Advances in childhood immunisation in South Africa: where to now? Programme managers’ views and evidence from systematic reviews

Table 6 Summary of the quality of evidence

Challenges identified by EPI managers	Remedial strategies suggested by EPI managers	GRADE quality of evidence*
Insufficient knowledge of vaccines and immunisation issues among health workers	Regular education	High
	Supportive supervision/educational outreach	High
	Audit and feedback	High
	Printed educational materials.	Low
Anti-immunisation rumours and resistance from parents	Parent reminder and recall systems	Moderate
	Community health workers	Moderate
	Mass media	Moderate
	Structured, tailored, or interactive communication tools	Moderate
	Conditional cash transfers	Moderate
Insufficient financial and human resources	Tax-funded financing of immunisation programmes	No systematic review of effects
	Social health insurance scheme for financing of EPI	Low

*GRADE quality of evidence (From reference [15]):
High quality: “We are very confident that the true effect lies close to that of the estimate of the effect”.
Moderate quality: “We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different”.
Low quality: “Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect”; Very low quality: “We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect”.

ISSN: 1471-2458