Enhancing Workforce Capacity to Improve Immunization Data Quality using Low Dose High-Frequency Intervention Approach in Ebonyi State, Nigeria: A Randomized Controlled Study

Abstract

ABSTRACT Background: Immunization data quality is poor, particularly in developing countries. This study evaluated the effect of a low-dose high-frequency (LDHF) capacity-building training approach in improving immunization data quality in Ebonyi State, Nigeria. Methods: A randomized controlled study was conducted in 145 health facilities selected through cluster sampling in Ebonyi State. The intervention comprised low but frequent training doses, supportive supervision, and peer mentoring delivered onsite by immunization officers to facility health workers. Immunization data quality was compared before and 6 months after the intervention using an interviewer-administered validated data quality self-assessment questionnaire. A percentage score ≥ 80% was classified as good quality. Variables were compared with the Student’s t and Chi-square significant tests. Findings: The total mean score of immunization data quality was higher in the intervention group, 66.8 ± 11.0, than in the control group, 55.5 ± 16.6 (P = 0.001). A higher proportion of facilities in the intervention (54.2%) than the control group (24.7%) had overall good quality data (P = 0.001). Similarly, a higher proportion of the intervention than the control group had good quality in the immunization monitoring system elements—recording, reporting, archiving, demographic information, core output, and use of evidence for action (P < 0.05). Health facilities with accurate data were higher in the intervention group, 95.8%, than in the control group, 71.1% (P = 0.001). A higher proportion in the intervention (93.7%) compared to the control group (68.0%) had complete data (P = 0.001). Conclusion: The study found low-quality immunization data, which improved more in the intervention group compared to the control group. This intervention approach should be adopted and scaled up.