Part 1. Data Analysis

Task 1. Flag all the susppicious values (Outliers, repetitions etc.)

From the excel file, it is clear that-

1. Many months have reprtitions ( February, March all the Districts)

2. Many months have Outliers ( April, May-District 3, May District 4)

3. Some months have very low coverage value (Nov, District 13)

4. Denominator issue ( some have more than 100% coverage and some have as low 48% coverage)

Task 2. Review the National and Subnational coverage for MR1.

After review the cnclusions are below:

1. Since 2011, sof the sub natioanlal unit repeatedly reported a coverage >100%, which looks like an issue with over reporting (especially Grandtown and Remo) and appropriate dinominator set up.

2. Units like Nimo, Westtan aloways reporting a low coverage which indicates a potential dinominator issue as well as access/utilization issue of vaccination

3. Nationally MR1 coverage remains low except 2016. This is an indication of potential immunity gap over the years.

Task 3. Review coverage evaluation survey data.

It was clear from the administrative data that there is potential data quality issue. Survey data indicated the same. 2013 survey data represents 2012 birth cohort ( hence 2012 coverage). Also if we take adjusment factor (dividing 2013 survey data to 2012 administrative data) and multiply the factor to next few years administative data, we will find the adjusted coverage for those years. It also shows a reduced coverage in most of the units as like as Chello, Grandtan. Westtan still has high coverage more tha 100% that is potentially a denominator issue.

Task 4. Review the chart with the age distribution of Measles cases.

After review the chart I found most of the Measles case distribution falls in to age group 1-4 and 5-9 years. That indicates immuniy gap in young age group who are very much susceptable to measles infection. This indicates a constant missing out of children from MR dose over the years, creating imminity gap resulting in large scale outbreak. This also tell the story of potential data quality issue (over reporting, low denominator resulting high coverage and missing children) as administrative coverage showing high MR1 coverage (especialy Grandtown that has the highest Measles cases).

Part 2. Brief Minister

Task 5. Brief the Minister. Summarize the situation in three bullet points.

1. Vacciland has Potential data quality issue (over reporting, outliers and repititions) that needs to be fixed in order to find quality data and use of that fo dicision making.

2. Vacciland has potential denominator issue where some unit has low dinominator resulting in high coverage and missing children. Also ther is some unit has low coverage though survey data shows hoigh coverage. Denominators need to set up correctly.

3. Current Measles Outbreak shows immunity gap among young age group (1-9 years) as well as in the adult age group. This indicates a wide rang of population remains un immunized that triggers large scale measles outbreak.

Task 6. Brief the Minister. Propose Three actions to respond to the Outbreak.

1. Assess population immunity and reduce population unimmunity by supplementary immunization activity should be the priority activity.

2. SIA should be non selective including 6 months to 15 years of age.

3. Plan for future nationwide catchup campaign to reduce the immunity gap.

Task 7. Formulate Recomondations.

1. Root cause analysis of the existing data quality issue.

2. Traingulation of data from different data sources to find out region specific and age specific denominator.

3. Use of different analytical method to find out data discrepancies like repititions, outliers, vaccine dosage use vs total vaccine given, total vaccine given vs total syringe uses etc.

4. Training of the responsible health care workers on denominators setup, data reporting, recording, analysis and use of data for action.





















Note: All districts had similar figures of MR1 doses for February and March, except for District 13. Some districts coverage were good (District 6 and District 13)