Evaluation of the adverse events following immunization surveillance system, Ghana, 2019

Abstract

Background With over 80% of children worldwide vaccinated, concerns about vaccine safety continues to be a public health issue. Ghana’s Adverse Events Following Immunization surveillance started in 1978 with the objective to promptly detect and manage AEFI cases either real or perceived. Periodic evaluation of the surveillance system is critical for optimal performance; hence we evaluated the system to assess its attributes, usefulness and system’s performance in meeting its objectives. Methods A case of AEFI was defined as any untoward medical event occurring within 28 days after vaccination and may not necessarily have causal relationship with the vaccine use. We reviewed surveillance data and procedures for the period 2014 to 2018 and interviewed key stakeholders. Adapting the CDC’s Updated Guidelines for Evaluating Public Health Surveillance Systems, we assessed the system’s attributes and usefulness. We performed summary descriptive statistics on quantitative data and directed content analysis on information gathered from interviews. Results In all, 2,282 AEFI cases including 476 (21%) serious cases (life threatening events) were reported for the period. The highest case detection rates of 61.45 AEFIs per 100,000 surviving infants was recorded in 2018. Reporting forms were modified to accommodate new indicators without any disruption in the function of the system. At the national level, completeness of 100 randomly sampled reporting forms (100%) and was higher than the region (27%) but timeliness (50%) was lower than the region (83%). All (16/16) Community Health Nurses interviewed indicated “fear of being victimized” as the reason for underreporting, nonetheless, the system was useful as it made them cautious when vaccinating children to prevent reactions. Data on AEFI surveillance was also useful in guiding training needs and provision of vaccination logistics. Conclusion The AEFI surveillance system is useful at all levels but partially meeting its objective due to underreporting. We recommend training and supportive supervision to improve timeliness of reporting, data completeness and acceptability.

Perception of Health Workers on Reporting of Adverse Events Following Immunization in Jigawa State, Nigeria, 2022

“…Similarly, more than 40% of health workers alluded to time constraints and lack of belief in the event being related to immunization. Similar findings have been documented in studies conducted in the country and other countries [16,[21][22][23][24]. These are critical reasons that require the attention of the health authorities to address.…”

“…Though majority of the health workers had good perception of AEFI reporting like findings from studies in other states [21], the study further identified good knowledge of AEFI and routine receipt of feedback from the higher administrative level as predictors of good perception on AEFI amongst providers. This further buttressed fact that beyond the health systems requesting these reports from the service delivery points, surveillance systems including that of AEFI is a two-way process whereby reporting should be followed by feedback on the outcome of the reports [2,22,25]. The global surveillance guideline indicates that irrespective of the outcome of reported AEFI cases, findings from the investigation and lessons learnt from the causality assessment of serious cases, should provide insights on the immunization programme for the technical team and immunization programme managers and there should be prompt and clear communication and with all stakeholders including feedback to the healthcare workers that reported as well as the community on the next line of action [2].…”

“…Systems must be put in place to ensure that these guidelines are adhered to, and feedback shared from the higher levels. This is exemplified by the surveillance system evaluation in Ghana where lack of timely feedback from higher levels affected the usefulness of the system as surveillance officers got discouraged from sending reports to higher levels, and that affected the use of data for action [22]. The good perception indicates that health workers will be willing to report encountered AEFIs based on the identified motivating factors if all their fears on the perceived negative consequences could be addressed.…”

Assessment of adherence to pre-vaccination precautions and AEFI reporting practices during BCG vaccination in 4 hospitals in Ghana

“…Low AEFI reporting is a problem in most LMICs leading to scanty safety information on vaccines that affects the quality of causality assessment reports. 31 HCPs at vaccination centers have the responsibility of educating mothers about both the common and self-limiting AEFIs as well as rare and unexpected ones while urging them to report. In the current study, about 70% of the participants did not inform mothers of infants who received the BCG vaccine and this requires significant improvement.…”

Enhancing global health security in Thailand: Strengths and challenges of initiating a One Health approach to avian influenza surveillance

“…CDC Evaluation Guidelines”) framework [ 38 ]. The U.S. CDC Evaluation Guidelines has been used and validated in studies to evaluate surveillance programs across the world, including Brazil [ 39 ], Ghana [ 40 ], Jordan [ 41 ], Yemen [ 42 ], and others [ 43 ]. The U.S. CDC Evaluation Guidelines considers nine metrics: i) simplicity, ii) flexibility, iii) data quality, iv) acceptability, v) sensitivity, vi) predictive value positivity, vii) representativeness, viii) timeliness, and ix) stability.…”