Building Data Triangulation Capacity for Routine Immunization and Vaccine Preventable Disease Surveillance Programs to Identify Immunization Coverage Inequities.

The Expanded Programme on Immunization (EPI) and Vaccine Preventable Disease (VPD) Surveillance (VPDS) programs generate multiple data sources (e.g., routine administrative data, VPD case data, and coverage surveys). However, there are challenges with the use of these siloed data for programmatic decision-making, including poor data accessibility and lack of timely analysis, contributing to missed vaccinations, immunity gaps, and, consequently, VPD outbreaks in populations with limited access to immunization and basic healthcare services. Data triangulation, or the integration of multiple data sources, can be used to improve the availability of key indicators for identifying immunization coverage gaps, under-immunized (UI) and un-immunized (zero-dose (ZD)) children, and for assessing program performance at all levels of the healthcare system. Here, we describe the data triangulation processes, prioritization of indicators, and capacity building efforts in Bangladesh, Nigeria, and Rwanda. We also describe the analyses used to generate meaningful data, key indicators used to identify immunization coverage inequities and performance gaps, and key lessons learned. Triangulation processes and lessons learned may be leveraged by other countries, potentially leading to programmatic changes that promote improved access and utilization of vaccination services through the identification of UI and ZD children.

Pilot implementation of a routine immunization module of the district health information system version 2 in Kano State, Nigeria, 2014 - 2015.

Introduction: Timely and accurate data are necessary for informing sound decision-making and developing effective routine immunization (RI) programs. We launched a pilot project in Kano State to strengthen routine immunization (RI) data reporting through the immunization module of the District Health Information System version 2 (DHIS2). We examined the completeness and timeliness of reporting monthly RI data one year before and one year after DHIS2 module pilot in the State. Methods: The first phase of the DHIS2 RI module pilot in Kano included training on RI data tools in November 2014 and in January 2015 for 36 state and zonal personnels, 276 local government area (LGA) personnel, and 2,423 health facility (HF) staff. A RI-focused dashboard to display core RI accountability framework indicators, such as completeness and timeliness of reporting, planned immunization sessions conducted, coverage and dropout was implemented. Report completeness was ratio of submitted reports to number of health facilities while report timeliness was ratio of reports on the DHIS2 by 14th of the month to number of expected. Results: Completeness of data reporting increase from 70% in 2014 to 87% in 2015, while timeliness of reporting increase from 64% to 87% over the same period. Challenges encountered during the implementation process included limited access to internet, power outages, health workers strike, staff attrition and competing state activities. Conclusion: The pilot implementation of the DHIS2 immunization module in Kano State led to modest improvement in the reporting of RI services. Several lessons learned were used to guide scale-up to other states in the country.

Progress toward poliomyelitis eradication in Kano State, Nigeria, 2010 - 2017.

Introduction: Kano State in Northern Nigeria was a major source of Wild Polio Virus (WPV) cases in Nigeria up until 2015. In 2009, the State reported 168 WPV cases out of the 388 reported nationally. This paper characterizes the progress made by Kano State in polio eradication. Methods: In December 2017, we conducted a descriptive review of Routine Immunization (RI) from both the District Vaccine Data Management Tool (DVD-MT) and District Health Information System (DHIS2) from 2010 to 2017. Also, we reviewed the Acute Flaccid Paralysis (AFP) and Supplementary Immunization Activities (SIAs) data reported for Kano State from 2010 to 2017. Also, we obtained the number of reported WPV cases by serotypes. Results: From 2010 to 2017, a total of 65 confirmed WPV cases were reported in Kano State. Of these, 58 (89%) were WPV1 and 7 (11%) WPV3. Almost half of these cases were reported in 2012 from 14 LGAs. The number of reported cases fell to 15 (23%) in 10 LGAs in 2013, and further decreased to 5 (8%) in four LGAs in 2014. No new WPV cases have been detected in Kano since 2015. During the same period, 23 circulating Vaccine Derived Polio Viruses (cVDPV2) cases were reported in Kano. Specifically, 10 LGAs reported 10 cases in 2011. Three LGAs reported three cases in 2012, while eight LGAs reported 10 total cases in 2014. During the 2010 to 2017 period 61 SIAs were conducted. Conclusion: Kano State made progress toward polio eradication. Sustained eradication efforts, in form of high quality RI, SIAs and AFP surveillance are necessary to avert possible importation from 2016 polio resurgence in nearby Borno State, Nigeria.

Determinants of improved data consistency across routine immunization data tools for health facilities in Kano State, Nigeria.

INTRODUCTION: in this study, determinants of improved data consistency for routine immunization information at health facilities was measured to identify associated factors. METHODS: between June and August 2015, 1055 HFs were visited across 44 Local Government Areas in Kano state. We assessed data consistency, frequency of supportive supervision visits, availability of trained staff and attendance to monthly LGA RI review meetings. We compared RI monthly summary forms (MSF) versus national health management information system summary form (NHMIS) and vaccine management form 1a (VM1a) versus HF vaccine utilization summary monthly summary (HFVUM) for consistency. Data consistency at HF was determined at <+10% between number of children reportedly immunized, and doses of vaccine opened using 3 antigens (BCG, Penta and Measles). Levels of discrepancy <10% were considered as good data consistency. Bivariate and multivariate analysis used to determine association. RESULTS: data Consistency was observed in 195 (18.5%) HFs between (MSF vs NHMIS) and 90 (8.5%) HFs between (VM1a vs HFVUM). Consistency between MSF vs NHMIS was associated with receiving one or more SS visits in the previous month (p=0.001), data collection tools availability (p=0.001), recent attendance to monthly LGA RI review meeting and availability of trained staff. Data consistency between VM1a form and the HF VU summary was associated with a recent documented SS visit (p=0.05) and availability of trained staff (p=0.05). CONCLUSION: low level of data consistency was observed in Kano. Enhanced SS visits and availability of trained staff are associated with improved data quality.