Part one Data Analysis

Task 1 some of the repetation and suspecious observed include: 

• Repetation in the data recorded in February - March 2017 in all districts exccept in district 13 of the same months.
• High coverage in the reported antigen of >100% in 8 of the districts.
• Coverage within 100% in 2 of the distircts ( district 6 and 13 ).
• Coverage within 80% - 89% in 2 district (district 7 and 8).
• Coverage of 97% in only one district (ditric9).
• Coverage of below 59% in two of the district ( district 2 and 5).

In the other hand it was found that district 3 has a cummulative coverage of 255%. This entile's the problem of denomerator.

• Significant drop in number immunized (150) in Agust 2017 was noticed while the record shoot up in November (460) to meet up with the expected target.
• Very low coverage in district 2 and 5 (48% & 58% repectively ) result to immunity gap.
• Another data repetation was noticed in district 14 in Februart and March. High coverage of 205% was recorded.
• Data inconsistancy was noticed in district 15. Fall in number of children immunized (366) in March while sudden rised in immunized (849) was seen in the subsiquent month of April.
• It was found in district 13 that, the number of children vaccinated significantly fall from 483 to 196 in February as against March.
• Cummulatively in May 2017, significant increase in the number immunized recorded in January - April. The coverage was above 180%.
• Sudden decrease in the following month of June was noticed. 

Task 2 : - National and sub national coverage of MR1 was reviewed as follows'when the data was disagregated at the sub national level the result was presented as thus;

• MR1 coverage in Grandtown immunined more than surviving infant throught 2011 - 2017. This was also simillar to Remo showing coverage above 100% ( exccept in 2014 - 2015) as incase of Grandtown.
• Regions like Nemo, Chello and Westtan coverage was < 80% could not reache adminstrative target, an indication of immunity gap potential risk to disease outbreak.
• Looking at the data from 2011 - 2017 of that region a left out children and pocket of un immunized children may likely be found ( all thing been equal).
• The national data was significantly consistant with close coverage of 90% - 95% through the years of 2011 - 2017 with excception of 2015 with coverage of 89%.
• It shown that even at the national level trend of the surving infants was significantly unstable with out consistant progression rather than flactuating with in the years (2011 - 2018 respectively). 

Coclusion: - Both at national and subntional level there found a problem of denomerator leading to missing of some number of eliglble children in some districts. High coverage in some region above the expected target. Inconsistancy in number of surviving infants reached with vaccination and percentage coverage recorded. These may be atributed to occurance of the outbreak recorded in the affected areas. 

Task 3: -  Triangulations of the data through coverage survey

• Raliability of the national data was consistance with the coverage survey 89.2% vs. 89% in 2015.
• Grandtown immunization was in disagreement with coverage survey. Indicated 115% as against 89.0% respectively.
• Offcourse outbreak was consistant because of infux of migrants, under served population,rapid expansion of the mega cities like Grandtown with some level of vaccine hesitency which may trigger the risk of subsiquent outbreak and other social unrest. 

Task 4:- Trend of Disease Outbreak by Age Distribution. 

The chart show various age distrubution of affected age groups. However, the age distribution was not very much clear to understand whenther it's in month or year cohort. We assumed the analysis was based on month cohort.

• 2011 was the alarming stage of the outbreak (462 children involved) progressively reached it peak in 2012 (3,285 involved) of th normal epidemic curve.
• The outbreak was control probalbly due to quality national Measle SIAs conducted leading to sustained immunity level to the targeted age cohort some years.
• 2018 was danger signal (625 involved) to another serious outbreak compared with 2011 - 2012 trends. More outbreak may likely to occur in the following year among the age groups if there is no prompt intervention.

Further analytic findings shown that: 

• Age cohort of 1- 4 (26%) and 30+ (22%) were the highest burden of the disease incedence these are children Beyond infancy which may likely be Partially immunzed or not immunized at all.
• It could be applicable to the age of 20 - 29 group as mentioned above. The disease prevalence was signifcantly reach 16% and represent the 3rd group of the victims.
• Though less than one year of age were also affected it's also suggest some resoanable number of surviving infants are either left over, un immunized or partially immunized with the expected vaccine even though the schedule of MR doses was within 9 - 15month of age based on the national scheduled program.
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Part 2 Briefing of the Minister:-

Task 5: Summarization of the briefing can be conducted using SWOT analysis. 

• STRENGTH 

Availabilty and lauded functional RI services at both level which was free. VPD surveillance and RI data reporting system was timely and complete through good HIMS.Reburst national laboratory. Good vaccine focast and distribution system coupled with well functioning stock management system.

• WEAKNESS

Some of the weakness observed in the Vacciland include fast growing urbanisation specially in mega towns like Grandtow. Large and growing number of poor and under served population. weak and outdated registry which was paper based. Weak capacities among the lower personnel. Denomirator challenges and vaccine hesitancy was idenfied with some sporodic stock out of routine vaccines in some selected areas.

• THREAT

Progression of the outbreak to high epidemic threshold as shown in 2011 -2012 outbreak data. Importation and exportation ( through Migration) of the other VPDs across various part of the land particularly in mega cities Grandtown, boardering districts and underserved population.

Task 6 : - Three actions proposed in respond to the outbreak.

• Createa rebbust rapid respond team if not available at all level.If in existance re activate the team. Provide sustainable logistical support with strict adherance of the SOP to take an urgent step.
• Review the existing micro plan (RED): These include Map of the location/ settllments,house to house enumeration of all eligible age group. Use of tracking system to identified the uncover or missed settlements. Logitical requirements both human resource and monetory to be adequately provided.
• Plan for MR follow up campaign (National SIAs) to capture missing ages and bridge the immunity gaps.

Task 7: - Recommendations for Data strenghtening in the Vacciland.

• Create regular means of capacity building to the personnel especially lower staff.
• Update data registry to be more reburst and ensure it's meet to regianal standard level. Botton - Top approach electronic data flow system to be provide through SMS, DHIS systema both at weekly, monthly and quater basis.
• Data Quality Assessment to be regularly conducted with actionable/feasible action points.
• Issue of Denomerator to be address based on vaccine consumption or last immunized coverage as a target. However, this should be with utmost care.
• Surveillance network to be expanded and reporting system to enhance.