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The impact of interventions by a community-based organization on inner-city vaccination coverage: Fulton County,
C W LeBaron1, D Starnes, E F Dini
1National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. cel3@cdc.gov
Insights
Community-based reminder-recall strategies significantly improved childhood immunization rates in clinics. However, broader community saturation efforts did not show a statistically significant impact on vaccination coverage.
Area of Science:
- Public Health
- Community Health Interventions
- Vaccination Programs
Background:
- Childhood immunization is crucial for preventing infectious diseases.
- Community-based organizations play a vital role in public health initiatives.
- Identifying effective strategies to improve vaccination rates is an ongoing public health priority.
Purpose of the Study:
- To assess the effectiveness of community-based organization interventions on immunization rates among young children.
- To compare the impact of clinic-based versus residence-based intervention strategies.
Main Methods:
- A controlled community intervention trial was conducted in Fulton County, Georgia.
- Participants included children aged 3 to 59 months, recruited through public clinics and community residences.
- Interventions included clinic-based reminder-recall systems and comprehensive residence-based community saturation strategies.
Main Results:
- Clinic-based reminder-recall interventions led to a significant increase in vaccination series completion rates (15 percentage points, P=.046).
- Residence-based interventions showed an increase in vaccination rates, but the difference between intervention and control groups was not statistically significant (+3 percentage points, P=.78).
- Baseline vaccination rates were 43-52% for clinic-based and 44% for residence-based interventions.
Conclusions:
- Reminder-recall strategies implemented within clinics are effective in improving childhood immunization rates.
- Comprehensive, residence-based community saturation approaches, while increasing overall vaccination, did not demonstrate a statistically significant advantage over standard care in this trial.
- Further research may be needed to optimize community-based interventions for vaccination uptake.
Objective:
To evaluate the impact of interventions by a community-based organization on immunization rates.
Design:
Controlled community intervention trial.
Setting And Participants:
Children aged 3 to 59 months in Fulton County, Georgia, who were patients of 1 of 4 public clinics (clinic based), or residents of 1 of 9 inner-city communities (residence based).
Interventions:
(1) Clinic-based intervention included monthly review of clinic vaccination records to identify undervaccinated children followed by contact with family (reminder-recall strategy); (2) residence-based intervention included door-to-door assessment and education campaigns followed by mobile van vaccinations, temporary on-site vaccination stations, free child care and transportation to providers, incentives of food and baby products, focus groups, and coalitions with local organizations (community saturation with vaccination messages and opportunities).
Outcome Measures:
Change in vaccination rates after 1 year based on clinic record reviews and population surveys.
Results:
For clinic-based intervention, series completion rates improved from 43% (87/204) to 58% (99/170) in intervention clinics (P=.003), while rates in control clinics did not change from the baseline of 52% (81/157 to 78/150), for a net difference between intervention and control arms of +15 percentage points (P=.046). For residence-based intervention, age-appropriate vaccination rates improved from 44% (154/347) to 61% (260/429) in intervention communities (+17 percentage points; P<.001) compared with improvement of 44% (78/178) to 58% (129/221) for control communities (+14 percentage points; P=.004), but the difference between arms was not significant (+3 percentage points, P=.78).
Conclusions:
Reminder-recall activities by the community-based organization improved vaccination rates in intervention clinics compared with control clinics. A statistically significant impact on vaccination rates could not be detected for residence-based interventions by the community-based organization.
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