Q1: List items currently missing from the questionnaire that are needed to achieve the stated survey objectives.

Answer:

• BCG vaccine
• IPV vaccine
• Sex of child
• Residence demography – Rural/Urban
• Residence address
• Birth order
• Literacy of caregiver

Q2: List of questionnaire items currently unrelated to achieving the stated survey objectives.

Answer:

• Yellow fever vaccine
• Rota vaccine as it will be introduced this year in Harmonia
• Mobility questions form RI6
• Questions (RI118 – RI121) relating to abscess on form RI5

Q3: Recommend how to improve the alignment between questionnaire and the stated survey objectives.

Answer:

• Form RI2 should be reorganized to reflect the information (and order) on the vaccination cards in Harmonia
• Vaccination data by card and recall be placed side by side
• Reason for partial or no vaccination questions after vaccination data

Q4: What steps would you take to ensure that interviewers ask the questions in the same standardized manner?

Answer:

• Selection of interviewers from the health work force knowledgeable on EPI schedule
• Training of interviewers on IPC skills for them to be able get vaccination records from parents/caregivers and how to interpret evidence of vaccination
• Piloting/ field trial of the survey questionnaire
• Survey forms should be simple and may be translated into the local language
• National EPI schedule should be printed and attached to each questionnaire
• Explanatory notes for the questions been asked
• Questionnaire should be checked by the interviewer first, and later by the supervisor to ensure that they are filled correctly.
• Supportive supervision and monitoring

Q5: What factors may contribute to ascertainment bias in this survey?

Answer:

• Household selection - Selection bias
• Recall bias – Vaccination is misclassified by parents/caregivers as they are not able to give correct details
• Interviewers bias – interviewer may apply his own knowledge to fill the data when parents are not sure
• Social desirability bias - Providing true maternal recall, for reasons for no vaccination
• Information bias – inconsistent probing by interviewer for vaccination information recall
• Absence of respondents in the homes
• Non- availability of SOPs and instructions for each questionnaire
• Questionnaires have terms that are not understood by the respondents
• Lack of testing the questionnaires field and at the health facilities
• Poor quality of interviewer's training
• Lack of cross checking the data before leaving the house