POST 00285 : MISSING DPT-1 DATA PART 3

Post00285 MISSING DPT-1 DATA PART 3 9 October 2000 CONTENTS 1. RE: Post00283 MISSING DPT-1 DATA PART 2 In Technet Post00282, 2 October 2000, Robert Steinglass, BASICS, asked "SHOULDN'T WHO BE ASKING FOR DTP 1 DATA?", particularly since countries already collect the data. Some reasons for collecting and using DPT dose 1 data were discussed. Maureen Birmingham, WHO/V&B, commented that DPT-1 data would probably be included in the next edition of the country immunization coverage reporting form. In Technet Forum Post00283, 6 October 2000, The need for the use of DPT1 data as well as caution in its use were discussed. The question of 2 doses and fully immunized status was also raised. In todays posting: * Anne Kempe, DHS/SA, discusses the Australian experience of calculating immunization coverage and the problem of the 3rd dose assumption (a reported 3rd dose implies that doses 1 and 2 were given!). * John Lloyd, PATH, discusses the difficulty of using DPT-1 data for calculating drop-out rates at facility level in Kenya - where due to the use of multiple facilities and client mobility - doses are given at different facilities. John points out that this problem is probably less important at district level and above. From: "Kempe, Ann (DHS)" To: "'Technet Moderator'" Subject: RE: Post00283 MISSING DPT-1 DATA PART 2 (Australian experience of the 3rd-dose DTP assumption: Date: Fri, 6 Oct 2000 10:16:15 +0930 Australian experience of the 3rd-dose DTP assumption: Since 1996, Australian has had a national vaccination register that tracks all children in the country under the age of 6. One of the benefits has been the ability to calculate coverage on a timely and frequent basis. The Australian Childhood Immunisation Register (ACIR) denominator population is all children registered on Medicare (universal health insurance system) and over 90% of Australian children are registered within 2-3 months of age. The numerator data are all vaccination encounters notified by all immunisation service providers in Australia and these doctors and nurses received a $A6 per service encounter payment for data received. In terms of analysis of data on the ACIR to calculate coverage: the vaccination status of each cohort (defined by date of birth in 3 month age groups)is assessed at 12 months and 24 months of age (the ACIR is too "young" to calculate accurate coverage for 5 year old). Coverage is measured several months after the due date for completion of each milestone to allow for data lag. It is assumed that notification of receipt of a later vaccine dose implies receipt of earlier doses even if no earlier vaccination is recorded. A child is defined as "fully vaccination" at 12 months if he or she has received a 3rd dose of DTP (acellular or whole cell), poliomyelitis vaccine (oral or inactivated) and HBOC (or two doses of PRP-OMP). ACIR coverage estimates for the 1st vaccination milestone is notification of the first three scheduled doses of DTP, OPV and 2 or 3 doses of Hib). Hull and McIntyre published a paper early this year that revisited coverage reporting through the ACIR and evaluated the so called "third-dose assumption". This paper demonstrated that our coverage estimates dropped across all cohorts, ranging from 13% for Western Australia to 10% in the Northern Territory. Overall the authors state that "if the third dose assumption was no longer applied to the assessment rules, Australian national coverage estimates would fall from approxiamtely 85% to 73% for three doses of DTP for Australia". Regardless of this there is a long term plan to move away from the third-dose assumption at some time in the future. If anyone is interested to read the paper, the reference is: Hull, B. P. and McIntyre, P.B., Immunisation coverage reporting through the Australian Childhood Immunisation Register - an evaluation of the third-dose assumption. Australian and New Zealand Journal of Public Health, 2000, Vol 24 No 1, pp17-21. The website for the ACIR is www.hic.gov.au and click on the ACIR. the ACIR email address is [[email protected]][email protected][/email] I understand that there will be differences between our experiences and those countries where EPI is involved but I thought this might add to the discussion. Ann Kempe South Australia, Immunisation Coordinator CDC Branch, Dept. Humuan Service PO Box 6, Rundle Mall South Australia 5000 --- From: [[email protected]][email protected][/email] Date: Fri, 6 Oct 2000 05:27:44 EDT Subject: Re: Post00283 MISSING DPT-1 DATA PART 2 To: [[email protected]][email protected][/email] I do agree that DTP1 data are essential to calculate dropout rates which are an important indicator for immunization services management. But Linda Archer and I have just completed the first field test of the GAVI Immunization Data Quality Audit (IDQA) in Kenya during which we found a difficulty of using this indicator at health facility level but not necessarily at district and above. In this part of Kenya where there is a significant proportion of hospital deliveries, BCG is administered by the hospital and the mother is asked to return for the first DTP and Polio at 6 weeks. Many mothers, at least in our field test, were returning to the outpatient department of the hospital for the first DTP and then progressively changing to their local health facility for the 2nd or 3rd DTP. This shows up as a negative dropout rate in the health facility and a high positive dropout at the outpatient facility. This artifact and other market reasons for changing health facility in mid- series of injections, makes dropout a weak indicator of management at health facility level, although the variations are resolved at district level. We would be interested to here is this would be the case in other country settings. John S. Lloyd Resident Advisor PATH Program for Appropriate Technology in Health Bill and Melinda Gates Children's Vaccine Programme Centre d'Aumard 55 Avenue Voltaire F-01210 Ferney-Voltaire FRANCE Tel: (33) 450-28-06-09/00-49 Fax: (33) 450-28-04-07 [email protected] http://www.ChildrensVaccine.org http://www.path.org ____________________________________*______________________________________