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      The immunization data quality audit: verifying the quality and consistency of immunization monitoring systems Translated title: Contrôle de la qualité des données de vaccination: vérification de la qualité et de la cohérence des systèmes de vaccinovigilance Translated title: Auditoría de la calidad de los datos de inmunización: comprobación de la calidad y coherencia de los sistemas de monitoreo de la inmunización

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          Abstract

          OBJECTIVE: To evaluate the consistency and quality of immunization monitoring systems in 27 countries during 2002-03 using standardized data quality audits (DQAs) that had been launched within the framework of the Global Alliance for Vaccines and Immunization. METHODS: The consistency of reporting systems was estimated by determining the proportion of third doses of diphtheria-tetanus-pertussis (DTP-3) vaccine reported as being administered that could be verified by written documentation at health facilities and districts. The quality of monitoring systems was measured using quality indices for different components of the monitoring systems. These indices were applied to each level of the health service (health unit, district and national). FINDINGS: The proportion of verified DTP-3 doses was lower than 85% in 16 countries. Difficulties in verifying the doses administered often arose at the peripheral level of the health service, usually as the result of discrepancies in information between health units and their corresponding districts or because completed recording forms were not available from health units. All countries had weaknesses in their monitoring systems; these included the inconsistent use of monitoring charts; inadequate monitoring of vaccine stocks, injection supplies and adverse events; unsafe computer practices; and poor monitoring of completeness and timeliness of reporting. CONCLUSION: Inconsistencies in immunization data occur in many countries, hampering their ability to manage their immunization programmes. Countries should use these findings to strengthen monitoring systems so that data can reliably guide programme activities. The DQA is an innovative tool that provides a way to independently assess the quality of immunization monitoring systems at all levels of a health service and serves as a point of entry to make improvements. It provides a useful example for other global health initiatives.

          Translated abstract

          OBJECTIF: Évaluer la cohérence et la qualité des systèmes de vaccinovigilance dans 27 pays pendant la période 2002-2003 à travers des contrôles de la qualité des données (DQA) normalisés, lancés dans le cadre de l'Alliance mondiale pour les vaccins et la vaccination. MÉTHODES: On a estimé la cohérence des systèmes de notification en déterminant la proportion de troisièmes doses de vaccin diphtérie-tétanos-coqueluche (DTC3) rapportées comme ayant été administrées, dont l'administration peut être confirmée par des documents écrits tenus par les installations de santé et les districts. On a mesuré la qualité des systèmes de vaccinovigilance à l'aide d'indices de qualité s'appliquant aux différents composants de ces systèmes. Ces indices ont été appliqués à chaque niveau de service de santé (niveau de la formation sanitaire ou du district ou encore niveau national). RÉSULTATS: La proportion de doses de DTC3 vérifiées était inférieure à 85 % dans 16 pays. Les difficultés pour vérifier les doses administrées se rencontrent souvent au niveau périphérique du service de santé et résultent habituellement de divergences dans les informations détenues par les formations sanitaires et les districts correspondants ou de l'impossibilité d'obtenir, auprès de ces formations sanitaires, des formulaires d'enregistrement remplis. Les systèmes de vaccinovigilance de tous les pays présentent des points faibles : incohérences dans l'utilisation des tableaux de contrôle, surveillance insuffisante des stocks de vaccins, matériel d'injection et manifestations postvaccinales indésirables, pratiques informatiques peu sûres et suivi insuffisant de l'exhaustivité et de la promptitude des notifications. CONCLUSION: Les données de vaccination présentent des incohérences dans de nombreux pays, ce qui compromet leurs possibilités d'utilisation pour gérer les programmes de vaccination. Il faudrait que les pays utilisent ces résultats pour renforcer leurs systèmes de vaccinovigilance, de manière à ce que les données qu'ils fournissent puissent guider de façon fiable les activités des programmes. Le DQA est un outil novateur permettant d'évaluer de manière indépendante la qualité des réseaux de vaccinovigilance à tous les niveaux de service de santé et servant de point d'entrée pour introduire des améliorations. Il fournit un exemple utile pour d'autres initiatives mondiales dans le domaine sanitaire.

          Translated abstract

          OBJETIVO: Evaluar la coherencia y calidad de los sistemas de monitoreo de la inmunización en 27 países durante 2002-2003, usando para ello auditorías normalizadas de la calidad de los datos emprendidas en el marco de la Alianza Global para las Vacunas y la Inmunización. MÉTODOS: La coherencia de los sistemas de notificación se estimó determinando la proporción de terceras dosis de la vacuna contra difteria, tétanos y tos ferina (DTP-3) cuya administración previamente notificada pudo verificarse mediante documentación escrita en establecimientos y distritos de salud. La calidad de los sistemas de monitoreo se midió usando índices de calidad para distintos componentes de los sistemas de monitoreo. Estos índices se aplicaron a cada nivel del servicio de salud (puestos de salud, distrito y ámbito nacional). RESULTADOS: La proporción de dosis de DTP-3 verificadas fue inferior al 85% en 16 países. La comprobación de las dosis administradas tropezó a menudo con dificultades en la periferia del servicio de salud, generalmente como resultado de discrepancias entre la información de los puestos de salud y la de sus correspondientes distritos, o porque los puestos de salud no aportaban formularios de registro completos. Todos los países presentaban puntos débiles en sus sistemas de monitoreo, como por ejemplo el uso incoherente de gráficos de monitoreo; una vigilancia inadecuada de las reservas de vacuna, los suministros de inyección y los eventos supuestamente atribuibles a la vacunación o la inmunización; la baja seguridad de las prácticas de computación; y un escaso monitoreo de la integralidad y puntualidad de los informes. CONCLUSIÓN: Los datos de inmunización adolecen de incoherencia en muchos países, lo cual limita la capacidad de éstos para gestionar sus programas de inmunización. Los países deberían usar estos resultados para fortalecer los sistemas de monitoreo de modo que los datos puedan orientar de manera fiable las actividades programáticas. La auditoría de la calidad de los datos es un instrumento innovador que permite evaluar independientemente la calidad de los sistemas de monitoreo de las inmunizaciones a todos los niveles de un servicio de salud y sirve de punto de entrada para introducir mejoras. Además, constituye un valioso ejemplo para otras iniciativas de salud mundiales.

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          Most cited references15

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          GAVI, the first steps: lessons for the Global Fund.

          The Global Alliance for Vaccines and Immunization (GAVI) is seen as a model for the new Global Fund to Fight AIDS, Tuberculosis and Malaria, to be launched early in 2002. We did an assessment in four African countries to report the experiences of ministries of health and their partners in applying to GAVI for funds to strengthen health systems and for new vaccines. Countries welcomed the introduction of hepatitis B vaccine, safe injection equipment, and the financial support to strengthen immunisation programmes. All reported that the pace of the application process was too rapid. District visits revealed low staffing levels, insufficient transport and fuel, poorly functioning cold chains, and infrequent supervision. Information systems were unreliable, which will be an obstacle to GAVI when monitoring and rewarding improvements in immunisation coverage. Also, the high cost of expensive new vaccines will be difficult to sustain if GAVI funding stops at the end of its 5 year commitment. Our study suggests that applications for support and planning for AIDS, tuberculosis, and malaria control under the new Global Fund, will be more complex and demanding on already over-stretched ministries of health. Further, the rapid onset of activities, coupled with uncertainty about the time-scale of donor commitment, could be problematic. A limited and carefully assessed set of initial activities, focusing on where and how to strengthen existing country systems, is more likely to be successful and could provide useful models for scaling-up to larger programmes in different contexts.
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            Validity of reported vaccination coverage in 45 countries.

            Monitoring and assessment of coverage rates in national health programmes is becoming increasingly important. We aimed to assess the accuracy of officially reported coverage rates of vaccination with diphtheria-tetanus-pertussis vaccine (DTP3), which is commonly used to monitor child health interventions. We compared officially reported national data for DTP3 coverage with those from the household Demographic and Health Surveys (DHS) in 45 countries between 1990 and 2000. We adjusted survey data to reflect the number of valid vaccinations (ie, those administered in accordance with the schedule recommended by WHO) using a probit model with sample selection. The model predicted the probability of valid vaccinations for children, including those without documented vaccinations, after correcting for bias from differences between the children with and without documented information on vaccination. We then assessed the extent of survey bias and differences between officially reported data and those from DHS estimates. Our results suggest that officially reported DTP3 coverage is higher than that reported from household surveys. This size of the difference increases with the rate of reported coverage of DTP3. Results of time-trend analysis show that changes in reported coverage are not correlated with changes reported from household surveys. Although reported data might be the most widely available information for assessment of vaccination coverage, their validity for measuring changes in coverage over time is highly questionable. Household surveys can be used to validate data collected by service providers. Strategies for measurement of the coverage of all health interventions should be grounded in careful assessments of the validity of data derived from various sources.
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              Global health improvement and WHO: shaping the future

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                Author and article information

                Journal
                bwho
                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra, Genebra, Switzerland )
                0042-9686
                July 2005
                : 83
                : 7
                : 503-510
                Affiliations
                [05] Geneva orgnameSecretariat for the Global Alliance for Vaccines and Immunization Switzerland
                [04] orgnameProgram for Appropriate Technology in Health orgdiv1Children's Vaccine Program France
                [01] Geneva orgnameWorld Health Organization orgdiv1Vaccines and Biologicals orgdiv2Department of Immunization Switzerland
                [02] Atlanta GA orgnameCenters for Disease Control and Prevention orgdiv1National Immunization Program orgdiv2Immunization Services Division USA
                [03] Atlanta GA orgnameCenters for Disease Control and Prevention orgdiv1National Immunization Program orgdiv2Global Immunization Division USA
                Article
                S0042-96862005000700010 S0042-9686(05)08300710
                2626295
                16175824
                9cf54bd2-82fd-464e-9437-4575eee71153

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 8
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