Validity of Maternal Recall to Assess Vaccination Coverage: Evidence from Six Districts in Zhejiang Province, China

Abstract

Background: Although recall-based data are collected by survey when the vaccination records are not available, the preferred estimates remain the record-based ones due to the limited validity of recall-based data. However, the evidence on validity of maternal recalls is limited and varied across vaccine types. To close the gaps, we validated the maternal recall on vaccination against record-based data in six districts in Zhejiang Province, China. Methods: We used a cross-sectional survey of about 648 households with mothers who delivered in the last 12 months prior to the survey in October 2017, from six districts in Zhejiang Province. Vaccination status on five vaccine types scheduled before 12 months of age were collected through maternal recall and vaccination records. The level of agreement and recall bias between the two resources, the sensitivity and specificity of maternal recall were evaluated. Risk factors for maternal recall bias were also identified through logistic regression model for each type of vaccine. Results: The level of agreement between recall and record was above 90% across vaccine types, with the recall bias ranged from 2.2% to 9.7%. Recall bias due to over-reporting was slightly higher than that due to under-reporting. Recall bias was positively associated with high parity, home delivery, younger mothers, mothers with low education, and migrant mothers. Conclusions: This study indicated most of the vaccination status across vaccine types was accurately identified through maternal recall and supported the use of maternal recall to estimate the vaccination coverage as an alternative in the absence of record-based data.

Trends of influenza vaccination coverage in pregnant women: a ten-year analysis from a French healthcare database

“…Hu et al compared survey data and administrative data in children’s vaccination, to evaluate the impact of recall bias by their mother. The results showed the frequency of over-reporting of vaccination in the survey data, up to 6.6% for DPT vaccine, linked to social desirability bias 43 .…”

Critical assessment of the current indicator for antenatal iron‐containing supplementation coverage: Insights from a mixed‐methods study

“…Agreement between the observed prevalence of exclusive breastfeeding at 3 months postpartum, and a 12‐month postpartum survey that asked about the prevalence of breastfeeding practices at 3 months postpartum was also found to be high (Schneider et al, 2020). Finally, Hu et al (2019) found >90% agreement between clinical records of vaccinations given to children in the previous year and maternal recall. These studies comparing direct observation with recall across several different timeframes report variable validity depending on the intervention.…”

Israeli parents` views on coronavirus (COVID-19) vaccinations for children: A cross-sectional study

“…Finally, recall and social-desirability biases in relation to routine vaccination of the child could distort the findings. On the other hand, previous studies found that the history of child vaccination was accurately identified through maternal recall and concluded that it might be used to estimate the vaccination coverage ( Binyaruka & Borghi, 2018 ; Hu et al, 2019 ). The complete anonymity of this study decreases the possibility of a social-desirability bias ( Lelkes et al, 2012 ).…”