Redefining vaccination coverage and timeliness measures using electronic immunization registry data in low- and middle-income countries

Jessica C. Shearer,Skye S. Gilbert,Emily Carnahan,Tove K. Ryman,Emily N. Beylerian,Jenny Thompson,Samantha B. Dolan,Laurie Werner

doi:10.1016/j.vaccine.2019.02.017

Abstract

Vaccine coverage is routinely used as a performance indicator for immunization programs both at local and global levels. For many national immunization programs, there are challenges with accurately estimating vaccination coverage based on available data sources, however an increasing number of low- and middle-income countries (LMICs) have begun implementing electronic immunization registries to replace health facilities’ paper-based tools and aggregate reporting systems. These systems allow for more efficient capture and use of routinely reported individual-level data that can be used to calculate dose-specific and cohort vaccination coverage, replacing the commonly used aggregate routine health information system data. With these individual-level data immunization programs have the opportunity to redefine performance measures to enhance programmatic decision-making at all levels of the health system. In this commentary, we discuss how measures for assessing vaccination status and program performance can be redefined and recalculated using these data when generated at the health facility level and the implications of the use and availability of electronic individual-level data.

Highlights

Immunization programs strive to ensure that every child within their target population is adequately protected from vaccinepreventable diseases (VPDs)
These measures are not new or novel, we present them in a context specific to immunization programs transitioning from aggregate measures, often generated by paper-based tools, to individual electronic data collection tools in low-resource settings and their potential limitations [14]
The terms drop-out, incomplete or partial vaccination, and lost to follow-up are often used interchangeably amongst immunization program staff; for the purposes of the measures discussed here, drop-out is antigen specific and refers to delays in the administration of subsequent scheduled antigen-doses while lost to follow-up refers to a child who does not return to a facility for any subsequent vaccinations

Summary

Introduction

Immunization programs strive to ensure that every child within their target population is adequately protected from vaccinepreventable diseases (VPDs). When an EIR has additional functionalities, such as vaccine management or interoperability with other electronic systems, it is considered an immunization information system (IIS) These systems allow for more efficient capture and use of routinely reported individual-level data that can be used to calculate dose-specific and cohort vaccination coverage, replacing the commonly used aggregate RHIS data [16]. We discuss major considerations for how measures for assessing vaccination status and program performance can be redefined and recalculated using individual-level data generated at the health facility level These measures are not new or novel, we present them in a context specific to immunization programs transitioning from aggregate measures, often generated by paper-based tools, to individual electronic data collection tools in low-resource settings and their potential limitations [14]. We aim to describe what it means for LMICs moving from aggregate to individual data by way of introduction of an EIR in terms of performance measurement

Historic measurement challenges in LMICs

Common vaccination measures

Vaccination coverage

Drop-out and lost to follow-up

Dose validity and timeliness

Potential benefits of EIRs to improve measurement

Challenges and considerations for using EIRs

Future directions

Conclusion