Poor Immunization Data Quality Led to Wrong Decision Making in Pertussis Outbreak Management in Southern Ethiopia: a Cross Sectional Study
Authors: Argaw Mesele D. , Desta Binyam F. , Tsegaye Zergu T. , Mitiku Aychiluhim D. , Atsa Afework A , Tefera Bekele B. , Rogers Deirdre , Teferi Ephrem , Abera Wondwosen S. , Beshir Ismael A. , Kora Zelalem A. , Setegn Sisay , Anara Amare A. , Sinamo Tadelech , Muloiwa Rudzani 
Published: February 2021

Abstract
Background: The aim of this study was to investigate the quality of immunization data and monitoring systems in the Dara Malo district (woreda) of the Gamo Administrative Zone, Southern Nations, Nationalities and Peoples Region (SNNPR) of Ethiopia.Method: A cross-sectional study was conducted from August 4 to September 27, 2019 in Dara Malo District. The district was purposively selected during the management of a pertussis outbreak based on the hypothesis ‘there is no difference in reported and recounted immunization status of children 7 to 23 months in Dara Malo District of Ethiopia’. The study used the World Health Organization (WHO)-recommended Data Quality Self-Assessment (DQS) tools. The accuracy ratio was determined using data from the routine Expanded Program of Immunization (EPI) and household survey. Facility data spanning the course of 362 months were abstracted from EPI registers, tally sheets, and monthly routine reports. In addition, household surveys collected data from caretakers or immunization cards or oral reports. Trained DQS assessors collected the data to explore the quality of the monitoring system at health posts, health centers and district health offices. A quality index (QI) and proportions of completeness, timeliness and accuracy ratio of the first and third doses of pentavalent vaccines and the first dose of measles-containing vaccines (MCV) were made.Results: In this study, 336-month facility data were extracted. In addition, 595 children aged 7 - 23 months, with a response rate of 94.3%, were assessed and compared for immunization status using register and immunization cards or caretakers’ oral reports through the household survey. At the district level, the proportion of the re-counted vaccination data on EPI registers for first dose pentavalent was 95.20%, three doses of pentavalent was 104.2% and first dose of measles was 98.6%. However, the ratio of vaccination data compared using tallies against the reports showed evidence of overreporting with 50.8%, 45.1% and 46.5% for first pentavalent, third pentavalent and first dose of measles vaccinations, respectively. The completeness of the third dose of pentavalent vaccinations was 95.3%, 95.6% and 100.0% at health posts, health centers and at the district health office, respectively. The timeliness of the immunization reports was 56.5% and 64.6% at health posts and health centers, respectively, while the district health office does not have timely submitted on time to the next higher level for twelve months. The QI scores ranged between 61.0% and 80.5% for all five categories, namely, 73.0% for recording, 71.4% for archiving and reporting, 70.4% for demographic information, 69.7% for core outputs and 70.4% for data uses and were assessed as suboptimal at all levels.Conclusion: Immunization data completeness was found to be optimal. However, in the study area, the accuracy, consistency, timeliness and quality of the monitoring system were found to be suboptimal. Therefore, poor data quality has led to incorrect decision making during the reported pertussis outbreak management. Availing essential supplies, including tally sheets, monitoring charts and stock management tools, should be prioritized in Daro Malo District. Enhancing the capacity of healthcare providers on planning, recording, archiving and reporting, analyzing, and using immunization data for evidence-based decision making is recommended.