Application Research Of Immunization Unit Client’s Cases On Evaluating Immunization Coverage Of National Immunization Programme Vaccines

BackgroundImmunization coverage rate is one of the main indicator to evaluate the expanded immunization program. Reported immunization coverage rate and the coverage rate by sampling are usually higher than the true level under the influence of human and other factors. Since the deployment of Immunization information management system (IIMS) in2007, the coverage rate has increased year after year. There are a large number of immunization cases in immunization unit clients. It is convenient to download database from immunization unit clients. And a large amount of immunization cases can be acquire in a short time. Immunization information data can be analyzed by the method of Kaplan-Meier. This method can display the immunization coverage with different age, and predict if the unit can reach the goal of immunization coverage. The method of use the immunization information from immunization unit clients to evaluate the vaccination coverage of national immunization program vaccines (NIPV) is studied. It is important to evaluate the immunization coverage rate quickly and exactly through this method NIPV coverage by IMS client.ObjectiveTo understand the data quality of the immunization unit clients. To explore the application condition of immunization unit evaluating the immunization coverage. To know the immunization coverage rate and possible influence factors of the immunization coverage in the study area. To explore the adequate method of evaluating vaccination coverage rate based on the immunization clients’cases.MethodThis research was carried out in two provinces. There were two cities in each province and two counties were selected in each city. There were total four cities and eight counties in this study. Multi-stage random Sampling was used. We selected five townships in each county with the method of the simple random sampling. Then five villages were randomly selected in each selected township. Ten children were investigated in the village of the commune-level government located in.8children were investigated in other villages. We investigated the immunization service utilization in all the40villages, such as the number of the villages, the furthest distance between the immunization unit and the village, and so on. We also investigated the basic information and the immunization of the children born in September1,2009and August31,2011of all the200villages. We collected the questionnaires about the influence factors and backup the database of the immunization unit client. We evaluated the quality of the data by the report client and toolkit. Epidata3.1software were used to establish database and collate the immunization information. Statistical product and service solutions17.0software was used for statistical analysis, immunization coverage using Kaplan-Meier method, and influence factors analysis using multi-factor regression.Results91.25%of the children who were born in2009to2011were included in the Immunization information unit. The client coverage rate had increased year after year. The client coverage rate was100%in the1680investigated children.1680records of children were examined, in which seven children (0.42%) were not in the client. In the total of30129doses of inoculation,97.43%was perfectly agreement. The agreement rate was higher than85%in investigated counties.The investigated immunization coverage rate of each vaccine was more than70%. The timely immunization coverage rate of First Dose of Measles-containing Vaccine (MCV1) was57.80%and the timely immunization coverage rate of First Dose of Hepatitis B Vaccine (HepB1) was92.56%. However, the immunization coverage rate was higher than60%and the timely immunization coverage rate of MCV1was52.93%and the timely immunization coverage rate of HepBi was89.80% calculated by the data from immunization unit clients.When91.25%of the children were included in the Immunization information unit and95.79%of the doses of inoculation were perfectly agreement, the investigated immunization coverage rate (82.32%～99.58%) was higher than the immunization coverage rate calculated by the data from immunization unit clients. When more than80%of the children were included in the Immunization information unit and more than90%of the doses of inoculation were perfectly agreement, the investigated immunization coverage rate (82.32%～99.58%) was higher than the immunization coverage rate calculated by the data from immunization unit clients in most counties. The differences had no statistical significance in some counties which investigated immunization coverage rate was less than the immunization coverage rate calculated by the data from immunization unit clients. The immunization coverage vaccinated every month was lower than vaccinated every day, every week and every10days. The immunization coverage of the centralized vaccination study in towns was higher than that of the centralized vaccination study in towns and villages.The vaccination coverage of HepB3, Tirdoses Oral Poliomyelitis Attenuated Live Vaccine (OPV3), Tirdoses Diphtheria, Tetanus and Pertussis Combined Vaccine (DTP3) and MCV1was low in specified vaccination age.12months cumulative immunization coverage of DTP3and MCV1was less than90%, HepB3and OPV3was more than90%in2counties. The vaccination coverage of HepB3, OPV3, DTP3and MCV1was more than90%in Other6counties.Multivariate regression analysis showed that the main influence factors of cumulative coverage rate of nation immunization program vaccines were the immunization service period, the longest distance between the immunization unit and the village, kind of landform and shortage of vaccines.Conclusion1、Since the introduction of the immunization information system, the system has continuously improved and the quality of database has also increased. The accuracy of database from immunization unit clients was high in investigated area. 2、The coverage of national immunization program vaccines was high, the timely coverage rate of HepB1was also high, but the timely coverage of MCVi was low.3、The information of immunization unit clients can be used to evaluate the vaccination coverage, when more than78%of children were included in immunization unit client and the agreement rate between the immunization information from immunization unit clients and immunization certificates was more than90%. It was convenient to use this kind of information to evaluate the immunization coverage. The results of this method were stable because the clients contained a lagrer number of the samples. It can also save time, physical resource and manpower through this method.4、With the method of Kaplan-Meier, the whole process of immunization coverage of every vaccine can be intuitive displayed to us. It’s helpful in rapidly the immunization coverage of different area and predict if the unit can reach the goal of immunization coverage.5、The main influence factors of cumulative coverage rate of national immunization program vaccines were the immunization service period, the longest distance between the immunization unit and the village, kind of landform and shortage of vaccines.