Enhancing Workforce Capacity to Improve Vaccination Data Quality, Uganda

Ward, Kirsten; Mugenyi, Kevin; Benke, Amalia; Luzze, Henry; Kyozira, Carol; Ampeire, Immaculate; Tanifum, Patricia; Kisakye, Annet; Bloland, Peter B.; MacNeil, Adam

doi:10.3201/eid2313.170627

Cited by 28 publications

(20 citation statements)

References 15 publications

(20 reference statements)

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“…Despite the increasing use of RHIS data for research purposes, the quality of these data remains imperfect and such issues should be identi ed and addressed in order to limit estimation error and bias. RHIS data quality issues remain a particular concern in some settings [113][114][115] , however, other studies have shown that strategies that have been implemented to improve RHIS data across different international contexts can be successful 5,116 . Multiple strategies were discussed in the articles we reviewed in our paper, including strategies to address common data quality issues such as missingness and data validity, for example the simple exclusion of missing data and various imputation and interpolation methods.…”

Section: Discussionmentioning

confidence: 99%

Using Routine Health Information Data for Research in Low- and Middle-Income Countries: A Systematic Review

Hung

Hoxha

Irwin

et al. 2020

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Background : Routine health information systems (RHISs) support resource allocation and management decisions at all levels of the health system, as well as strategy development and policy-making in many low- and middle-income countries (LMICs). Although RHIS data represent a rich source of information, such data are currently underused for research purposes, largely due to concerns over data quality. Given that substantial investments have been made in strengthening RHISs in LMICs in recent years and that there is a growing demand for more real-time data from researchers, this systematic review builds upon the existing literature to summarize the extent to which RHIS data have been used in peer-reviewed research publications. Methods : Using terms ‘routine health information system’, ‘health information system’, or ‘health management information system’ and a list of LMICs, four electronic peer-review literature databases were searched from inception to February 20 2019: PubMed, Scopus, EMBASE, and EconLit. Articles were assessed for inclusion based on pre-determined eligibility criteria and study characteristics were extracted from included articles using a piloted data extraction form. Results : We identified 132 studies that met our inclusion criteria, originating in 37 different countries. Overall, the majority of the studies identified were from Sub-Saharan Africa and were published within the last five years. Malaria and maternal health were the most commonly studied health conditions, although a number of other health conditions and health services were also explored. Conclusions : Our study identified an increasing use of RHIS data for research purposes, with many studies applying rigorous study designs and analytic methods to advance program evaluation, monitoring and assessing services, and epidemiological studies in LMICs. RHIS data represent an underused source of data and should be made more available and further embraced by the research community in LMIC health systems.

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Section: Discussionmentioning

confidence: 99%

Using Routine Health Information Data for Research in Low- and Middle-Income Countries: A Systematic Review

Hung

Hoxha

Irwin

et al. 2020

Preprint

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“…Nervetheless, given the similar rural-urban distribution of populations for majority of Ugandan districts, our results provide valuable lessons for other districts in the country and similar countries in sub Saharan Africa. Second, we used routinely collected data and these data have been shown to have weaknesses such as missing and incomplete entries [36] which may result in misclassi cation of the performance of the health facilities. The WHO commissioned a Strategic Advisory Group of Experts (SAGE) to examine the quality and use of global mmmunization and surveillance data.…”

Section: Discussionmentioning

confidence: 99%

Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a Health Facility level assessment

Kwikiriza¹,

Bajunirwe

Bagenda

2020

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Background: Globally immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of a health facility may influence performance of its immunization programs. Therefore, the purpose of this study was to examine whether geographical location of a health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda.Methods: We conducted a cross sectional study using a mixed methods approach. The study unit was a health center and we interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results: We collected data at 49 health facilities. Most of these facilities (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p<0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations.Conclusions: Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

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“…EPI data used to assess the performance of Dara Malo district were found poor in accuracy, consistency, completeness and timeliness. This might have led the health system to misunderstand the quality of services as the district health system lacks capacity to effectively use quality of immunization monitoring system for evidence-based timely decision making and response for vaccine preventable diseases outbreak [16][17][18] Hence, the most likely reason for delayed identification, verification and control measures against the reported pertussis outbreak might be related to the poor immunization data quality and its use for health improvement in Daro Malo districts [19].…”

Section: Discussionmentioning

confidence: 99%

Data Quality on Expanded Programme on Immunization in Pertussis Outbreak Affected District: The Case of Dara Malo woreda, Southern Ethiopia

Argaw¹,

Desta²,

Tsegaye³

et al. 2019

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Background: The aim of this study was to investigate the quality of immunization data and monitoring system in the Dara Malo district (woreda) of Gamo Administrative Zone, Southern Nations, Nationalities and Peoples Region (SNNPR) of Ethiopia. Method: a cross-sectional study was conducted from August 4 to September 27, 2019 in Dara Malo District. The district was purposively selected during the management of a pertussis outbreak based on the hypothesis ‘there is no difference in reported and recounted immunization status of children 7 to 23 months in Dara Malo District of Ethiopia’. A quality index (QI) and proportions of completeness, timeliness and accuracy ratio of the first and third doses of pentavalent vaccines and the first dose of measles-containing vaccines (MCV) were made. Results: in this study 336 month-facility data were extracted. In addition, 595 children aged 7 - 23 months, with a response rate of 94.3%, were assessed and compared for immunization status using register and immunization cards or caretakers’ oral report through the household survey. The ratio of vaccination data compared using tallies against the reports showed evidences of over reporting with 50.8%, 45.1% and 46.5% for first pentavalent, third pentavalent and first dose of measles vaccinations, respectively. Completeness of third dose of pentavalent vaccinations were 95.3%, 956% and 100.0% at health posts, health centers and at the district health office, respectively. The QI scores ranged between 61.0% and 80.5% for all five categories, namely, 73.0% for recording, 71.4% for archiving and reporting, 70.4% for demographic information, 69.7% for core outputs and 70.4% for data uses and were assessed as suboptimal at all levels. Conclusion: The immunization data completeness was found to be optimal. However, in the study area, the accuracy, consistency, timeliness and quality of monitoring system were found to be sub-optimal. Therefore, poor data quality has led to wrong decision making during the reported pertussis outbreak management. Enhancing the capacity of healthcare providers on planning, recording, archiving and reporting, analyzing, and use of immunization data for evidence-based decision making is recommended.

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Enhancing Workforce Capacity to Improve Vaccination Data Quality, Uganda

Cited by 28 publications

References 15 publications

Using Routine Health Information Data for Research in Low- and Middle-Income Countries: A Systematic Review

Using Routine Health Information Data for Research in Low- and Middle-Income Countries: A Systematic Review

Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a Health Facility level assessment

Data Quality on Expanded Programme on Immunization in Pertussis Outbreak Affected District: The Case of Dara Malo woreda, Southern Ethiopia

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