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MEASURING COVERAGE IN MNCH: DESIGN, IMPLEMENTATION, AND INTERPRETATION CHALLENGES ASSOCIATED WITH TRACKING VACCINATION COVERAGE USING HOUSEHOLD SURVEYS

Wednesday, 12th of June 2013

• MEASURING COVERAGE IN MNCH: DESIGN, IMPLEMENTATION, AND INTERPRETATION CHALLENGES ASSOCIATED WITH TRACKING VACCINATION COVERAGE USING HOUSEHOLD SURVEYS

Full text, with graphics, is at

http://www.ploscollections.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001404

 

Abstract

Vaccination coverage is an important public health indicator that is measured using administrative reports and/or surveys. The measurement of vaccination coverage in low- and middle-income countries using surveys is susceptible to numerous challenges. These challenges include selection bias and information bias, which cannot be solved by increasing the sample size, and the precision of the coverage estimate, which is determined by the survey sample size and sampling method. Selection bias can result from an inaccurate sampling frame or inappropriate field procedures and, since populations likely to be missed in a vaccination coverage survey are also likely to be missed by vaccination teams, most often inflates coverage estimates. Importantly, the large multi-purpose household surveys that are often used to measure vaccination coverage have invested substantial effort to reduce selection bias. Information bias occurs when a childs vaccination status is misclassified due to mistakes on his or her vaccination record, in data transcription, in the way survey questions are presented, or in the guardians recall of vaccination for children without a written record. There has been substantial reliance on the guardians recall in recent surveys, and, worryingly, information bias may become more likely in the future as immunization schedules become more complex and variable. Finally, some surveys assess immunity directly using serological assays. Sero-surveys are important for assessing public health risk, but currently are unable to validate coverage estimates directly. To improve vaccination coverage estimates based on surveys, we recommend that recording tools and practices should be improved and that surveys should incorporate best practices for design, implementation, and analysis.

Citation: Cutts FT, Izurieta HS, Rhoda DA (2013) Measuring Coverage in MNCH: Design, Implementation, and Interpretation Challenges Associated with Tracking Vaccination Coverage Using Household Surveys. PLoS Med 10(5): e1001404. doi:10.1371/journal.pmed.1001404

Academic Editor: David Osrin, Wellcome Trust Senior Research Fellow in Clinical Science, UCL Reader in International Child Health, Honorary Consultant, Great Ormond Street Hospital for Children, United Kingdom

Published: May 7, 2013

This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Funding: FTC and DAR were contracted by The Bill & Melinda Gates Foundation to undertake this work. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed in this paper are those of the individual authors and not necessarily those of the US Food and Drug Administration.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: BCG, Bacille Calmette Guerin vaccine against tuberculosis; DHS, Demographic and Health Survey/s; EPI, Expanded Programme on Immunization; HBR, home-based record; LQAS, Lot Quality Assurance Sampling; MICS, Multiple Indicator Cluster Survey/s; UNICEF, United Nations Childrens Fund; WHO, World Health Organization

Provenance: Submitted as part of a sponsored Collection; externally reviewed.

This paper is part of the PLOS Medicine “Measuring Coverage in MNCH” Collection.