Evaluating an Intervention to Improve the Quality of Routine Immunization Data and Monitoring System in Enugu State, Nigeria: A Pre-and Post-Study

Abstract

ABSTRACT Background: Studies evaluating what interventions might improve the quality of routine immunization (RI) data and use in decision-making are scarce in Sub-Saharan Africa. This study assessed the effect of a data-focused intervention on the accuracy of RI data and the quality of the data monitoring system (DMS). Methods: A ”before and after” study was conducted in randomly selected health facilities (n = 60) in Enugu State, Nigeria. Data on three routine vaccinations in tallied registers, facility reports, and District Heath Information System II, and the quality of the DMS were compared before and after the intervention. The DMS covered recording, reporting, archiving, demographic information, core output and analysis, and data use. The intervention included monthly data review meetings and supervision of facility RI staff. We compared mean differences (MD) of log-transformed data accuracy and quality scores between baseline and end-line using paired samples t-test. Additionally, interviews were conducted with purposively selected RI stakeholders (n = 21) on the interventions and self-selected changes in RI data management practices. Data were coded and analyzed thematically using NVivo software version 11. Results: The accuracy of Measles2 facility reports improved post-intervention (MD = -0.62, t = 2.70, ρ = 0.009). The overall quality of the DMS (MD = -10.1, t = -4.4, ρ = 0.001), recording (MD = -6.5, t = -3.0, ρ = 0.048), demographic information (MD = -24.1, t = -6.1, ρ = 0.001), core output and analysis (MD = -14.2, t = -3.9, ρ = 0.004), and data use (MD = -17.05, t = -4.3, ρ = 0.001) improved post-intervention. Regarding the qualitative findings, adopting “tally as you vaccinate,” timely reporting, use of demographic information, archiving paper records, updating the monitoring charts regularly, and data-informed decisions improved the RI data monitoring system. However, resistance to changes in recording practices, staff shortage, use of inappropriate denominators, interrupted supply of monitoring charts, and lack of funds constrained the data monitoring system. Conclusion: Supervision and data review meetings improve the accuracy of Measles2 and the quality of the RI DMS. The feasibility of sustaining the data management practices requires RI stakeholders to address contextual limitations identified in this study.