Abstract
Health facility (HF) and household (HH) data can complement each other to provide a better understanding of the factors that contribute to vaccination status. In 12 zones with low vaccination coverage within Kinshasa Province, Democratic Republic of Congo, we conducted 2 surveys: (1) a linked HH and HF survey among 6-11-month-old infants, and (2) a HH survey among 12-23-month-old children. Linked survey objectives were to identify factors associated with vaccination status and to explore methodological considerations for linked survey implementation. To provide linked HH and HF data, we enrolled 6-11-month-old infants in HH clusters in each zone and then surveyed HFs located within the 12 zones and cited by caregivers of the enrolled infants as the most recent HF visited for vaccination or curative care. To provide vaccination coverage estimates for the 12-zone area, we enrolled 12-23-month-old children in every fourth HH. Of the HHs with a child aged 6-23 months, 16% were ineligible because they had resided in the neighborhood for <3 months or were unavailable to be interviewed, 4% refused, and 80% were eligible and participated. Of 1224 enrolled infants 6-11 months of age, records of 879 (72%) were linked to one of the 182 surveyed HFs. For the coverage survey, 710 children aged 12-23 months participated. Home-based vaccination cards were available for 1210 of 1934 children (63%) surveyed. The surveys were successful in assessing HH information for 2 age groups, documenting written vaccination history for a large proportion of 6-23-month-old children, linking the majority of infants with their most recently visited HF, and surveying identified HFs. The implementation of the individually linked survey also highlighted the need for a comprehensive list of HFs and an analysis plan that addresses cross-classified clusters with only 1 child.
Highlights
Household (HH) and health facility (HF) data can complement each other to provide a better understanding of the demand- and supply-side factors that contribute to infant vaccination status [1, 2, 3]
The expected number of HFs was unknown before the survey; 182 HFs located within the 12 zones of interest and cited by caregivers of the enrolled 6–11 month old infants as the most recent facility attended for vaccination or curative care were enrolled in the survey
Of the 1,224 infants 6–11 months of age who participated in this survey, 879 (72%) infants were linked to an interviewed HF located in one of the 12 zones of interest [Figure 3], with a range of 54 to 101 infants by infant zone of residence
Summary
Household (HH) and health facility (HF) data can complement each other to provide a better understanding of the demand- and supply-side factors that contribute to infant vaccination status [1, 2, 3]. Caregivers in 81% of HHs identified for the 6–11 month old survey were interviewed, providing data for 1,224 infants, 62% of the protocol’s sample size. Caregivers in 77% of HHs identified for the 12–23 month old survey were interviewed, providing data for 710 children, 66% of the protocol’s sample size. The expected number of HFs was unknown before the survey; 182 HFs located within the 12 zones of interest and cited by caregivers of the enrolled 6–11 month old infants as the most recent facility attended for vaccination or curative care were enrolled in the survey. For 51 infants, including the 30 that were interviewed using the 12–23 month old form, there was not adequate information to identify the HF; 9 infants were linked to a HF in the 12 zones of interest and had vaccination history abstracted from the register, but the facility was not interviewed. The register abstraction forms for 45 infants were not available
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