Week 1 Community assignment instructions

Instructions

Download the Vacciland package…
Complete all seven tasks below (see below, Part 1 and Part 2)
Post your assignment in a Community Update in the IMA Level 1 Scholar community. DO NOT POST ON YOUR PERSONAL PROFILE. (You will find instructions how to do this in the Scholar community.)

Part 1. Data analysis

Before you head into the meeting with the Minister, you want to make sure your data are solid. Most of the cases occurred in the capital, Grandtown, where reported coverage is high. You want to ensure that the data for Grandtown don’t contain any mistakes, so you requested this table with reported doses of MR1 for last year.

Task 1. Flag all the suspicious values. (Outliers, repetitions, etc.) (spend max 15 minutes)

Some districts have monthly coverage much higher than the target population (Blue)

Duplication of monthly coverage data for some districts (Yellow)

All coverages are rounded up to higher figure, providing an impression of higher coverage

The total surviving infants of 82,648 reported in the year does not add up to the real target population of population (case study)

Task 2. Review the national and subnational coverage for MR1. Your data manager produces the following tables.What can you conclude from the administrative data?

National and subnational coverage for MR

Grandtown and Remo coverages are higher than 100% showing a problem of denominator (Yellow)
Despite a coverage of 90% nationally, coverages of Nemo, Chello, Grandton Westtan are consistently low. The national coverage masks the poor performance.

Task 3. Review coverage evaluation survey data.You remember that in 2013, there was a coverage evaluation survey. You pull up the data for that. Does this change your view about coverage at national level? For any of the regions?

Coverage survey shows a 91.9% (CI 86.5% - 91.9%) with national coverage administrative coverage of 91% (2012) with in the same range of CI. Data is reliable falls within the CI

Task 4. Review the chart with the age distribution of measles cases.Does that tell you anything additional about coverage?

The most affected population is less 1 - 4 years (26%) and 30+years (22%).
Low immunisation coverages in the immunisation target population 0-4years and an existing immunity gap in the older population due to accumulating unimmunized children is fertile ground for outbreaks in these age groups
Wider age group 0-14years constitutes the largest outbreak cases (56%). Vaccinating this group would contribute hard immunity
If finances are available wide age group vaccination would be conducted

Part 2. Brief the Minister

Task 5. Brief the Minister (spend max 1/2 hour on this section). Summarize the situation in three bullet points.

The current 2018 measles outbreak of 625 is the worst in last 7 years only next to the 2011 outbreak

Among the children, Age group less 0-14 years is worst affected due to low immunity as result of suboptimal immunisation coverage. 80% of cases are unvaccinated or have unknown vaccination status. If resources are available we could conduct a wide age group vaccination campaign.

Vacciland has fast-growing urbanization worse in the Capital, Grandtown (~19% of the population), large and growing number of poor and underserved people compromising immunisation service delivery. Data discrepancy in coverage provides suboptimal guidance to decision making.

Task 6. Brief the Minister.Propose three actions to respond to the outbreak.

Need of political commitment and advocacy to strengthen immunisation services and resource mobilisation for response action

Strengthening of immunisation program components (program management, service delivery, data management, monitoring and supervision, disease surveillance and advocacy and communication), and strong efforts to harmonization of target population through community registration for use in immunisation coverage improvement

Plan to conduct wide age group Measles Containing Vaccine campaign nation wide

Task 7. Formulate recommendations.List your top 3-5 recommendations specific to data strengthening you would prioritize as the EPI and surveillance teams in Vacciland

Vacciland Ministry of Health to develop a national data improvement plan (DIP)

Implement the DIP at all levels of health service delivery including training of health workers and data quality assessments
Ministry of health and health partners to support district community registration of target population so as to ensure all target population is reached with immunization services
Establish a strong partnership between public and private health facilities all included in DIP to improve immunisation services in Vacciland