Immunization rates for children and adults are rising, but coverage levels have not reached optimal goals. As a result, vaccine-preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care, and large demands on primary care providers, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage.

Key findings

- Reminding people to have vaccinations likely increases the number of people who receive vaccinations by an average of 8 percentage points.

- Reminding people over the telephone was more effective than the other types of reminders.

- The increases in vaccinations were observed among children, adolescents, and adults.



Immunisation is a powerful public health strategy for improving child survival, not only by directly combatting key diseases that kill children but also by providing a platform for other health services. However, each year millions of children worldwide, mostly from low- and middle-income countries (LMICs), do not receive the full series of vaccines on their national routine immunisation schedule.

This review focuses on interventions for improving childhood immunisation coverage in LMICs.

Key findings

- Giving information about vaccinations to parents and community members, specially designed vaccination reminder cards, providing vaccines through regular immunization and rewards, identifying unvaccinated children through home visits and referrals to health clinics and integrating vaccination services with other services may lead to more children getting vaccinated ;

- Evidence-based discussions that aims at knowledge translation to community members may be more effective than conventional health education strategies;

- Integrating immunization services with other services may lead to more children getting vaccinated.


The Human papillomavirus (HPV) test and the Pap test are tests that a doctor performs to check for the development of cervical cancer or lesions that would grow into a cancer. These lesions can develop into cervical cancer within about 10 to 20 years. The HPV test checks whether a woman has an HPV infection which may lead to cervical cancer. If the HPV test is positive, it may mean that there are lesions that would grow into a cancer in the cervix. There are many types of HPV tests. One of them is called the HC2 test. The Pap test checks for whether cells in the cervix are abnormal. Abnormal cervical cells graded as ‘low grade to high grade’ may mean that there are changes in the cervix that may lead to cervical cancer. There are two types of Pap test:  conventional cytology and liquid-based cytology. Depending on the results of the test, a woman may need to have the cervix examined or could receive surgery to have the lesions removed.

Key findings

-For every 1000 women screened, around 20 women will have precancerous changes. HPV test will correctly identify 16 of these 20 women and will miss 4 while the Pap test will correctly identify 12 women and miss 8 of them.

-The women who are missed could develop cervical cancer

-For women screened who will not have precancerous changes (980), the HPV test will correctly identify 879 women and 101 women will be incorrectly told that they have a lesion while the Pap test will correctly identify 951 women and 29 will be incorrectly told that they have a lesion

-Women who are incorrectly told that they have a lesion may have their cervix examined or may receive surgery unnecessarily.


Typhoid fever and paratyphoid fever are infections caused by the bacteria Salmonella typhi and Salmonella paratyphi A respectively.

The term ‘enteric fever’ is used to describe both infections. Enteric fever can be difficult to diagnose as the signs and symptoms are similar to those of other infectious diseases that cause fever such as malaria.

The recommended test to confirm if a person has enteric fever is to grow the Salmonella from their blood. It takes at least 48 hours to give a result, so cannot help healthcare workers make a diagnosis the same day the blood culture is taken. Blood cultures may give a negative result even though a person has enteric fever. The test also requires a laboratory and trained staff, which are often unavailable in communities where enteric fever is common.

Key findings

- TUBEX showed an average sensitivity of 78% and specificity of 87%, Typhidot studies, showed an average sensitivity of 84% and specificity of 79% and Test-It Typhoid and prototypes (KIT) showed an average sensitivity of 69% and specificity of 90%.

- The sensitivity and specificity of TUBEX, Typhidot and its variants, and Test-it Typhoid test and its KIT protypes are not robust enough in terms of performance to replace existing diagnostic tools in enteric fever (blood cultures and Vidal).



Many health treatment and screening decisions have no single ’best’ choice. These types of decisions are considered ’preference sensitive’ because there is insufficient evidence about outcomes or there is a need to trade off known benefits and harms. Clinical Evidence analyzed 3000 treatments, classifying 50% as having insufficient evidence, 24% as likely to be beneficial, 7% as requiring trade-offs between benefits and harms, 5% as unlikely to be beneficial, 3% as likely to be ineffective or harmful, and only 11% as being clearly beneficial. Not only does one have to take into account the strength of the evidence, but even for the 11% of treatments that show beneficial effects for populations, physicians need to translate the probabilistic nature of the evidence for individual patients to help them reach a decision based on informed values. Patient decision aids are an intervention that can be used to present such evidence.

Key findings

- People who use decision aids may achieve decisions that are consistent with their informed values (evidence is not as strong; more research could change results).

- People and their clinicians were more likely to talk about the decision when using a decision aid.

- Decision aids have a variable effect on the option chosen, depending on the choice being considered.

- Decision aids do not worsen health outcomes, and people using them are not less satisfied.