse the data deductively^10–12. The JHIF outlines six key stages (before, during and after) in the journey to accessing and using immunization services. According to the framework, the first step entails knowledge, awareness and beliefs which in turn influences intent to get immunized, followed by preparation, cost and effort which leads to the point of service (immunization), experience of service and after service experience. The JHIF will therefore help to synthesize and understand which measures/strategies have been put in place to address the different stages in the journey to access and use childhood vaccines. The framework frameworks will also be useful in identifying gaps and opportunities in the existing strategies, policies and guidelines reviewed that can be exploited/tailored to improve access and uptake of childhood vaccines in Kenya and Uganda. In addition to the framework, an inductive approach will also be employed to capture new themes/ areas not captured in the framework. Findings from the review will be presented in a descriptive format in line with the review objectives.

Meta-bias(es)

Not applicable

Confidence in cumulative evidence

Not applicable

Study status

Completion of this review is anticipated to be by September 2023. The study team is currently screening documents identified through online searches.

Conclusion

The review intends to provide an understanding of the Kenyan and Ugandan context in regard to immunization policies. Specifically, it will focus on how equity and vulnerability issues are framed in policy documents in order to identify gaps and opportunities that can be harnessed to address vulnerabilities that influence access and uptake of vaccines. In addition, a comparison between Kenya and Uganda will be made and learnings drawn. We intend to explore the gaps identified through the review with relevant stakeholders in the two countries through primary research and contribute to improvement of the policy landscape around immunization through policy recommendations.

Data availability

Extended data

Harvard Dataverse: Equity, vulnerability and childhood immunization in Kenya and Uganda: a systematic review of policy documents protocol. https://doi.org/10.7910/DVN/GZOQTL.

This project contains the following extended data:

Extended data file 1. PRISMA-P checklist (The checklist reports items addressed in this systematic review protocol).
Extended data file 2. Data extraction template (This data extraction template will be used to manually extract relevant data from the documents included for analysis as per the review objectives)

Data are available under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0)

Reporting guidelines

A PRISMA-P checklist has been completed and uploaded on Harvard Dataverse. https://doi.org/10.7910/DVN/GZOQTL.

Faculty Opinions recommended

References

1. Doherty M, Buchy P, Standaert B, et al.: Vaccine impact: Benefits for human health. Vaccine. 2016; 34(52): 6707–6714. PubMed Abstract | Publisher Full Text
2. World Health Organization (WHO). Reference Source
3. Ikilezi G, Augusto OJ, Sbarra A, et al.: Determinants of geographical inequalities for DTP3 vaccine coverage in sub-Saharan Africa. Vaccine. 2020; 38(18): 3447–3454. PubMed Abstract | Publisher Full Text
4. World Health Organzation (WHO): Explorations of inequality: Childhood immunization. Geneva, Switzerland, 2018. Reference Source
5. World Health Organization (WHO): Immunization Agenda 2030: A global strategy to leave no one behind.
6. Donfouet HPP, Agesa G, Mutua MK: Trends of inequalities in childhood immunization coverage among children aged 12-23 months in Kenya, Ghana, and Cote d'Ivoire. BMC Public Health. 2019; 19(1): 988. PubMed Abstract | Publisher Full Text | Free Full Text
7. World Health Organization (WHO): Regional Strategic Plan for Immunization 2014-2020. Brazzaville, Republic of Congo, 2015. Reference Source
8. World Health Organization (WHO): Global Vaccine Action Plan 2011-2020. Geneva, Switzerland, 2013. Reference Source
9. Owino EA, Mafigiri D, Kamuya D, et al.: Equity, vulnerability and childhood immunization in Kenya and Uganda: a systematic review of policy documents protocol. Harvard Dataverse, 2023. Publisher Full Text
10. United Nations Children's Fund (UNICEF): Gender and Immunization Demand: Final Report and Recommendations. United Nations Children’s Fund (UNICEF): New York, USA, 2022. Reference Source
11. Ivanova V, Shahabuddin ASM, Sharkey A, et al.: Advancing Immunization Coverage and Equity: A Structured Synthesis of Pro-Equity Strategies in 61 Gavi-Supported Countries. Vaccines (Basel). 2023; 11(1): 191. PubMed Abstract | Publisher Full Text | Free Full Text
12. Dadari I, Higgins-Steele A, Sharkey A, et al.: Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries. Vaccine. 2021; 39(17): 2434–2444. PubMed Abstract | Publisher Full Text

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Version 2

VERSION 2 PUBLISHED 24 Nov 2023

Author details Author details

David Mafigiri
Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing

Dorcas Kamuya
Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing

Caroline Jones
Roles: Conceptualization, Funding Acquisition, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing

Primus Chi
Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

This project is funded by the National Institute for Health and Care Research (NIHR) under its [Global Health Research Units and Groups (GHRUG) Programme (Grant Reference Number NIHR134531)]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Article Versions (2)

version 2

Revised

Published: 27 May 2025, 3:64

https://doi.org/10.3310/nihropenres.13449.2

version 1

Published: 24 Nov 2023, 3:64

https://doi.org/10.3310/nihropenres.13449.1

© 2023 Owino EA et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Owino EA, Mafigiri D, Kamuya D et al. Equity, vulnerability and childhood immunization in Kenya and Uganda. A review of policy documents protocol. [version 1; peer review: 2 approved with reservations]. NIHR Open Res 2023, 3:64 (https://doi.org/10.3310/nihropenres.13449.1)

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Version 1

VERSION 1

PUBLISHED 24 Nov 2023

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Reviewer Report 11 May 2024

Nicholas Spencer, University of Warwick, Coventry, England, UK

Approved with Reservations

https://doi.org/10.3310/nihropenres.14588.r31141

As the authors state, equity in vaccination uptake and coverage is essential in achieving the targets of the WHO agenda 2021-2030. The proposed review aims to explore the extent to which issues of (in)equity are included in Kenyan and Ugandan policy documents and identify gaps and opportunities presumably with a view to informing strategies to promote equity. I assume that the authors are aware of existing inequity in the two countries and relevant existing data should be included in the introduction to give the reader an indication of the extent of the problem.
Methodology used in conducting a systematic reviews of policy documents may differ in some respects from that required for a systematic review of published literature but clear inclusion/exclusion criteria and an appropriate measure of quality of the document would seem to me to be essential components of a robust review. The policy analysis triangle may provide a measure of quality but the authors need to specify how they will assess quality.
This is a potentially valuable contribution to addressing vaccination inequity in these two countries but I think attention should be given to the issues I have raised.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Inequity in child health; Child Public Health including vaccination coverage issues

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 11 May 2024

Patricia Mechael, HealthEnabled, Cape Town, South Africa

Approved with Reservations

https://doi.org/10.3310/nihropenres.14588.r31362

This proposed review of equity policies related to immunization is an important and timely piece of work. One recommendation is to not call it a "systematic review" as that has connotations of a state of evidence review based on randomized controlled trials. Rather it could be referred to as a "systematic policy review" or "systematic review of policies."

A few additions that would strengthen the protocol would be the inclusion of a search strategy and/or initial coding structure, a proposed output of a timeline mapping number and type of equity-focused policies, and a proposed output of summarizing an equity-related immunization outcome (such as number/percent of zero-dose children) as available in existing surveys such as Demographic and Health Surveys and/or MICS.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Immunization, digital health, data use, health equity

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Author Response 28 May 2025

Esther Owino, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya

28 May 2025

Author Response

Thank you very much for this useful feedback.
We have incorporated the recommendation about the title. The revised title now reads as follows; Vulnerability and childhood immunization in Kenya: a systematic review ... Continue reading Thank you very much for this useful feedback.
We have incorporated the recommendation about the title. The revised title now reads as follows; Vulnerability and childhood immunization in Kenya: a systematic review of policy documents protocol

We have included the Inclusion and search strategy in the revised version.
We have also included a data extraction template as one of our extended data files.

Since we have revised the scope of the protocol and the focus is no longer on equity but vulnerability, the recommendation to map equity-based policies might not be applicable.
Thank you very much for this useful feedback.
We have incorporated the recommendation about the title. The revised title now reads as follows; Vulnerability and childhood immunization in Kenya: a systematic review of policy documents protocol

We have included the Inclusion and search strategy in the revised version.
We have also included a data extraction template as one of our extended data files.

Since we have revised the scope of the protocol and the focus is no longer on equity but vulnerability, the recommendation to map equity-based policies might not be applicable.
Competing Interests: None Close
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Author Response 28 May 2025

Esther Owino, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya

28 May 2025

Author Response

Thank you very much for this useful feedback.
We have incorporated the recommendation about the title. The revised title now reads as follows; Vulnerability and childhood immunization in Kenya: a systematic review ... Continue reading Thank you very much for this useful feedback.
We have incorporated the recommendation about the title. The revised title now reads as follows; Vulnerability and childhood immunization in Kenya: a systematic review of policy documents protocol

We have included the Inclusion and search strategy in the revised version.
We have also included a data extraction template as one of our extended data files.

Since we have revised the scope of the protocol and the focus is no longer on equity but vulnerability, the recommendation to map equity-based policies might not be applicable.
Thank you very much for this useful feedback.
We have incorporated the recommendation about the title. The revised title now reads as follows; Vulnerability and childhood immunization in Kenya: a systematic review of policy documents protocol

We have included the Inclusion and search strategy in the revised version.
We have also included a data extraction template as one of our extended data files.

Since we have revised the scope of the protocol and the focus is no longer on equity but vulnerability, the recommendation to map equity-based policies might not be applicable.
Competing Interests: None Close
Report a concern

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Version 2

VERSION 2 PUBLISHED 24 Nov 2023

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Version 2 (revision) 27 May 25	read
Version 1 24 Nov 23	read	read

Patricia Mechael, HealthEnabled, Cape Town, South Africa
Nicholas Spencer, University of Warwick, Coventry, UK

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30 May 2025 | for Version 2

Patricia Mechael, HealthEnabled, Cape Town, South Africa

7 Views Cite this report Responses(0)

Approved

This revision is much improved. The authors have sufficiently addressed the reviewer comments provided. I look forward to reading the study findings.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Immunization, digital health, data use, health equity

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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11 May 2024 | for Version 1

Nicholas Spencer, University of Warwick, Coventry, England, UK

12 Views Cite this report Responses(0)

Approved With Reservations

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Inequity in child health; Child Public Health including vaccination coverage issues

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11 Views

11 May 2024 | for Version 1

Patricia Mechael, HealthEnabled, Cape Town, South Africa

11 Views Cite this report Responses(1)

Approved With Reservations

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Immunization, digital health, data use, health equity

Respond to this report

Responses (1)

Author Response

28 May 2025

Esther Owino, Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya

Thank you very much for this useful feedback.
We have incorporated the recommendation about the title. The revised title now reads as follows; Vulnerability and childhood immunization in Kenya: a systematic review of policy documents protocol

We have included the Inclusion and search strategy in the revised version.
We have also included a data extraction template as one of our extended data files.

Since we have revised the scope of the protocol and the focus is no longer on equity but vulnerability, the recommendation to map equity-based policies might not be applicable.

View more View less

Competing Interests

None

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

[1] 1. Doherty M, Buchy P, Standaert B, et al.: Vaccine impact: Benefits for human health. Vaccine. 2016; 34(52): 6707–6714. PubMed Abstract | Publisher Full Text

[2] 2. World Health Organization (WHO). Reference Source

[3] 3. Ikilezi G, Augusto OJ, Sbarra A, et al.: Determinants of geographical inequalities for DTP3 vaccine coverage in sub-Saharan Africa. Vaccine. 2020; 38(18): 3447–3454. PubMed Abstract | Publisher Full Text

[4] 4. World Health Organzation (WHO): Explorations of inequality: Childhood immunization. Geneva, Switzerland, 2018. Reference Source

[5] 5. World Health Organization (WHO): Immunization Agenda 2030: A global strategy to leave no one behind.

[6] 6. Donfouet HPP, Agesa G, Mutua MK: Trends of inequalities in childhood immunization coverage among children aged 12-23 months in Kenya, Ghana, and Cote d'Ivoire. BMC Public Health. 2019; 19(1): 988. PubMed Abstract | Publisher Full Text | Free Full Text

[7] 7. World Health Organization (WHO): Regional Strategic Plan for Immunization 2014-2020. Brazzaville, Republic of Congo, 2015. Reference Source

[8] 8. World Health Organization (WHO): Global Vaccine Action Plan 2011-2020. Geneva, Switzerland, 2013. Reference Source

[9] 9. Owino EA, Mafigiri D, Kamuya D, et al.: Equity, vulnerability and childhood immunization in Kenya and Uganda: a systematic review of policy documents protocol. Harvard Dataverse, 2023. Publisher Full Text

[10] 10. United Nations Children's Fund (UNICEF): Gender and Immunization Demand: Final Report and Recommendations. United Nations Children’s Fund (UNICEF): New York, USA, 2022. Reference Source

[11] 11. Ivanova V, Shahabuddin ASM, Sharkey A, et al.: Advancing Immunization Coverage and Equity: A Structured Synthesis of Pro-Equity Strategies in 61 Gavi-Supported Countries. Vaccines (Basel). 2023; 11(1): 191. PubMed Abstract | Publisher Full Text | Free Full Text

[12] 12. Dadari I, Higgins-Steele A, Sharkey A, et al.: Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries. Vaccine. 2021; 39(17): 2434–2444. PubMed Abstract | Publisher Full Text

Equity, vulnerability and childhood immunization in Kenya and Uganda. A review of policy documents protocol.

Abstract

Introduction

Methods

Discussion

Plain Language Summary

Plain English Summary

Keywords

Introduction

Methods

Eligibility criteria

Information sources

Search strategy

Study records

Review outcomes

Risk of bias in individual studies

Data synthesis

Meta-bias(es)

Confidence in cumulative evidence

Study status

Conclusion

Data availability

Extended data

Reporting guidelines

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

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Equity, vulnerability and childhood immunization in Kenya and Uganda. A review of policy documents protocol.

Abstract

Introduction

Methods

Discussion

Plain Language Summary

Plain English Summary

Keywords

Introduction

Methods

Eligibility criteria

Information sources

Search strategy

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Risk of bias in individual studies

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Confidence in cumulative evidence

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Conclusion

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Extended data

Reporting guidelines

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