Analysis of Independent Monitoring Data from Polio National Immunization Day Campaigns in Kinshasa Province, Democratic Republic of Congo: Proportions of Missed Children from 2010 - 2013
Boyle, Shanda B.
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Poliovirus transmission has been interrupted from many parts of the world by mass vaccination. However, polio can re-emerge due to importation from endemic areas. To prevent this, concerted vaccination efforts are still required. In 2010 the Democratic Republic of Congo had a reintroduction of polio virus that took 2 years and many high-quality supplemental immunization activities (SIA) to stop transmission. To ensure high campaign quality, end-process independent monitoring is conducted to rapidly estimate if the number of children vaccinated reached the established target. The key indicator of success is the vaccination of at least 90% of the target population (typically the <5 years population). If more than 10% of the target population surveyed are found to be unvaccinated, immediate revaccination of the area is conducted. A longitudinal analysis was conducted of independent monitoring data collected between 2010 and 2013, following supplemental immunization activities in 35 districts in Kinshasa Province, Democratic Republic of Congo. There was an overall decrease in the proportion of missed or unvaccinated children from 2010 to 2013, with 2013 reflecting the lowest proportion of missed children was identified and found to be statistically significant through univariate analysis (F= 16.74, P<0.0001, F=15.79, P<0.0001). A more detailed investigation performed on district level data revealed instances where the proportion of unvaccinated children was greater than determined by the aggregated provincial level data. The poorer performing districts identified greater than 10% unvaccinated children in 8 of the 12 (75%) campaigns performed during 2010 - 2013 as shown by two reporting methods. To improve campaign quality and performance in Kinshasa province, future monitoring should include more descriptive questionnaires including expanding the vaccine refusal categories from four to 10 to allow for more targeted interventions to reduce the number of unvaccinated children. Additional actions include targeted training of monitors on survey methodology, and the timely disbursement of funds to the local levels to allow for adequate planning, training and implementation of OPV campaigns.
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