Limitations of immunization registers at community health centers for measuring immunization coverage: a case study of the Japanese encephalitis mass immunization program in Bali Province, Indonesia

Abstract

Objectives:The aim of this study was to compare the coverage of Japanese encephalitis (JE) immunization obtained from a recall survey and immunization registers at community health centers (CHCs) in Bali Province, Indonesia. Methods: A population-based survey was conducted, and random 2-staged selection of clusters of sub-villages was performed. The sample consisted of households with children aged 9 months to 15 years old. Interviews were carried out with carers to recall JE immunization status. The recall immunization status was considered valid when name, date, and confirmation of immunization were available in an immunization register at a CHC. Descriptive analysis was performed. The completeness of the information within immunization registers at CHCs was assessed. Results: The coverage of JE immunization obtained from the recall survey was 93.8% (95% confidence interval [CI],). It decreased to 74.9% (95% CI, 72.8-77.2) after being validated against immunization registers. The recall coverage of JE immunization was significantly higher than immunization register data suggested. This discrepancy varied from 6.5% to 36.4% across 6 districts; however, none of these districts achieved the recommended target coverage of 95%. The quality of immunization registers varied across CHCs. Conclusion:The use of an immunization register may result in underestimating the true coverage of vaccination programs, and its utilization for measuring immunization coverage requires further consideration.

Japanese encephalitis in Bali, Indonesia: ecological and socio-cultural perspectives

“…Although it has not been implemented in animals in Indonesia, the vaccination against JEV in humans has been nationally applied. In the first quarter of 2018, Bali was chosen to be the first area in Indonesia that implemented the Chengdu SA-14-14-2 live-attenuated JEV vaccine targeted in 890,050 local children [ 33 , 82 ]. Almost 94% (95% CI: 92.8–94.9) of the children received the vaccination after the first campaign [ 83 ].…”

Barriers felt by nurses related to childhood basic immunisation in East Nusa Tenggara: A phenomenological study

“…Poor record-keeping is a perceived challenge in assessing immunisation coverage levels. A study in Bali, Indonesia, conducted in six districts, showed that an ineffective recording and reporting system based on reporting at the community health centre could reduce the quality of data on immunisation programme achievements (Sawitri et al, 2021). Comprehensive information systems are needed to track immunisation uptake at the individual and population levels (Atkinson et al, 2020).…”

Pemetaan Digital Capaian Imunisasi Japanese Encephalitis Menggunakan Sistem Informasi Geografis

“…Namun hasil tersebut tidak sejalan dengan hasil studi capaian imunisasi JE by recall yang menemukan bahwa hanya 6 kabupaten/kota yang mencapai target capaian imunisasi > 95%. 15 Hal ini kemungkinan terjadi karena perhitungan estimasi sasaran imunisasi yang kurang tepat di lapangan atau adanya mobilisasi kelompok sasaran tidak terduga ke suatu kabupaten/kota pada saat pelaksanaan imunisasi berlangsung yang mengakibatkan angka capaian meningkat. 15…”

“…15 Hal ini kemungkinan terjadi karena perhitungan estimasi sasaran imunisasi yang kurang tepat di lapangan atau adanya mobilisasi kelompok sasaran tidak terduga ke suatu kabupaten/kota pada saat pelaksanaan imunisasi berlangsung yang mengakibatkan angka capaian meningkat. 15…”