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The quality of immunization data from routine primary health care reports: a case from Nepal
S R Onta1, S Sabroe, E H Hansen
1Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Insights
Official immunization data in Nepal overestimates coverage, potentially hindering expected reductions in child mortality. Accurate data is crucial for effective public health interventions.
Area of Science:
- Public Health
- Epidemiology
- Health Systems Research
Background:
- Nepal reports high immunization coverage, theoretically reducing child mortality.
- Concerns exist regarding the accuracy of reported immunization data.
- Assessing data quality is vital for evaluating public health program impact.
Purpose of the Study:
- To evaluate the quality and accuracy of immunization data in a mid-west hill district of Nepal.
- To compare immunization data from primary health care registers with official reports.
Main Methods:
- Data collected from Immunization Registers at three Primary Health Care Service Outlets (PHCSOs).
- Compared register data with monthly PHC Reports and District Health Office (DHO) Reports.
- Analyzed discrepancies in reported immunizations for BCG, DPT, polio, and measles.
Main Results:
- PHC Reports consistently showed higher numbers of immunizations than Immunization Registers.
- DHO Reports exceeded PHC Reports for BCG, DPT, and measles, but underestimated polio.
- Overall, DHO Reports overestimated immunizations by 31% (BCG) to 155% (polio) compared to registers.
Conclusions:
- Official immunization reports in the studied district significantly overestimate coverage.
- The actual impact of the immunization program on reducing child morbidity and mortality may be less than reported.
- Investments in immunization programs may not yield expected public health gains due to data inaccuracies.
Abstract:
Reported high immunization coverage achieved in Nepal over the last ten years is expected to reduce child mortality in the country. The present study, carried out in hill district in mid-west Nepal, aimed to assess the quality of immunization data in Nepal. The number of children who received different vaccines during one year was obtained from three sources: 1) the Immunization REgister of three Primary Health Care Service Outlets (PHCSOs) where each immunized child is recorded; 2) monthly PHC Reports, which are based on the Immunization Register; 3) monthly DHO Reports, which are based on the above PHC Reports (the DHO reports are the source of official statistics). The number of children in the PHC Reports was higher than the number in the Immunization REgisters for all vaccines. The number of immunizations in the DHO Reports was higher than the number in the PHC Reports for BCG, DPT, and measles; the number was lower for poliomyelitis. The overall number of immunizations was higher in the DHO Reports than in the Immunization Registers, by 31% for BCG, 44% for DPT, 155% for polio, and 71% for measles. We conclude that the official report overestimates the immunization coverage in the district. The immunization programme, therefore, might not result in the expected reduction of morbidity and mortality despite the investment in the programme and reported high coverage.