Desafíos y estrategias en la implementación de esquemas de inmunización en comunidades rurales: una revisión sistemática

Marcos Broumel Calderón López; Amparo Haydi Porras Casquete; Xavier Antonio Sandoval Poveda; Fabrizzio Roberto Araujo Reyna

doi:10.70577/ASCE/2272.2286/2025

Authors

Marcos Broumel Calderón López Universidad Cesar Vallejo https://orcid.org/0009-0002-7744-688X
Amparo Haydi Porras Casquete Universidad Cesar Vallejo https://orcid.org/0009-0002-1694-8093
Xavier Antonio Sandoval Poveda Universidad Cesar Vallejo https://orcid.org/0009-0008-6564-5308
Fabrizzio Roberto Araujo Reyna Universidad Cesar Vallejo https://orcid.org/0009-0007-2024-5397

DOI:

https://doi.org/10.70577/ASCE/2272.2286/2025

Keywords:

Vaccine Coverage, Rural Health Accessibility, Immunization Strategies

Abstract

The aim of this systematic review was to identify the main barriers in the implementation of immunization programs in rural areas, evaluate the strategies applied and formulate evidence-based recommendations to improve vaccination coverage and reduce inequalities in access to health care. Following the PRISMA protocol, an exhaustive search was carried out in databases such as PubMed, Scopus and Latindex, applying specific inclusion and exclusion criteria. After the selection and critical evaluation process, 18 studies were identified that provided relevant information on barriers and effective strategies in rural contexts. Among the most frequent barriers were limited geographic accessibility, insufficient health infrastructure, socioeconomic inequalities and cultural distrust of health services, factors that affect both coverage and continuity of vaccination schedules. On the other hand, successful strategies were identified, such as the decentralization of services through mobile brigades and community vaccination points, the strengthening of health education and the integration of immunization with other primary health care services. As a result, recommendations are proposed aimed at strengthening trust between communities and health personnel, improving health infrastructure and adopting comprehensive approaches that take into account socio-cultural and territorial particularities, which are essential to ensure equitable, sustainable and effective access to vaccination in rural areas.

Downloads

Download data is not yet available.

References

Akwataghibe, N., Ogunsola, E. A.., Broerse, J., Popoola, O., Agbo, A., & Dieleman, M. (2019). Exploring Factors Influencing Immunization Utilization in Nigeria—A Mixed Methods Study. Front. Public Health, 7(392), 1–13. https://doi.org/10.3389/fpubh.2019.00392 DOI: https://doi.org/10.3389/fpubh.2019.00392

Aquino, B., Correa, L., Loo, M., Guillen, N. R., & Alatrista, M. del S. (2022). Factores asociados al incumplimiento de la vacunación infantil de difteria, pertussis y tétanos en perú, año 2019. Rev. Fac. Med. Hum, 22(2), 287–296. https://doi.org/10.25176/RFMH.v22i2.4775 DOI: https://doi.org/10.25176/RFMH.v22i2.4775

Aslam, F., Ali, I., Babar, Z., & Yang, Y. (2022). Building evidence for improving vaccine adoption and uptake of childhood vaccinations in low- and middle-income countries: a systematic review. Drugs & Therapy Perspectives, 38, 133–145. https://doi.org/https://doi.org/10.1007/s40267-021-00890-7 DOI: https://doi.org/10.1007/s40267-021-00890-7

Asmare, G., Madalicho, M., & Sorsa, A. (2022). Disparities in full immunization coverage among urban and rural children aged 12-23 months in southwest Ethiopia: A comparative cross-sectional study. Human Vaccines & Immunotherapeutics, 18(6), 1–12. https://doi.org/10.1080/21645515.2022.2101316 DOI: https://doi.org/10.1080/21645515.2022.2101316

Calle, M. (2019). La vacunación a menores de 2 años en los cantones Cascales, Gonzalo Pizarro y Sucumbíos de la provincia de Sucumbíos, Ecuador. Revista Del Centro de Estudio y Desarrollo de La Amazonia, 9(2), 75–80. https://revistas.unl.edu.ec/index.php/cedamaz/article/view/707

Chopra, M., Bhutta, Z., Blanc, D. C., Checchi, F., Gupta, A., Lemango, E. T., Levine, O. S., Lyimo, D., Nandy, R., O’Brien, K., Okwo, J., Bele;, Rees, H., Soepardi, J., Tolhurst, R., & Victora, C. G. (2020). Addressing the persistent inequities in immunization coverage. Bulletin of the World Health Organization, 98(2), 146–148. https://doi.org/10.2471/BLT.19.241620 DOI: https://doi.org/10.2471/BLT.19.241620

De Oliveira, J., Pagotto, V., Rocha, B., Scalize, P, Guimarães, R., De Lima, M., Da Silva, L., Da Silva, M., Moura, W., Teles, S., Rosso, C., & Caetano, K. (2023). LowVaccine Coverage and Factors Associated with Incomplete Childhood Immunization in Racial/Ethnic Minorities and Rural Groups, Central Brazil. Vaccines, 11(838), 1–12. https://doi.org/10.3390/vaccines11040838 DOI: https://doi.org/10.3390/vaccines11040838

Galadima, A., Zulkefli, N., Said, S., & Ahmad, N. (2021). Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health, 21(1475), 1–20. https://doi.org/10.1186/s12889-021-11466-5 DOI: https://doi.org/10.1186/s12889-021-11466-5

Grimaldi, A., & Abreu, F. (2023). Principales factores que influyen en el alcance de coberturas de vacunación en niños menores de 2 años. Revista Pertinencia Académica, 7(2), 1–13. https://doi.org/10.5281/zenodo.8133162

Guan, H., Zhang, L., Chen, X., Zhang, Y., Ding, Y., & Liu, W. (2024). Enhancing vaccination uptake through community engagement: evidence from China. Scientific Reports, 10(10845). https://doi.org/10.1038/s41598-024-61583-5 DOI: https://doi.org/10.1038/s41598-024-61583-5

Kimera, A., Atuyambe, L., Mutyaba, H., Nantongo, C., Namagembe, A., Nalumansi, A. M., Basenero, A., Auma, P., Mukiza, N., & Mutyoba, J. (2024). Prevalence and factors associated with hepatitis b vaccination uptake and completion among communities targeted for mass vaccination in gulu: a cross-sectional study. BMC Public Health, 24(866), 1–9. https://doi.org/10.1186/s12889-024-18330-2 DOI: https://doi.org/10.1186/s12889-024-18330-2

Maves, R., Gaglani, B., & Salem, W. (2024). Breaking Down Barriers in Vaccine Coverage. CHEST, 166(1), 1–5. https://doi.org/10.1016/j.chest.2024.03.020 DOI: https://doi.org/10.1016/j.chest.2024.03.020

Monar, J. A., & Camacho, A. M. (2023). Factores de abandono de vacunación en niños menores de 2 años en Centro Salud Capilla de Pacay. FACSalud, 7(13), 4–12. https://doi.org/10.29076/issn.2602-8360vol7iss13.2023pp4-12p DOI: https://doi.org/10.29076/issn.2602-8360vol7iss13.2023pp4-12p

Muhoza, P., Shah, M., Gao, H., Amponsa, K., Quaye, P., Opare, W., Okae, C., Aboyinga, P., Opare, K., Wardle, M., & Wallace, A. S. (2023). Predictors for Uptake of Vaccines Offered during the Second Year of Life: Second Dose of Measles-Containing Vaccine and Meningococcal Serogroup A-Containing Vaccine, Ghana, 2020. Vaccines, 11(1515), 1–27. https://doi.org/10.3390/vaccines11101515 DOI: https://doi.org/10.3390/vaccines11101515

Page, M., McKenzie, J., Bossuyt, P., Boutron, I., Hoffmann, T., Mulrow, C., Shamseer, L., Tetzlaf, J., Akl, E., Brennan, S., Brennan, S., Glanville, J., Grimshaw, J., Hrobjartsson, A., Lalu, M., Li, T., Loder, E., Mayo, E., McDonald, S., Moher, D. (2021). Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Revista Española de Cardiología, 74(9), 790–799. https://doi.org/10.1016/j.recesp.2021.06.016 DOI: https://doi.org/10.1016/j.rec.2021.07.010

Singh, P., Dhalaria, P., Kashyap, S., Soni, G., Nandi, P., Ghosh, S., Mohapatra, M., Rastogi, A., & Prakash, D. (2022). Strategies to overcome vaccine hesitancy: a systematic review. Systematic Reviews, 11(78), 1–13. https://doi.org/https://doi.org/10.1186/s13643-022-01941-4 DOI: https://doi.org/10.1186/s13643-022-01941-4

Siramaneerat, I., & Agushybana, F. (2021). Inequalities in immunization coverage in Indonesia: a multilevel analysis. Rural and Remote Health, 21(6348), 1–11. https://doi.org/10.22605/RRH6348 DOI: https://doi.org/10.22605/RRH6348

Sychareun, V., Rowlands, L., Vilay, P., Durham, J., & Morgan, A. (2019). The determinants of vaccination in a semi rural area of Vientiane City, Lao People’s Democratic Republic: a qualitative study. Health Research Policy and Systems, 17(2), 1–12. https://doi.org/10.1186/s12961-018-0407-9 DOI: https://doi.org/10.1186/s12961-018-0407-9

Vanderpool, R., Stradtman, L., & Brandt, H. (2019). Policy opportunities to increase HPV vaccination in rural communities. Human Vaccines & Immunotherapeutics, 15(7–8), 1527–1532. https://doi.org/10.1080/21645515.2018.1553475 DOI: https://doi.org/10.1080/21645515.2018.1553475

Vasudevan, L., Baumgartner, J., Moses, S., Ngadaya, E., Mfinanga, S., & Ostermann, J. (2020). Parental concerns and uptake of childhood vaccines in rural Tanzania– a mixed methods study. BMC Public Health, 20(1573), 1–11. https://doi.org/10.1186/s12889-020-09598-1 DOI: https://doi.org/10.1186/s12889-020-09598-1

Yibeltal, K., Tsegaye, S., Zelealem, H., Worku, W., Demissie, M., Worku, A., & Berhane, Y. (2022). Trends, projection and inequalities in full immunization coverage in Ethiopia: in the period 2000-2019. BMC Pediatrics, 22(193), 1–11. https://doi.org/10.1186/s12887-022-03250-0 DOI: https://doi.org/10.1186/s12887-022-03250-0