Task 1. Suspicious data entries:

TASK 1: Suspicious values

Task 2. Conclusion about the National and Subnational coverage table

The administrative coverage showed mark differences among the respective regions. To a large extent, this suggests unreliability of the denominator used by the regions, especially in Grandtown where coverage has consistently been >100% from 2011 to date. This is not logically possible as there is no point in time an immunization program can consistently reach all the children of such a large population for such a long time.

Task 3. My view about the National Coverage after triangulating with the Survey results:

The coverage evaluation survey results are very close to the admin coverage; hence it supported the high coverage showed by the admin data. My view of the high coverage at national level remains unaltered.

Task 4. Additional information conveyed by the age distribution of cases table

The fact that 37% of the cases were between the ages of 1 – 5 year suggests presence of a large number of unprotected children. This could have been as a result of accumulation of unvaccinated children over the course of the period in review; a proxy to low coverage.

Task 5. Briefing of the Minister on the situation (3 bullet points)

• ​The outbreak affects Children under five years most; constituting 37% of all the cases
• Grandtown region, where admin coverage was consistently highest for the past seven years is the most affected.
• The outbreak could be as a result of accumulation of unvaccinated children, in Grandtown in particular. The fact that coverage in this area has been high as per the admin data have clouded the actualities about coverage which might have led to complacency in making efforts to reach more children for vaccination.

Task 6. Proposed three actions to respond to the outbreak

To respond to the outbreak, the MoH should:

• Embark on a Mass Vaccination campaign to break the transmission cycle
• Create demand for vaccination through aggressive sensitization of communities on importance of vaccination
• Engage and utilize local structures to enhance trust and confidence in vaccines. This would go a far way in addressing vaccine hesitancy.

Task 7. 3 – 5 priority recommendations specific to data strengthening

 The MoH should:

• Create data quality teams at all levels that would be vetting and validating admin data prior to transmission to next higher level. This would enhance credibility of the admin data
• review denominators through involvement of all stakeholders, especially the government statistics department to ensure the use of realistic targets
• Invest in electronic immunization data systems that capture individual level data, and track immunization to completion.