Child immunization data quality in Rwanda: an assessment of routine health information system data

Area of Science:

• Public Health
• Health Informatics
• Global Health

Background:

• Routine data documentation and reporting are crucial for childhood immunization programs.
• Health management information systems (HMIS) in low- and middle-income countries (LMICs) often face data completeness and reliability issues.
• Rwanda implemented the immunization e-Tracker, an individual-level HMIS built on DHIS2, nationwide in 2019.

Purpose of the Study:

• To assess the quality of routine immunization data within Rwanda's health management information system (HMIS) over time.
• To evaluate the impact of the e-Tracker system on data quality.

Main Methods:

• Data were collected from four HMIS sources (facility registers, district reports, national HMIS, e-Tracker) for 24 health facilities in 2020 and 2022.
• Data quality was assessed for three key childhood immunization indicators: Bacille Calmette-Guérin (BCG), Pentavalent 3 (Penta 3), and Measles & Rubella 1 (MR1).
• Accuracy ratios were computed by comparing HMIS reports against facility registers (2020) and e-Tracker (2022).

Main Results:

• In 2020, significant inconsistencies were found between paper-based facility registers and electronic HMIS reports for BCG, Penta 3, and MR1.
• Initially, only BCG data was recorded in the e-Tracker in 2020.
• By 2022, substantial improvements in e-Tracker completeness were observed for Penta 3 and MR1 data.

Conclusions:

• Data quality in Rwanda's paper-based HMIS was variable.
• The improved quality of e-Tracker data indicates increased adoption by health workers, likely due to the shift from paper-based reporting.
• Targeted implementation strategies supporting digital data entry can further enhance data quality.