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Musiwa AS, Sinha V, Hanley J, Ruiz-Casares M. Antenatal care coverage and early childhood mortality in Zimbabwe: new interpretations from nationally representative household surveys. Health Promot Int 2024; 39:daae039. [PMID: 38742894 PMCID: PMC11092268 DOI: 10.1093/heapro/daae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
Zimbabwe has implemented universal antenatal care (ANC) policies since 1980 that have significantly contributed to improvements in ANC access and early childhood mortality rates. However, Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), two of Zimbabwe's main sources of health data and evidence, often provide seemingly different estimates of ANC coverage and under-five mortality rates. This creates confusion that can result in disparate policies and practices, with potential negative impacts on mother and child health in Zimbabwe. We conducted a comparability analysis of multiple DHS and MICS datasets to enhance the understanding of point estimates, temporal changes, rural-urban differences and reliability of estimates of ANC coverage and neonatal, infant and under-five mortality rates (NMR, IMR and U5MR, separately) from 2009 to 2019 in Zimbabwe. Our two samples z-tests revealed that both DHS and MICS indicated significant increases in ANC coverage and declines in IMR and U5MR but only from 2009 to 2015. NMR neither increased nor declined from 2009 to 2019. Rural-urban differences were significant for ANC coverage (2009-15 only) but not for NMR, IMR and U5MR. We found that there is a need for more precise DHS and MICS estimates of urban ANC coverage and all estimates of NMR, IMR and U5MR, and that shorter recall periods provide more reliable estimates of ANC coverage in Zimbabwe. Our findings represent new interpretations and clearer insights into progress and gaps around ANC coverage and under-five mortality rates that can inform the development, implementation, monitoring and evaluation of policy and practice responses and further research in Zimbabwe.
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Affiliation(s)
- Anthony Shuko Musiwa
- School of Social Work, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
- Centre for Research on Children and Families, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
| | - Vandna Sinha
- School of Social Work, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
- Centre for Research on Children and Families, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
- School of Education, University of Colorado Boulder, Ofelia Miramontes and Leonard Baca Education Building, 249 UCB, Boulder, Colorado 80309-0249, USA
| | - Jill Hanley
- School of Social Work, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
- Sherpa University Institute, West-Central Montreal CIUSSS, CLSC de Parc-Extension, 7085 Hutchison Street, Montreal, QC H3N 1Y9, Canada
| | - Mónica Ruiz-Casares
- School of Social Work, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
- Centre for Research on Children and Families, McGill University, 550 Sherbrooke Ouest Suite 100, Tour Est, Montreal, Quebec H3A 1B9, Canada
- Sherpa University Institute, West-Central Montreal CIUSSS, CLSC de Parc-Extension, 7085 Hutchison Street, Montreal, QC H3N 1Y9, Canada
- School of Child & Youth Care, Toronto Metropolitan University, Sally Horsfall Eaton Centre for Studies in Community Health, 99 Gerrard Street East, Room SHE-641, Toronto, ON M5B 1G7, Canada
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Rhoda DA, Cutts FT, Agócs M, Brustrom J, Trimner MK, Clary CB, Clark K, Koffi D, Manibaruta JC, Sowe A, Gunnala R, Ogbuanu IU, Gacic-Dobo M, Danovaro-Holliday MC. A Practical Guide to Pilot Testing Community-Based Vaccination Coverage Surveys. Vaccines (Basel) 2023; 11:1773. [PMID: 38140178 PMCID: PMC10748182 DOI: 10.3390/vaccines11121773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 12/24/2023] Open
Abstract
Pilot testing is crucial when preparing any community-based vaccination coverage survey. In this paper, we use the term pilot test to mean informative work conducted before a survey protocol has been finalized for the purpose of guiding decisions about how the work will be conducted. We summarize findings from seven pilot tests and provide practical guidance for piloting similar studies. We selected these particular pilots because they are excellent models of preliminary efforts that informed the refinement of data collection protocols and instruments. We recommend survey coordinators devote time and budget to identify aspects of the protocol where testing could mitigate project risk and ensure timely assessment yields, credible estimates of vaccination coverage and related indicators. We list specific items that may benefit from pilot work and provide guidance on how to prioritize what to pilot test when resources are limited.
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Affiliation(s)
- Dale A. Rhoda
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH 43085, USA
| | - Felicity T. Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Mary Agócs
- American Red Cross, 431 18th Street NW, Washington, DC 20006, USA
| | - Jennifer Brustrom
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH 43085, USA
| | - Mary Kay Trimner
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH 43085, USA
| | - Caitlin B. Clary
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH 43085, USA
| | - Kathleen Clark
- American Red Cross, 431 18th Street NW, Washington, DC 20006, USA
| | - David Koffi
- Cabinet d’Appui au Développement Sanitaire, Abidjan, Côte d’Ivoire
| | - Jean Claude Manibaruta
- Burundi Country Office, World Health Organization, Boulevard de I’Uprona-Rohero II, Bujumbura P.O. Box 1450, Burundi
| | - Alieu Sowe
- Ministry of Health and Social Welfare, The Quadrangle, Banjul, The Gambia
| | - Rajni Gunnala
- US Indian Health Services Area Office, Indian Health Service, 40 N Central Ave #600, Phoenix, AZ 85004, USA
| | - Ikechukwu U. Ogbuanu
- Child Health and Mortality Prevention Surveillance (CHAMPS) Network, Crown Agents in Sierra Leone, 28 Bathurst Street, Freetown, Sierra Leone
| | - Marta Gacic-Dobo
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - M. Carolina Danovaro-Holliday
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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Hussain I, Khan A, Rhoda DA, Ahmed I, Umer M, Ansari U, Shah MA, Yunus S, Brustrom J, Oelrichs R, Soofi SB, Bhutta ZA. Routine Immunization Coverage and Immunization Card Retention in Pakistan: Results From a Cross-sectional National Survey. Pediatr Infect Dis J 2023; 42:260-270. [PMID: 36728580 PMCID: PMC9935567 DOI: 10.1097/inf.0000000000003804] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Immunization is one of the most successful public health interventions available, saving millions of lives from death and disability each year. Therefore, improving immunization coverage is a high priority for the Government of Pakistan and essential to progress toward universal health coverage. This survey reports the national and provincial/regional coverage and determinants of fully, partially, and not-vaccinated children 12-23 months of age, antigen-wise coverage, percentage of home-based vaccination records (HBR) retention, and reasons for nonretention; dropout, timeliness, and prevalence of missed opportunities for simultaneous vaccination (MOSV). METHODS The survey was a descriptive cross-sectional national household survey carried out across Pakistan. The survey included 110,790 children 12-23 months old and their caregivers. A World Health Organization (WHO)-Expanded Program on Immunization (EPI) Survey questionnaire was adapted to collect information. Data were analyzed using the WHO Vaccination Coverage Quality Indicators (VCQI) software and Stata version 17. RESULTS Nationally excluding Azad Jammu and Kashmir (AJK) and Gilgit Baltistan (GB), the coverage of fully vaccinated children was 76.5%. The likelihood of being fully vaccinated was higher among children of educated parents who belonged to higher wealth quintiles and resided in any province/region other than Balochistan. The main reasons for unimmunization were no faith in immunization, rumors about vaccines, and distance to the facility. About two-thirds (66.2%) of the children had their HBR available, and the main reasons for not having a card were never visiting a health facility and having no awareness about the importance of a card. Dropout was discernible for later doses of vaccines compared with earlier ones. Higher proportions of children received the last doses late by more than two months. Of the 218,002 vaccination visits documented on HBR in the provinces, MOSVs occurred in 17.6% of the visits. CONCLUSION The immunization coverage rates provide a direction to strategize the progress to improve the vaccination rates in Pakistan. The country needs to outline the immediate and long-term actions to combat vaccine-preventable diseases, such as escalating integrated immunization campaigns and outreach activities, provision of mobility support, and deploying behavioral interventions as a cross-cutting strategy to improve awareness and reduce misconceptions.
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Affiliation(s)
- Imtiaz Hussain
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Ahmad Khan
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | | | - Imran Ahmed
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Muhammad Umer
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Uzair Ansari
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | | | | | | | | | - Sajid Bashir Soofi
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Pakistan
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Brown DW, Danovaro-Holliday MC, Rhoda DA. Pairs of independent nationally representative vaccination coverage surveys conducted within one year of each other: A global overview covering 2000-2019. Vaccine X 2021; 7:100085. [PMID: 33644743 PMCID: PMC7887424 DOI: 10.1016/j.jvacx.2021.100085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Population-based surveys play an important role in measuring vaccination coverage. Surveys measuring vaccination coverage may be commissioned by the Expanded Programme on Immunization (EPI surveys) or part of multi-domain non-EPI surveys such as Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS). Surveys conducted too close in time to each other may not only be an inefficient use of resources but may also create problems for programme staff when results suggest inconsistent patterns of programme performance for similar time periods. Objective To summarize the occurrence of vaccination coverage surveys conducted close in time during 2000–2019 and compare results of EPI and non-EPI coverage surveys when the surveys were conducted within one year of each other. Methods Using a database of published national-level vaccination coverage survey results compiled by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), the authors abstracted information on survey field work dates, sample size, percentage of children with documented history of vaccination and the percent coverage, as well as published uncertainty intervals from DHS and MICS, for the first and third doses of diphtheria-tetanus toxoid-pertussis containing vaccine (DTP1, DTP3) and first dose of measles containing vaccine (MCV1). Survey results of EPI and non-EPI surveys were compared. Results The authors identified 646 surveys with final reports and estimates of national-level vaccination coverage for DTP1, DTP3, or MCV1 from a total of 687 surveys with data collection start date from 2000 to 2019. Of the 140 countries with at least one vaccination coverage survey, a median of four surveys was observed. Most countries were Gavi-eligible and located in the WHO Africa Region. Sixty-six survey dyads were identified where an EPI survey occurred within one year of a non-EPI survey. For the 66 dyads, in 49 of 59 with information available, EPI surveys reported higher proportion of documented evidence of vaccination and EPI survey results tended to suggest higher levels of vaccination coverage compared to the non-EPI surveys; quite often, differences were substantial. Surveys that found higher proportions of children with documented vaccination evidence tended to also find higher proportions of children who had been vaccinated. Summary Opportunities exist to improve overall planning of vaccination coverage measurement in population-based household surveys so that both EPI and non-EPI surveys are more comparable and survey coverage estimates are more appropriately spaced in time. When surveys occur too close in time, careful attention is warranted to ensure comparability and assess sources of documented evidence of vaccination and related coverage differences.
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Affiliation(s)
- David W. Brown
- BCGI LLC/pivot-23.5°, Cornelius, NC, USA
- Corresponding author at: BCGI LLC/pivot-23.5°, 19701 Bethel Church Road, Ste 103-168, Cornelius, NC 28031, USA.
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Wagai JN, Rhoda D, Prier M, Trimmer MK, Clary CB, Oteri J, Okposen B, Adeniran A, Danovaro-Holliday C, Cutts F. Implementing WHO guidance on conducting and analysing vaccination coverage cluster surveys: Two examples from Nigeria. PLoS One 2021; 16:e0247415. [PMID: 33635913 PMCID: PMC7909665 DOI: 10.1371/journal.pone.0247415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
In 2015, the World Health Organization substantially revised its guidance for vaccination coverage cluster surveys (revisions were finalized in 2018) and has since developed a set of accompanying resources, including definitions for standardized coverage indicators and software (named the Vaccination Coverage Quality Indicators—VCQI) to calculate them.–The current WHO vaccination coverage survey manual was used to design and conduct two nationally representative vaccination coverage surveys in Nigeria–one to assess routine immunization and one to measure post-measles campaign coverage. The primary analysis for both surveys was conducted using VCQI. In this paper, we describe those surveys and highlight some of the analyses that are facilitated by the new resources. In addition to calculating coverage of each vaccine-dose by age group, VCQI analyses provide insight into several indicators of program quality such as crude coverage versus valid doses, vaccination timeliness, missed opportunities for simultaneous vaccination, and, where relevant, vaccination campaign coverage stratified by several parameters, including the number of previous doses received. The VCQI software furnishes several helpful ways to visualize survey results. We show that routine coverage of all vaccines is far below targets in Nigeria and especially low in northeast and northwest zones, which also have highest rates of dropout and missed opportunities for vaccination. Coverage in the 2017 measles campaign was higher and showed less geospatial variation than routine coverage. Nonetheless, substantial improvement in both routine program performance and campaign implementation will be needed to achieve disease control goals.
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Affiliation(s)
| | - Dale Rhoda
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Mary Prier
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Mary Kay Trimmer
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Caitlin B. Clary
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Joseph Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Bassey Okposen
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | | | - Felicity Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Dong TQ, Rhoda DA, Mercer LD. Impact of state weights on national vaccination coverage estimates from household surveys in Nigeria. Vaccine 2020; 38:5060-5070. [PMID: 32532542 PMCID: PMC7327524 DOI: 10.1016/j.vaccine.2020.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022]
Abstract
National vaccination coverage estimates from household surveys are widely used in monitoring and planning of immunization programs. In Nigeria, survey-reported national coverage estimates have shown large fluctuations in the past few years. In this paper, we examine the impact of state-level survey weighting on Nigeria's national vaccination coverage estimation. In particular, we focus three vaccination-related outcomes among children aged 12-23 months: the coverage of the third dose of diphtheria, pertussis, and tetanus vaccine (DPT3); the coverage of the first dose of measles-containing vaccine (MCV1); and the availability rate of home-based vaccination record (HBR). We compare the sample selection and weight assignment of three major survey programs in Nigeria, and show that considerable portions of the changes in survey-reported national coverage estimates can be explained by shifts in state-level weights. Our analysis demonstrates the importance of state weighting method in estimating aggregated national coverage figures and provides important context for interpreting changes in coverage estimates between surveys in the future.
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Affiliation(s)
- Tracy Qi Dong
- Department of Biostatistics, University of Washington, 1705 NE Pacific St, Seattle, WA 98195, USA.
| | - Dale A Rhoda
- Biostat Global Consulting, 870 High Street, Worthington, OH 43085, USA
| | - Laina D Mercer
- Institute for Disease Modeling, 3150 139th Ave SE, Bellevue, WA 98005, USA
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