1. Evaluation of the recording of routine childhood immunization data in Burkina Faso
Lassané Kaboré1, 2, Clément Z. Méda3, François Sawadogo1, Michèle Bengue1, William Kaboré4, Isaïe Médah4, Edouard Betsem1,5,6
1) Agence de Médecine Préventive (AMP), Bobo-Dioulasso, Burkina Faso, 2) Université de Genève, Geneva, Switzerland ;3) Institut National des Sciences de la Santé (INSSA), Bobo-Dioulasso, Burkina-Faso ; 4) Ministry of Health, Ouagadougou, Burkina Faso ; 5) Laboratoire Mixte International de Vaccinologie (LAMIVAC), Bobo-Dioulasso, Burkina Faso; 6) Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé 1, Cameroon.
Introduction
Adequate recording of primary routine immunization data is crucial for an accurate estimation of vaccine coverage (VC). The quality of this recording largely relies on the availability and completion of standardized data collection forms. Burkina Faso, West Africa, has introduced several vaccines including Rotavirus and PCV13 in its EPI schedule since However, vaccination cards and registers have not been updated accordingly and ascertaining the vaccination status of a given child is not a straightforward task. The current study evaluated the availability and types of vaccination recording forms, their completion and their value in estimating VC in 10 Health Districts (HD) of the country.
Vaccination cards compared to HF registers
We calculated VC for each of the 17 doses, using vaccination card, HF register and a combination of both. Results are shown in Figure 2.
Fig. 2: Vaccine coverage for different vaccines by source of information
Methods
A 6-week cross-sectional survey was conducted in 30 health facilities (HF) across 10 poor-performing HDs. Study subjects were vaccine-eligible children aged 0-23 months, their caregivers and the health staff in charge of vaccination. Three HFs were selected in each HD based on a convenience sampling. Fifteen children aged 0-11 months and 5 aged months, and their caregivers were consecutively recruited in the HFs.
Results
Overall results
This evaluation was carried out in 30 HFs across 10 HDs (3 HFs in each HD). A total of 619 children were recruited, including 458 aged 0-11 months (74%) and 302 girls (48.9%); 44 children (6.2%) were missing from HF registers. The accompanying adult was the mother and uneducated in 98.1% and 62.7% of cases, respectively.
Characteristics of vaccination cards
At the time of the survey (January 2017), there were 17 doses of vaccine to be administered between birth and 15 months in Burkina Faso’s routine immunization schedule. The proportion of up-to-date cards (ie featuring all 17 doses) was 50.6%. Figure 1 shows that the most recently introduced vaccines (PCV, Rotavirus and MR2) were the most likely to be missed from cards.
Fig1. : Frequency of the 17 doses of vaccine on the cards
We also estimated the proportion of fully immunized children (FIC) using cards, registers and history as the source of information. Results are shown in Figure 3.
Fig. 3: Proportion of fully immunized children by source of information
Overall, 65.5% of the children had a discordance of their vaccination status on at least one of the 17 doses of vaccine (cards vs registers).
Factors associated with discordance
In a multivariate logistic regression, age group being months (OR=3.23, 95%CI: , p=0.022) was a significant risk factor for discordance of vaccination status, while up-to-date card (OR=0.52, 95% CI: , p=0.04) was protective.
Conclusion
We found inconsistencies in the vaccination status when comparing cards to registers, translating into a difference of 10 points in the estimation of the proportion of FIC, with cards being more sensitive. Adding history substantially improves VC. Having up-to-date cards is significantly associated with higher consistency. There is an urgent need to update and standardize vaccination cards in Burkina Faso, especially as the introduction of new vaccines such as IPV is expected in the near future.