Immunization Data Quality Research Articles

Monitoring progress of maternal and neonatal immunization in Latin America and the Caribbean

IntroductionThe Americas committed to strengthening maternal and neonatal immunization (MNI) through the Pan American Health Organization (PAHO) Regional Immunization Action Plan (RIAP) 2016–20. We describe the progress toward RIAP MNI-related targets and those related to improvement of data quality and information systems; analyze national MNI policies and vaccination coverages; and identify enablers and challenges of monitoring and reporting MNI vaccination coverage in Latin America and the Caribbean (LAC). MethodologyDescriptive study of national MNI policies, vaccination coverage, and information systems. Sources of information included PAHO–World Health Organization (WHO) / UNICEF Joint Reporting Forms on immunization (JRF) 2013–2019, and other reports. ResultsLAC has met two of three RIAP targets related to MNI (countries with universal hepatitis B birth dose introduction and elimination of maternal and neonatal tetanus) and is on track to meet the other (countries with vaccination of pregnant women). As of 2018, of the 49 countries and territories in LAC, 32 vaccinate pregnant women against influenza and 29 provide tetanus-containing vaccine. Twenty-five countries offer universal hepatitis B birth dose vaccine and 31 offer BCG vaccine. In 2018, regional influenza vaccine coverage among pregnant woman was 75%. Regional coverages for BCG and hepatitis B birth dose (<24 h) vaccines were 93% and 79%, respectively. Countries have exceeded RIAP targets related to the quality of vaccination coverage data and the establishment of electronic immunization registries (EIRs). Challenges in monitoring MNI coverage include estimation of denominators and difficulties disaggregating data by group (e.g., pregnant women versus other groups). ConclusionDespite progress in improving MNI in LAC, countries must further strengthen immunization monitoring systems and data quality to better report vaccination coverage among pregnant women and newborns. EIR and MNI information systems must be integrated, such that countries can use accurate data to design more timely and effective vaccination strategies.

Assessment of immunization data quality of routine reports in Ho municipality of Volta region, Ghana

BackgroundImmunization has been an important public health intervention for preventing and reducing child morbidity and mortality over the years and coverage has increased in the past decades. However, the validity of the data from immunization coverages is usually disputed. Immunization data from health facilities show poor concordance between tallied registers and monthly reports as they are reported to higher levels of the health system. The study assessed the quality of data from routine immunization of some health facilities in the Ho central municipality in the Volta region of Ghana.MethodsA descriptive cross-sectional study was used to review routine immunization data in tallied registers and reports submitted to the Municipal Health Directorate (MHD) from January to December, 2015. Simple random sampling was used to select three health facilities in Ho central municipality. The World Health Organization (WHO) Data Quality Self-assessment (DQS) tool was the main instrument used to present and analyze data for accuracy and discrepancy level between the tallied registers and reports. A template was created in Microsoft excel which automatically presented accuracy and discrepancy levels when data was entered. Ethical approval for the study was obtained from Ghana Health Service Ethics Review Committee.ResultsThe result showed discrepancies between recounted tallies at the facilities and reports submitted to the MHD. Accuracy ratios of 102, 64 and 94% for Bacillus Calmette Guerin (BCG), Pentavalent (Penta) vaccine dose 3 and Measles 2 respectively indicating underreporting for BCG and over reporting for the rest were obtained. There was 460 over reported data to the municipal level representing accuracy ratio of 80% and discrepancy level of 20%.ConclusionsImmunization data was characterized by underreporting and overreporting, hence not accurate and lacked quality. Immunization data quality should be a priority among health staff at health facilities.

Assessing the incremental costs and savings of introducing electronic immunization registries and stock management systems: evidence from the better immunization data initiative in Tanzania and Zambia.

IntroductionPoor data quality and use have been identified as key challenges that negatively impact immunization programs in low- and middle-income countries (LMICs). In addition, many LMICs have a shortage of health personnel, and staff available have demanding workloads across several health programs. In order to address these challenges, the Better Immunization Data (BID) Initiative introduced a comprehensive suite of interventions, including an electronic immunization registry aimed at improving the quality, reliability, and use of immunization data in Arusha Region, Tanzania, and Southern Province of Zambia. The objective of this study was to assess the incremental costs of implementing the BID interventions in immunization programs in these two countries.MethodsWe conducted a micro-costing study to estimate the economic costs of service delivery and logistics for the immunization programs with and without the BID interventions in a sample of health facilities and district program offices in each country. Structured questionnaires were used to interview immunization program staff at baseline and post-intervention to assess annual resource utilization and costs. Cost outcomes were reported as annual cost per facility, cost per district and changes in resource costs due to the BID interventions (i.e., costs associated with health worker time, start-up costs, etc.). Sub-group analyses were conducted by health facility to assess variation in costs by volume served and location (rural versus urban). One-way sensitivity analyses were conducted to identify influential parameters. Costs were reported in 2017 US dollars.ResultsIn Tanzania, the average annual reduction in resource costs was estimated at US$10,236 (95% confidence interval: $7,606-$14,123) per health facility, while the average annual reduction in resource costs per district was estimated at $6,542. In Zambia, reductions in resource costs were modest at an estimated annual average of $628 (95% confidence interval: $209-$1,467) per health facility and $236 per district. Resource cost reductions were mainly attributable to reductions in time required for immunization service delivery and reporting. One-way sensitivity analyses identified key cost drivers, all related to reductions in health worker time.ConclusionThe introduction of electronic immunization registries and stock management systems through the BID Initiative was estimated to result in potential time savings in both countries. Health worker time was the area most impacted by the interventions, suggesting that time savings gained could be utilized for patient care. Information generated through this work provides evidence to inform stakeholder decision-making for scale-up of the BID interventions in Tanzania and Zambia and to inform other Low-to-Middle-Income Countries (LMICs) interested in similar interventions.

Electronic Immunization Registries in Tanzania and Zambia: Shaping a Minimum Viable Product for Scaled Solutions.

As part of the work the Better Immunization Data (BID) Initiative undertook starting in 2013 to improve countries' collection, quality, and use of immunization data, PATH partnered with countries to identify the critical requirements for an electronic immunization registry (EIR). An EIR became the core intervention to address the data challenges that countries faced but also presented complexities during the development process to ensure that it met the core needs of the users. The work began with collecting common system requirements from 10 sub-Saharan African countries; these requirements represented the countries' vision of an ideal system to track individual child vaccination schedules and elements of supply chain. Through iterative development processes in both Tanzania and Zambia, the common requirements were modified and adapted to better fit the country contexts and users' needs, as well as to be developed with the technology available at the time. This process happened across four different software platforms. This paper outlines the process undertaken and analyzes similarities and differences across the iterations of the EIR in both countries, culminating in the development of a registry in Zambia that includes the most critical aspects required for initially deploying the registry and embodies what could be considered the minimum viable product for an EIR.

Accuracy and quality of immunization data in Iran: findings from data quality self-assessment survey in 2017

BackgroundThe aim of this study was to assess the accuracy and quality of immunization data on the pentavalent (diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B (Hib)) and MMR vaccines as the administrative data of the expanded program on immunization (EPI) in Iran.MethodsWe conducted a Data Quality Self-assessment (DQS) survey from October to December 2017. Standardized DQS tools were used to assess the accuracy of reported immunizations data and quality of the immunization monitoring system at the provincial level of the healthcare system including health houses, health posts, rural and urban health centers and district health centers. Multistage cluster random sampling with proportional to size (PPS) weights was used to select target provinces and related health units. Accuracy ratio, quality index (QI), completeness and relevant quality indices of first dose of MMR (MMR1) and third dose of pentavalent vaccines were reported. Corresponding period of the survey was limited to reported administrative immunization data during the first 6 months of 2016.ResultsIn relation to accuracy ratio, there was some evidence of under reporting of pentavalent (3rd dose) and MMR1 vaccines in health house units which were 100.94 and 101.1%, respectively. Completeness of reporting for both vaccines at different provincial levels was near 100%. However, the corresponding value for pentavalent (3rd dose) and MMR1 vaccines at the level of urban health centers was 96.67 and 94.17% respectively.Among the five components of a monitoring system data usage and core output had the lowest QI scores in either rural or urban as well as district healthcare centers.ConclusionsFindings from our DQS survey reveals that administrative reporting of the immunization data was adequate at provincial and district levels of the healthcare centers. Although, addressing the existing concerns regarding timelines of the reporting by health authorities and staffs of EPI is warranted.

Defining & assessing the quality, usability, and utilization of immunization data

BackgroundHigh quality data are needed for decision-making at all levels of the public health system, from guiding public health activities at the local level, to informing national policy development, to monitoring the impact of global initiatives. Although a number of approaches have been developed to evaluate the underlying quality of routinely collected vaccination administrative data, there remains a lack of consensus around how data quality is best defined or measured.DiscussionWe present a definitional framework that is intended to disentangle many of the elements that have confused discussions of vaccination data quality to date. The framework describes immunization data in terms of three key characteristics: data quality, data usability, and data utilization. The framework also offers concrete suggestions for a specific set of indicators that could be used to better understand immunization those key characteristics, including Trueness, Concurrence, Relevancy, Efficiency, Completeness, Timeliness, Integrity, Consistency, and Utilization.ConclusionBeing deliberate about the choice of indicators; being clear on their definitions, limitations, and methods of measurement; and describing how those indicators work together to give a more comprehensive and practical understanding of immunization data quality, usability, and use, should yield more informed, and therefore better, programmatic decision-making.

Assessing electronic immunization registries: the Pan American Health Organization experience.

ABSTRACTObjective.To develop a methodology to assess electronic immunization registries (EIRs) in low- and middle-income countries (LMICs) in Latin America and the Caribbean.Methods.A team from the Immunization Unit at the Pan American Health Organization (PAHO) reviewed existing methodologies to evaluate health information systems, particularly the Performance of Routine Information System Management (PRISM) framework and methodologies used to assess information systems. In 2014, the PAHO team convened a small working group to develop an evaluation approach to be added to the existing World Health Organization immunization data quality self-assessment (DQS) tool. The resulting DQS with an added EIR component was named “DQS Plus.” The DQS Plus methodology was used in Panama in May 2014 and in Honduras in November 2015.Results.The DQS Plus tool proved feasible and easy to implement in Panama and Honduras, including by not adding much time or resources to those needed for a usual DQS. The information obtained from the DQS Plus assessment was practical and helped provide health authorities with recommendations to update and improve their EIR, strengthen the use of the registry, and enhance the data the assessment produced, at all levels of the health system. These recommendations are currently being implemented in the two countries.Conclusions.The DQS Plus proved to be a practical and useful approach for assessing an EIR in an LMIC and generating actionable recommendations. Further work on defining operational and related EIR functional standards in LMICs will help develop an improved EIR assessment tool for Latin America and the Caribbean, and potentially elsewhere.

Improving immunization data quality in Peru and Mexico: Two case studies highlighting challenges and lessons learned

IntroductionThe Global Vaccine Action Plan and the Regional Immunization Action Plan of the Americas call for countries to improve immunization data quality. Immunization information systems, particularly electronic immunization registries (EIRs), can help to facilitate program management and increase coverage. However, little is known about efforts to develop and implement such systems in low- and middle-income countries. We present the experiences of Mexico and Peru in implementing EIRs. MethodsWe conducted case studies of an EIR in Mexico and of a population registry in Peru. Information was gathered from technical documents, stakeholder focus groups, site visits, and semi-structured interviews of national stakeholders. We organized findings into narratives that emphasized challenges and lessons learned. ResultsMexico built one of the world’s first EIRs, incorporating novel features such as local-level tracking of patients; however, insufficient resources and poor data registration practices led to the system’s discontinuation. Peru created an information system to improve affiliation to social programs, including the immunization program and quality of demographic data. Mexico’s experience highlights lessons in failed sustainability of an EIR and a laudable effort to reform a country’s information system. Peru’s demonstrates that attempts to improve health and other data may strengthen health systems, including immunization data. Major challenges in information system implementation and sustainability in Peru and Mexico related to funding, clear governance structures, and resistance among health workers. DiscussionThese case studies reinforce the need for countries to ensure adequate funding, plans for sustainability, and health worker capacity-building activities before implementing EIRs. They also suggest new approaches to implementation, including economic incentives for sub-national administrative levels and opportunities to link efforts to improve immunization data with other health and political priorities. More information on best practices is needed to ensure the successful adoption and sustainability of immunization registries in low- and middle-income countries.

Factors that affect immunization data quality in Kabarole District, Uganda.

IntroductionReliable and timely immunization data is vital at all levels of health care to inform decisions and improve program performance. Inadequate data quality may impair our understanding of the true vaccination coverage and also hinder our capability to meet the program objectives. It’s therefore important to regularly assess immunization data quality to ensure good performance, sound decision making and efficient use of resources.MethodsWe conducted an immunization data quality audit between July and August 2016. The verification factor was estimated by dividing the recounted diphtheria, pertussis and tetanus third dose vaccination for children under 1 year (DPT3<1 year) by reported DPT3<1 year. The quality of data collection processes was measured using quality indices for the 3 different components: recording practices, storage/reporting, monitoring and evaluation. These indices were applied to the different levels of the health care service delivery system. Quality index score was estimated by dividing the total question or observation correctly answered by the total number of answers/ observations for a particular component.ResultsThe mean health center verification factor was 87%. Sixty five percent (32/49) of the health centers had consistent data, 27% (13/49) over reported and 4% (2/49) under-reported. Health center 11s and 111s contributed to over-reporting and under-reporting. All the health centers’ reports were complete and timely between January and June and from November to December. The mean quality indices for the 3 different componets assessed were; recording practices 66%, storing/reporting 75%, monitoring and evaluation 43%. There was a weak positive correlation between the health center verifaction factor and quality index though this was not statistically significant (r = 0.014; p = 0.92).ConclusionLower level health centers contributed significantly to the inconsistencies in immunization data; there were wide variation between the quality indices of recording practices, storage/reporting, monitoring and evaluation. We recommended that District Local Governments and Ministry of Health focus on improving data quality at lower levels of health service delivery.

Assessment of routine immunization data quality in Oyo State, Nigeria, 2016

Introduction : quality routine immunization (RI) data is essential for proper planning and effective decision making. In February 2016, RI module of DHIS 2 was implemented in Oyo State to improve RI data quality and strengthen data management. Prior to its implementation, RI data were reported via administrative methods characterized by good reporting rate but poor quality. In November 2016, we assessed the quality of RI data in the State to determine if there was improvement in RI data quality and identify remaining gaps.

Country Immunization Information System Assessments - Kenya, 2015 and Ghana, 2016.

The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya=50%, Ghana=53%) and poor data concordance between child registers and facility tally sheets (Kenya=0%, Ghana=3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.

Immunization dropout rate and data quality among children 12\u201323 months of age in Ghana

BackgroundImmunization against diseases is one of the most important public health interventions with cost effective means to preventing childhood morbidity, mortality and disability. However, a proportion of children particularly in Africa are not fully immunized with the recommended vaccines. Thus, many children are still susceptible to the Expanded Program on Immunization (EPI) targeted diseases. The objective of this study was to determine the immunization dropout rate and data quality among children aged 12–23 months in Techiman Municipality, Ghana.MethodsA cross-sectional cluster survey was conducted among 600 children. Data was collected using semi-structured questionnaire through face-to-face interviews. Before the main data collection, the tools were pre-tested in three different communities in the Municipality. The mothers/caregivers were interviewed, extracted information from the child immunization cards and observation employed to confirm the presence of Bacillus Calmette-Guerin (BCG) scar on each child. Routine immunization data was also extracted from immunization registers and annual reports in the Municipality.ResultsImmunization coverage for each of the fifteen vaccines doses is above 90.0% while full childhood immunized status is 89.5%. Immunization dropout rate was 5.6% (using BCG and Measles as proxy vaccines). This is lower than the 10.0% cutoff point by World Health Organization. However, routine administrative data was characterized by some discrepancies (e.g. > 100.0% immunization coverage for each of the vaccines) and high dropout rate (BCG - Measles = 31.5%). Binary regression was performed to determine predictors of dropout rate. The following were statistically significant: married (OR = 0.31; 95% = CI 0.15–0.62; and p = 0.001), Christianity (OR = 0.27; 95% CI = 0.13–0.91; and p < 0.001), female child (OR = 0.50; 95% CI = 0.26–0.91; and p = 0.024) and possession of immunization card (OR = 50.3; 95% CI = 14.40–175.92; and p < 0.001) were found to be associated with immunization dropout.ConclusionChildhood full immunized status (89.5%) and immunization coverages (>90%) are high while dropout rate is lower than the recommended cutoff point by WHO. However, immunization data quality remains inadequate. Thus, health education and orientation of service providers is urgently needed. In addition, immunization registers and data quality are issues that require attention.

A pilot study of routine immunization data quality in Bunza Local Government area: causes and possible remedies.

IntroductionAs a result of poor quality administrative data for routine immunisation (RI) in Nigeria, the real coverage of RI remains unknown, constituting a setback in curtailing vaccine preventable diseases (VPDs). Consequently, the purpose of this pilot study is to identify source(s) and evaluate the magnitude of poor data quality as well as propose recommendations to address the problem.MethodsThe authors conducted a cross-sectional study in which 5 out of the 22 health facilities providing routine immunization services in Bunza Local Government Area (LGA), Kebbi State, Nigeria, were selected for data quality assessment. The reported coverage of RI in August and September, 2016 was the primary element of evaluation in the selected Health Facilities (HFs). Administered questionnaires were adapted from WHO Data Quality Assurance and RI monitoring tools to generate data from the HFs, as well as standardised community survey tool for household surveys.ResultsData inconsistency was detected in 100% of the selected HFs. Maximum difference between HF monthly summary and RI registration book for penta 3 data quality report analysis was 820% and 767% in MCH Bunza and PHC Balu respectively. However, a minimum difference of 3% was observed at Loko Dispensary. Maximum difference between HF summary and RI registration for measles was 614% at MCH Bunza and 43% minimum difference at Loko. In contrast to the administrative coverage, 60-80% of the children sampled from households were either not immunised or partially immunised. Further, the main sources of poor data quality include heavy workload on RI providers, over-reliance on administrative coverage report, and lack of understanding of the significance of high data quality by RI providers.ConclusionSubstantial data discrepancies were observed in RI reports from all the Health Facilities which is indicative of poor data quality at the LGA level. Community surveys also revealed an over-reporting from administrative coverage data. Consequently, efforts should be geared towards achieving good data quality by immunisation stakeholders as it has implication on disease prevention and control efforts.

Auditing the Immunization Data Quality from Routine Reports in Shangyu District, East China.

Objective: To evaluate the immunization data quality in Shangyu District, East China. Methods: An audit for immunization data for the year 2014 was conducted in 20 vaccination clinics of Shangyu District. The consistency of immunization data was estimated by verification factors (VFs), which was the proportion of vaccine doses reported as being administered that could be verified by written documentation at vaccination clinics. The quality of monitoring systems was evaluated using the quality index (QI). Results: The VFs of 20 vaccine doses ranged from 0.94 to 1.04 at the district level. The VFs for the 20 vaccination clinics ranged from 0.57 to 1.07. The VFs for Shangyu District was 0.98. The mean of total QI score of the 20 vaccination clinics was 80.32%. A significant correlation between the VFs of the 3rd dose of the diphtheria–tetanus–pertussis combined vaccine (DTP) and QI scores was observed at the vaccination clinic level. Conclusions: Deficiencies in data consistency and immunization reporting practice in Shangyu District were observed. Targeted measures are suggested to improve the quality of the immunization reporting system in vaccination clinics with poor data consistency.

The impact of electronic health record (EHR) interoperability on immunization information system (IIS) data quality.

Objectives: To evaluate the impact of electronic health record (EHR) interoperability on the quality of immunization data in the North Dakota Immunization Information System (NDIIS). Methods: NDIIS doses administered data was evaluated for completeness of the patient and dose-level core data elements for records that belong to interoperable and non-interoperable providers. Data was compared at three months prior to electronic health record (EHR) interoperability enhancement to data at three, six, nine and twelve months post-enhancement following the interoperability go live date. Doses administered per month and by age group, timeliness of vaccine entry and the number of duplicate clients added to the NDIIS was also compared, in addition to, immunization rates for children 19 – 35 months of age and adolescents 11 – 18 years of age. Results: Doses administered by both interoperable and non-interoperable providers remained fairly consistent from pre-enhancement through twelve months post-enhancement. Comparing immunization rates for infants and adolescents, interoperable providers had higher rates both pre- and post-enhancement than non-interoperable providers for all vaccines and vaccine series assessed. The overall percentage of doses entered into the NDIIS within one month of administration varied slightly between interoperable and non-interoperable providers; however, there were significant changes between the percentage of doses entered within one day and within one week with the percentage entered within one day increasing and within one week decreasing with interoperability. The number of duplicate client records created by interoperable providers increased from 94 duplicates pre-enhancement to 10,552 at twelve months post-enhancement, while the duplicates from non-interoperable providers only increased from 300 to 637 over the same period. Of the 40 core data elements in the NDIIS, there was some difference in completeness between the interoperable versus non-interoperable providers. Only middle name, sex, county, phone number, mother’s maiden name, vaccine manufacturer, lot number and expiration date were significantly (>=5%) different between the two provider groups. Conclusions: Interoperability with provider EHRs has had an impact on NDIIS data quality. Timeliness of data entry has improved and overall doses administered have remained fairly consistent, as have the immunization rates for the providers assessed. There are more technical and non-technical interventions that will need to be accomplished by NDIIS staff and vendor to help reduce the negative impact of duplicate record creation, as well as, data completeness.

Qualité des données de vaccination chez les enfants de 0 à 11 mois en Côte d’Ivoire

In order to guide the decisions of programme managers, an immunization Data Quality Self-Assessment was performed in Côte d’Ivoire in 2012. This study was designed to assess the accuracy of immunization data and the quality of the immunization tracking system with this tool. A descriptive cross-sectional study was conducted in 88 randomly selected immunization facilities from 30 health districts. These structures were included in the study based on the number of children aged 0-11 months who received three doses of vaccine against Diphtheria, Tetanus, Pertussis, Hepatitis B Viral and Haemophilus Influenzae b on the one hand and measles vaccine coverage on the other. This assessment focused on two criteria in particular: accuracy of immunization data measured by the verification factor (VF) and the quality of the immunization tracking system. The accuracy of immunization data was satisfactory at the district level (VF=95%), but not for the health centre level (VF=81%), as 73% of health districts and health centres obtained a satisfactory factor (≥95%).The number of children aged 0-11 months vaccinated differed from one level of the health system to another and from one document to another.The mean quality index was not satisfactory for both the district and health centre levels (64% vs 50%). Only one health district and one health centre obtained a quality index greater than 80%. Furthermore, 93% of health districts and 50% of health centres obtained quality indices ranging from 50% and 80%, respectively.The weakest components at both levels were “supervision and monitoring” and “analysis and use of data”. The deficiencies in data reporting and the quality of the immunization monitoring system need to be improved by supportive supervision.

Accuracy of Measles Immunization Records and Reporting in Maternal and Child Health Card and Cohort Book

ABSTRACTInfectious diseases such as diseases that can be prevented by immunization remains a problem in Indonesia, one of which is measles. The government has sought to prevent through measles immunization in infants aged 9 months. Seeing the efforts that have been made through measles immunization program and still finding measles in the community, it is necessary to evaluate the success of programs related to the measles immunization. This study was conducted to determine the problems that occur in terms of recording and reporting of data related to measles immunization in particular measles immunization data quality. The population was 5 posyandu with the highest number of children under five in the region of new health centers Gunung Anyar city of Surabaya. The number of respondents is as much as 50 respondents with details of each neighborhood health center will take 10 respondents. The sample selection is done through a rapid survey method. The variables studied were the quality of immunization data on books maternal and child health card or other health records compared with immunization data on a cohort book. Other variables are the quality of data on infants in posyandu regiter book by book cohort. The results showed that the percentage of the suitability of the data of measles in the community with book five cohort remains low in the neighborhood health center. Meanwhile, the percentage of suitability daata on the register books with babies in posyandu cohort book is also fairly low. This suggests that the quality of data recorded measles immunization is relatively low.Keywords: immunization, measles,infant recording, reporting

Accuracy of Measles Immunization Records and Reporting in Maternal and Child Health Card and Cohort Book

ABSTRACTInfectious diseases such as diseases that can be prevented by immunization remains a problem in Indonesia, one of which is measles. The government has sought to prevent through measles immunization in infants aged 9 months. Seeing the efforts that have been made through measles immunization program and still finding measles in the community, it is necessary to evaluate the success of programs related to the measles immunization. This study was conducted to determine the problems that occur in terms of recording and reporting of data related to measles immunization in particular measles immunization data quality. The population was 5 posyandu with the highest number of children under five in the region of new health centers Gunung Anyar city of Surabaya. The number of respondents is as much as 50 respondents with details of each neighborhood health center will take 10 respondents. The sample selection is done through a rapid survey method. The variables studied were the quality of immunization data on books maternal and child health card or other health records compared with immunization data on a cohort book. Other variables are the quality of data on infants in posyandu regiter book by book cohort. The results showed that the percentage of the suitability of the data of measles in the community with book five cohort remains low in the neighborhood health center. Meanwhile, the percentage of suitability daata on the register books with babies in posyandu cohort book is also fairly low. This suggests that the quality of data recorded measles immunization is relatively low.Keywords: immunization, measles,infant recording, reporting

Adequacy and quality of immunization data in a comprehensive electronic health record system.

Background and Purpose: Timely, simultaneous and combined vaccination is important to protect children from common infectious diseases. In a large health care delivery system in Western Kenya, we examined the adequacy and quality of data within the electronic health record (EHR) to assess the feasibility of developing a clinical decision support system to improve childhood vaccination uptake and coverage. Methods: The study evaluated vaccination information collected and stored in an EHR between 2006 and 2012 involving 23,270 children. Encounters for 10,299 children lacked immunization information and were excluded. Results: Documentation of vaccination coverage and timeliness is rendered in Kaplan–Meier time-to-event plots. Vaccination coverage at the end of one year ranges from 60% to 90% for all vaccines assessed individually that are part of the Kenya Expanded Program on Immunization (KEPI). Timely documentation of vaccination is low, with 52.8 weeks (95% CI: 52.1, 53.5) for measles vaccine and 29.2 weeks (95% CI: 28.5, 29.8) for the Bacillus Calmette–Guerin (BCG) vaccine. Complete vaccine observations were recorded in 16% of the encounters. Combination and simultaneous vaccine administration had high congruence and consistency. Conclusion: A clinical decision support system that generates reminders to clinicians and caretakers of children would optimize vaccination uptake and improve overall immunization coverage. To achieve this, immunization data in the EHR must be timely, complete and consistent. Assessed vaccination timeliness is low, despite high coverage. Vaccine observations are often incomplete. There is need to improve the data collection process to achieve data quality levels that can adequately support a clinical decision support system. Keywords: Vaccination, Electronic health records, Developing countries, Data quality

Prospective cost–benefit analysis of a two-dimensional barcode for vaccine production, clinical documentation, and public health reporting and tracking

In the United States recording accurate vaccine lot numbers in immunization records is required by the National Childhood Vaccine Injury Act and is necessary for public health surveillance and implementation of vaccine product recalls. However, this information is often missing or inaccurate in records. The Food and Drug Administration (FDA) requires a linear barcode of the National Drug Code (NDC) on vaccine product labels as a medication verification measure, but lot number and expiration date must still be recorded by hand. Beginning in 2011, FDA permitted manufacturers to replace linear barcodes with two-dimensional (2D) barcodes on unit-of-use product labels. A 2D barcode can contain the NDC, expiration date, and lot number in a symbol small enough to fit on a unit-of-use label. All three data elements could be scanned into a patient record. To assess 2D barcodes’ potential impacts, a mixed-methods approach of time–motion data analysis, interview and survey data collection, and cost–benefit analysis was employed. Analysis of a time–motion study conducted at 33 practices suggests scanning 2D-barcoded vaccines could reduce immunization documentation time by 36–39s per dose. Data from an internet survey of primary care providers and local health officials indicate that 60% of pediatric practices, 54% of family medicine practices, and 39% of health departments would use the 2D barcode, with more indicating they would do so if they used electronic health records. Inclusive of manufacturer and immunization provider costs and benefits, we forecast lower-bound net benefits to be $310–334 million between 2011 and 2023 with a benefit-to-cost ratio of 3.1:1–3.2:1. Although we were unable to monetize benefits for expected improved immunization coverage, surveillance, or reduced medication errors, based on our findings, we expect that using 2D barcodes will lower vaccine documentation costs, facilitate data capture, and enhance immunization data quality.