Caregiver recall in childhood vaccination surveys: Systematic review of recall quality and use in low- and middle-income settings

Rakesh N. Modi, Carina King, Naor Bar-Zeev, Tim Colbourn

Research output: Contribution to journalReview article

Abstract

Introduction: High population coverage is key to the impact of vaccines. However, vaccine coverage estimates in low- and middle-income countries (LMICs) have repeatedly been shown to be of poor quality. LMICs often rely on ‘caregiver recall’ of vaccination, the validity and collection method of which remains uncertain. We aimed to critique the quality of caregiver recall and make recommendations for its collection and use. Methods: We performed a systematic review for methods assessing childhood vaccination coverage in LMICs. We searched Medline using variations of the key terms: (child) AND (vaccinat) AND (survey OR recall OR coverage) AND (reliab OR valid). We selected articles assessing the quality of recall in LMICs and extracted reported validity, reliability and completeness. We synthesised recommendations on collecting, analysing and presenting caregiver recall for varying resource availabilities. Results: Of 1268 articles, 134 full texts were screened and eight were included for review. There was heterogeneity in study designs, ways of incorporating recall data and outcomes measured. Sensitivity of recall was 41–98%; specificity was 12–80%. There was a dearth of reliability measures and no consistent method for dealing with data incompleteness. Conclusion: There are quality concerns with caregiver recall and difficulty in assessing it given the lack of a ‘gold standard’ for vaccine status. To improve coverage estimates and the impact of vaccines, caregiver recall should be used. Other recommendations include: recall is included for those presenting vaccine records; missing data is imputed; recall and record quality are assessed in a sub-sample; and sensitivity analyses are performed.

Original languageEnglish (US)
Pages (from-to)4161-4170
Number of pages10
JournalVaccine
Volume36
Issue number29
DOIs
StatePublished - Jul 5 2018

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caregivers
systematic review
childhood
Caregivers
Vaccination
income
Vaccines
vaccination
vaccines
methodology
Reproducibility of Results
gold
experimental design
Surveys and Questionnaires
Population

Keywords

  • Bias
  • Caregiver recall
  • Developing countries
  • Reproducibility of results
  • Vaccines

ASJC Scopus subject areas

  • Molecular Medicine
  • Immunology and Microbiology(all)
  • veterinary(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Caregiver recall in childhood vaccination surveys : Systematic review of recall quality and use in low- and middle-income settings. / Modi, Rakesh N.; King, Carina; Bar-Zeev, Naor; Colbourn, Tim.

In: Vaccine, Vol. 36, No. 29, 05.07.2018, p. 4161-4170.

Research output: Contribution to journalReview article

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N2 - Introduction: High population coverage is key to the impact of vaccines. However, vaccine coverage estimates in low- and middle-income countries (LMICs) have repeatedly been shown to be of poor quality. LMICs often rely on ‘caregiver recall’ of vaccination, the validity and collection method of which remains uncertain. We aimed to critique the quality of caregiver recall and make recommendations for its collection and use. Methods: We performed a systematic review for methods assessing childhood vaccination coverage in LMICs. We searched Medline using variations of the key terms: (child) AND (vaccinat∗) AND (survey OR recall OR coverage) AND (reliab∗ OR valid∗). We selected articles assessing the quality of recall in LMICs and extracted reported validity, reliability and completeness. We synthesised recommendations on collecting, analysing and presenting caregiver recall for varying resource availabilities. Results: Of 1268 articles, 134 full texts were screened and eight were included for review. There was heterogeneity in study designs, ways of incorporating recall data and outcomes measured. Sensitivity of recall was 41–98%; specificity was 12–80%. There was a dearth of reliability measures and no consistent method for dealing with data incompleteness. Conclusion: There are quality concerns with caregiver recall and difficulty in assessing it given the lack of a ‘gold standard’ for vaccine status. To improve coverage estimates and the impact of vaccines, caregiver recall should be used. Other recommendations include: recall is included for those presenting vaccine records; missing data is imputed; recall and record quality are assessed in a sub-sample; and sensitivity analyses are performed.

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