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
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