Facilitators and barriers for use of rotavirus vaccine amongst various stakeholders and its implications for Indian context – A systematic review

Figures & data

Table 1. Health care provider-related factors affecting uptake of rota viral vaccine.

Health care provider-related factors	References	Proportions of health care providers	RR or OR for behaviours significantly associated with likelihood for vaccination^$	Correlation with intention to vaccinate (r)
Being a paediatrician vs. family practitioner	^Citation14–Citation16^,^Citation18	70-88% (P); 46.1-55% (FP)	1.13 for P Ref: FP
Disease severity and need for vaccination
Perceived severity of the disease	^Citation14^,^Citation18^,^Citation19	55.6-83% (P); 46.1% (FP)	1.51-1.84
Experience of severe gastroenteritis during medical practice	^Citation19	84% (P)
Significant economic burden due to disease	^Citation19	62% (P)
Perceived need for vaccination	^Citation16^,^Citation18^,^Citation19	66- 83% (P); 28% (FP)	5.81
Perceived efficacy of vaccine	^Citation14^,^Citation16^,^Citation18^,^Citation19	45.1 -89% (P)	1.45 -4.13	0.54
Recommendation by health authorities	^Citation14^,^Citation16^,^Citation18	41-91.4% (P); 44% (FP)
Did not perceive need for vaccination	^Citation16^,^Citation18	12-16.3% (P); 33% (FP)	0.14-0.34
Vaccine-related factors
Knowledge about the vaccine and its schedule	^Citation18^,^Citation19	59-62% (P);32% (FP)
Complexity of recommendations for timing of rota vaccine doses	^Citation18	29% (P) 40% (FP)	0.59
Mode of administration of the vaccine	^Citation19	85% (P)		0.40
Logistic factors
Availability in public health system	^Citation14^,^Citation19	59% – 92.2% (P)
Unwarranted burden of work	^Citation18		0.34
Obtaining adequate supplies	^Citation18		0.65
Adding vaccine to already overloaded schedule	^Citation16^,^Citation18	8 -29% (P);50% (FP)	0.17 -0.47
Time taken to discuss vaccine safety with parents	^Citation16	14.5% (P)	0.10-0.64
Upfront cost to purchase vaccine	^Citation16^,^Citation18^,^Citation19	49.2-60% (P)	0.48	-0.22
Lack of reimbursement /adequate reimbursement	^Citation16^,^Citation18	75-81% (P)	0.42
Vaccine safety
Reluctance to vaccinate due to withdrawal of previous rota vaccine	^Citation16^,^Citation18	68% (P)	0.38, 0.45
Perception of vaccine safety	^Citation14^,^Citation16^,^Citation19	45.5 – 75.5% (P)	0.22 – 0.72
The fact that it's a new vaccine	^Citation19	44% (P)		-0.29

P – Paediatrician, FP – Family practitioner, ^{$ –} risk ratios of odd's ratios representing association of certain behaviours with the likelihood of vaccination as compared to all others.

Figure 1. PRISMA 2009 Flow Diagram.

Table 2. Health system -related factors for uptake of rota viral vaccine.

Health System-related factors	References	Proportion of stakeholders recommending/using vaccine	RR or OR for systems associated with significant likelihood for rota vaccination*	Correlation coefficient (r)
Practice setting	^Citation16^,^Citation18		HMO/HP/Clinic 1.36- 2.97 CHC/HBP 1.85 PP Ref
No of providers in practice	^Citation18		10 or more – 1.91 1to 3 -Ref
Type of primary care provider	^Citation15^,^Citation17	82% (P) 70.9% (FP)	P – 1.13; FP – Ref FP – 0.14; P -0.699; WBC – Ref
Availability of the vaccine in public health system or UIP	^Citation19^,^Citation20	59% paediatricians	Availability in public health system – 8.5 – 29.3
Coverage of routine immunisation (esp DTaP)	^Citation15	80.3% in infants receiving at least one dose of DTaP vs 62.2% in infants not receiving DTaP	≥ 1 dose of DTaP – 1.26 No DTaP – Ref
Routine vaccination with PCV	^Citation14		Received PCV -13.2 Not received PCV – Ref
Receiving DTaP vaccination within 24 or 32 weeks	^Citation22		DTaP<24 or 32 wks -17.8 DTap> 24 or 32 wks -Ref
Delay during pentavalent vaccination	^Citation21	Dose 1: 78.3% after age limit; 94.7% before age limit Dose 2: 64.1% after age limit; 87.7% before age limit	Dose 1: After age limit – 0.2 Before age limit – Ref. Dose 2: After age limit – 0.1 Before age limit -Ref
Delay in receiving DTP-HiB vaccine	^Citation23	Dose 1: 99.0% for DTP-Hib1 Vs 95.2% for Rota1 (3.8% difference) – 9.5% receiving dose 1 after 14 weeks Dose 2: 98.4% for DTP-Hib2 Vs 83.0% for Rota2 (15.4% difference) – 16.6% receiving dose 2 after 24 weeks		0.82, p = 0.09 0.90, p = 0.04
Vaccine being given with other routine immunisation	^Citation20		Given with routine vaccine – 4.3 Not given with routine vaccine – Ref

HMO – Health management organization; HP – Hospital, CHC – community health centre, HBP – Hospital based practice; UIP – universal immunisation program; P – paediatrician, FP – Family Physician; * – Ref is all others wherever not mentioned.

Table 3. Parent-related factors affecting uptake of rota viral vaccine.

Parent-related factors	References	Proportions of parents	OR or RR for parental factors/behaviours associated with significant likelihood for vaccination*	Correlation with intention to vaccinate
Proportion of parents recommending/vaccinating	^Citation17^,^Citation20^,^Citation4	67-92.2%	9.78
Education of fathers	^Citation17		Bachelor degree – 5.88 Master degree – 3.33 Primary education – Ref
Employment status of fathers	^Citation17		Unemployed -0.21 Fully salaried – ref
Employment status of mothers	^Citation17		Unemployed – 0.30 Fully salaried – ref
Household income	^Citation24^,^Citation17		> 75K $ – 2.24 <75K $ – ref EUR 2–3K – 2.63 EUR 3–4K – 3.125 > EUR 4 K – 5.55 ≤ EUR 2 K – Ref	0.11
Maternal age	^Citation15	< 25 yrs - 73.9% 30–35 yrs – 81.5%	0.91
Single parent	^Citation24			-0.06
Personal normative belief	^Citation20^,^Citation24		4.59 – 9.9	0.42
Subjective norm	^Citation20^,^Citation24		0.6 -2.5	0.24
Recommendation by doctors	^Citation20^,^Citation24		1.13 – 21.1
Recommendation by national advisory committee	^Citation20		21.7- 22.7
Information by media	^Citation20		0.54, 0.5

Personal normative belief – parents’ perceptions of the moral correctness of having their child vaccinated; Subjective norm – parents’ perceptions that significant others will approve rotavirus vaccination, * – Ref is all others wherever not mentioned.

Table 4. Vaccine-related and social/family-related factors for uptake of rota viral vaccine.

Factors	References	Proportions	RR or OR for factors associated with significant likelihood for vaccination	Correlation with intention to vaccinate	Beta associated with intention to vaccinate against rota
Vaccine-related factors
Mode of administration of the vaccine	^Citation19^,^Citation20^,^Citation4	85% health care providers	0.93 -2.5	0.40
Cost of the vaccine	^Citation16^,^Citation18^,^Citation19	49.2%-60% health care providers	0.48	-0.22
Social/family-related factors
First child	^Citation15^,^Citation20	46.2% vs. 28.7%	First child – 2.3 Birth order of 2 or more – ref
More than one child in the family	^Citation15^,^Citation17^,^Citation24	3 or more siblings in the family 58% vs. 71.2% for no sibling for at least one vaccination	3 or more siblings - 0.19- 0.89 No sibling/only child – Ref		-0.09
Gender	^Citation22^,^Citation25		Females – 0.99-1.02 Males – ref
Race	^Citation22		Black – 0.96 Hispanic – 0.98 White – ref
Daycare attendance	^Citation17		Professional daycare -2.17 No daycare – Ref

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