MODULE A2- Assignment week 1

In your Update, address these five issues:

1. List items currently missing from the questionnaires that are needed to achieve the stated survey objectives.

The questionnaire is lacking questions to assess the following objectives:

Factors related with birth order, literacy of mother and/or caregiver, vaccination strategy used (routine or campaign).

· Proportion of children with zero doses in RI or campaigns

 

Additionally, BCG vaccine was not listed in section titled “Routine Immunization Dose Data by Card”. Yellow fever vaccine was included, but is not mention as part of the national immunization schedule in the Harmonia concept note.

 

2. List questionnaire items currently unrelated to achieving the stated survey objectives.

Questions on population mobility, adverse reaction following vaccination (AEFI) and promotion of vaccination are not part of the study objectives.

Additionally, it’s suggested to re-order some of the questions, to follow a better logic order. For instance, question R107 should be moved to section RI5.

 

3. Recommend how to improve the alignment between questionnaire and the stated survey objectives.

The easiest way is to draft the questions following the study objectives listed in the protocol. If possible, questions may be organized per each study objective (i.e., reasons for unvaccinated/under vaccinated). When piloting the questionnaire, a step should be included to evaluate whether skip patterns were correctly observed. In addition, it’s important to determine a priori what questions will require probing or not. Both piloting and training sessions will contribute to shape the final versions of the data collection tools.

 

4. What steps would you take to ensure that interviewers ask the questions in the same standardized manner?

Training should include role plays or simulation exercises, in which interviewers will ask questions included in the questionnaires to surveyors. Role play sessions with the interviewers and supervisors will help to shape the necessary skills for:

- Conducting the interview

- Probing

Handling difficult and unusual situations

 

Role plays should be recorded, and then reviewed them with facilitators to provide feedback to trainees.

 

5. What factors may contribute to ascertainment bias in this survey?

At this stage in survey planning, data collection tools that are not aligned with study objectives will contribute with ascertainment bias, as they will create a systematic distortion in measuring the frequency of a phenomenon. The latter should also be considered in the type of questions (free text versus multi-option) to be included, the language used when drafting questions, options and/or answers, the use of probing per question, the design of the forms, the lack of field testing etc. If proper training is not implemented, interviewers may not develop the necessary skills to ask questions in a standardize manner, in order to keep with quality control efforts. In addition, it’s highly recommended to photograph the vaccination card to increase accuracy of vaccination data for coverage estimations and other measures (i.e. timeliness). If vaccination card is not available, seeking the data at the health facility (vaccination records) should be implemented. Finally, data quality checks should be in placed throughout data collection.

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Harmonia Survey Objectives

The main objective of the vaccination coverage survey in Harmonia is

1) to estimate vaccination coverage for all vaccine/doses childhood vaccines in the immunization schedule among children 12-23 and 24-35 months by province (10 provinces) and at the national level.

Other specific objectives include assessing:

2) Coverage by card

3) Coverage by card or health facility documentation

4) Coverage by recall (only for those without documented evidence of vaccination)

5) Coverage by card or health facility documentation plus by recall

6) Proportion of children with zero dose:

· a. In routine immunization, and

· b. In RI or campaigns

7) Proportion of children fully vaccinated for their age:

· a. Among children aged 12-23 months (includes all vaccines in schedule minus measles-rubella (MR) second dose), and

· b. Among children aged 24-35 months (includes all vaccines in schedule)

8) Drop-out rates between DTP doses, OPV doses, PCV doses and MR doses;

9) Vaccination timeliness (defined no later than 1 month after the recommended age and with an appropriate interval between doses: at least 28 days for Penta, OPV, PCV and MR

10) Simultaneity of vaccines recommended at the same age;

11) Missed opportunities for vaccination, as defined in the WHO 2015 Vaccination Coverage Survey Reference Manual;

12) Reasons for no or under vaccination;

13) Predictive value of maternal believe that child has received all the vaccines that are recommended for her/his age

14) Factors associated with no or under vaccination, including:

· a. rural/urban;

· b. sex of the child;

· c. birth order;

· d. literacy of the mother/caregiver;

· e. strategy used usually to get the child vaccinated (fixed post vs outreach/mobile posts)

· f. sector (public, private, other) where child if usually vaccinated and/or where he/she received the last vaccine