Surveys of measles vaccination coverage in eastern and southern Africa: a review of quality and methods used

Abstract

ObjectiveTo assess the methods used in the evaluation of measles vaccination coverage, identify quality concerns and provide recommendations for improvement.MethodsWe reviewed surveys that were conducted to evaluate supplementary measles immunization activities in eastern and southern Africa during 2012 and 2013. We investigated the organization(s) undertaking each survey, survey design, sample size, the numbers of study clusters and children per study cluster, recording of immunizations and methods of analysis. We documented sampling methods at the level of clusters, households and individual children. We also assessed the length of training for field teams at national and regional levels, the composition of teams and the supervision provided.FindingsThe surveys were conducted in Comoros, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Uganda, Zambia and Zimbabwe. Of the 13 reports we reviewed, there were weaknesses in 10 of them for ethical clearance, 9 for sample size calculation, 6 for sampling methods, 12 for training structures, 13 for supervision structures and 11 for data analysis.ConclusionWe recommend improvements in the documentation of routine and supplementary immunization, via home-based vaccination cards or other records. For surveys conducted after supplementary immunization, a standard protocol is required. Finally, we recommend that standards be developed for report templates and for the technical review of protocols and reports. This would ensure that the results of vaccination coverage surveys are accurate, comparable, reliable and valuable for programme improvement.

A survey on Measles and Rubella Supplementary Immunization Activities (SIAs) in Iran

“…However, it was different from the rate reported by Tajikistan (93.8%), Ireland (70.8%), and the WHO European regions where the MR supplementary immunization coverage rates varied from 48.2% to 100% (9). Additionally, the vaccination coverage rate in the present study was higher than Eastern and Southern Africa with about 93% based on vaccination cards, finger marks, or self-report of participants (21).…”

“…In this study, 48% of vaccinated children had finger markings once visited. Comparably, immunization cards of the eligible children were available for about two-thirds of the study participants (21).…”

A National Survey to Evaluate Measles-Rubella National Vaccination Campaign Coverage in Egypt

“…Most of the reviewed surveys included some investigation of routine immunization services. (18) In the current survey the administrative vaccination coverage provided by the MOH (12) was higher in all governorates than the reported coverage. This minor discrepancy could be explained by the fact that during the campaign, all school children in fifth primary were included despite many of them were above 10 years of age, even children 11 years of age were included., meanwhile, in the present survey only children below 10 years were included.…”

“…All supplementary campaigns should include a plan or budget for an independent coverage evaluation survey as a part of general monitoring and planning. (18) In the present survey, validation of the campaign coverage determined, by the recall of administration, was done by conducting a coverage evaluation survey over 26 Egyptian governorates.…”

Monitoring vaccination coverage: Defining the role of surveys

“…The Expanded Programme on Immunization (EPI) cluster survey was developed over 30 years ago as a simple non-probability sampling method that could be implemented with little or no technical assistance [20] , [21] . Although the EPI survey has been a valuable programme management tool, the use of non-probability sampling and lack of standardized, well-documented quality control procedures may reduce confidence in the results [1] , [22] , [23] . The 2015 working draft of the EPI cluster survey manual recommends using a probability sample (for which excellent collaboration is needed with the National Statistics or Census Office to obtain the sampling frame and maps of enumeration areas (EAs)), designing the survey and its sample size according to the evaluation goals, conducting appropriately weighted analyses, rigorous quality control, and fully documenting survey design and implementation.…”