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      Assessing immunization data quality from routine reports in Mozambique


      1 , 2 , 3 , , 2 , 3

      BMC Public Health

      BioMed Central

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          Worldwide immunization coverage shows an increase in the past years but the validity of the official reports for measuring change over time has been questioned. Facing this problem, donor supported initiatives like the Global Alliance for Vaccine and Immunizations, have been putting a lot of effort into assessing the quality of data used, since accurate immunization information is essential for the Expanded Program on Immunization managers to track and improve program performance. The present article, discusses the practices on record keeping, reporting and the support mechanism to ensure data quality in Mozambique.


          A process evaluation study was carried out in Mozambique in one district (Cuamba) in Niassa Province, between January and March 2003. The study was based on semi-structured interviews, participant observation and review of the data collection materials.


          Differences were found for all vaccine types when comparing facility reports with the tally sheets. The same applies when comparing facility reports with district reports. The study also showed that a routine practice during supervision visits was data quality assessment for the outpatient services but none related to data consistency between the tally sheets and the facility report. For the Expanded Program on Immunization, supervisors concentrated more on the consistency checks between data in the facility reports and the number of vaccines received during the same period. Meetings were based on criticism, for example, why health workers did not reach the target. Nothing in terms of data quality was addressed nor validation rules.


          In this paper we have argued that the quality of data, and consequently of the information system, must be seen in a broader perspective not focusing only on technicalities (data collection tools and the reporting system) but also on support mechanisms. Implications of a poor data quality system will be reflected in the efficiency of health services facing increased demands, with stagnant or decreasing resources.

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          Most cited references19

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          Do changes in policy affect vaccine coverage levels? Results of a national study to evaluate childhood vaccination coverage and reasons for missed vaccination in Italy.

          To evaluate the impact of actions taken in Italy since 1998 to improve vaccination coverage, a national EPI-survey was performed in 2003. Overall, 4602 children aged 12-24 months participated in the study; coverage was calculated for three doses of DT, polio, HBV, pertussis, and Hib, and for one dose of MMR/measles vaccine for children > or =16 months of age. Since 1998, when the last national survey was conducted, DT, polio, and HBV coverage have remained consistently high (95%), while pertussis, Hib, and MMR/measles significantly increased. Pertussis coverage reached the 95% target, and Hib is close to target (87%). Improving MMR coverage (77%), however, remains a national priority.
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            Hepatitis B vaccine freezing in the Indonesian cold chain: evidence and solutions.

            To document and characterize freezing temperatures in the Indonesian vaccine cold chain and to evaluate the feasibility of changes designed to reduce the occurrence of freezing. Data loggers were used to measure temperatures of shipments of hepatitis B vaccine from manufacturer to point of use. Baseline conditions and three intervention phases were monitored. During each of the intervention phases, vaccines were removed progressively from the standard 2-8 degrees C cold chain. Freezing temperatures were recorded in 75% of baseline shipments. The highest rates of freezing occurred during transport from province to district, storage in district-level ice-lined refrigerators, and storage in refrigerators in health centres. Interventions reduced freezing, without excessive heat exposure. Inadvertent freezing of freeze-sensitive vaccines is widespread in Indonesia. Simple strategies exist to reduce freezing - for example, selective transport and storage of vaccines at ambient temperatures. The use of vaccine vial monitors reduces the risk associated with heat-damaged vaccines in these scenarios. Policy changes that allow limited storage of freeze-sensitive vaccines at temperatures >2-8 degrees C would enable flexible vaccine distribution strategies that could reduce vaccine freezing, reduce costs, and increase capacity.
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              The quality of immunization data from routine primary health care reports: a case from Nepal.

              Reported high immunization coverage achieved in Nepal over the last ten years is expected to reduce child mortality in the country. The present study, carried out in hill district in mid-west Nepal, aimed to assess the quality of immunization data in Nepal. The number of children who received different vaccines during one year was obtained from three sources: 1) the Immunization REgister of three Primary Health Care Service Outlets (PHCSOs) where each immunized child is recorded; 2) monthly PHC Reports, which are based on the Immunization Register; 3) monthly DHO Reports, which are based on the above PHC Reports (the DHO reports are the source of official statistics). The number of children in the PHC Reports was higher than the number in the Immunization REgisters for all vaccines. The number of immunizations in the DHO Reports was higher than the number in the PHC Reports for BCG, DPT, and measles; the number was lower for poliomyelitis. The overall number of immunizations was higher in the DHO Reports than in the Immunization Registers, by 31% for BCG, 44% for DPT, 155% for polio, and 71% for measles. We conclude that the official report overestimates the immunization coverage in the district. The immunization programme, therefore, might not result in the expected reduction of morbidity and mortality despite the investment in the programme and reported high coverage.

                Author and article information

                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                11 October 2005
                : 5
                : 108
                [1 ]Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
                [2 ]Faculty of Mathematics and Natural Sciences, Department of Informatics, University of Oslo, Norway
                [3 ]Faculty of Medicine, Department of General Practice and Community Medicine, Section of International Health, University of Oslo, Norway
                Copyright © 2005 Mavimbe et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Research Article

                Public health


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