Eze Paul, Aniebo Chioma Lynda, Agu Ujunwa Justina, Agu Sergius Alex, Acharya Yubraj
Department of Health Policy and Administration, Penn State University, University Park, PA 16802, USA.
Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria.
Vaccine. 2022 Jan 3;40(1):28-36. doi: 10.1016/j.vaccine.2021.11.060. Epub 2021 Dec 1.
Vaccination coverage surveys in low- and middle-income countries typically estimate vaccination coverage using data from vaccination cards, parental recall, or a combination of the two. However, these surveys are often complicated by the pervasive absence of vaccination cards, forcing researchers to rely on parental recall. We assessed the validity of mothers' recall against home-based vaccination cards using data from a community-based household survey in Nigeria.
A cross-sectional survey of 1,254 mothers of children aged 12-23 months was performed in Enugu State, Nigeria in July 2020. Data on vaccination status for BCG, OPV, DPT, Measles, Yellow fever, and Vitamin A supplement were collected using two data sources: home-based vaccination cards and mothers' recall. We evaluated the level of agreement between the two data sources; estimated the sensitivity and specificity of mothers' recalls; and computed multivariable regression models to identify socio-demographic factors associated with mothers' recall bias.
Out of 1,254 mothers interviewed, 578 (46.1%) mothers with vaccination cards were included in this analysis. Vaccination coverage levels were generally similar across data sources, though recall-based data generally underestimated the coverage. The level of agreement between the two data sources was high (≥91.0% for all vaccine types) with recall bias due to under-reporting generally higher than recall bias due to over-reporting. The sensitivity of parental recalls was high for all vaccine types, while the specificity was low across vaccine types. Across all vaccines, mothers recall bias was significantly associated with the rural residence and not receiving postnatal care.
In the absence of vaccination cards, mothers' recall of their children' vaccination status for BCG, OPV, DPT, Measles, Yellow fever and Vitamin A is a valid instrument for estimating childhood vaccination coverage in this setting in Nigeria. However, additional research is needed to confirm these findings at higher sub-national and national levels.
低收入和中等收入国家的疫苗接种覆盖率调查通常使用疫苗接种卡数据、家长回忆或两者结合来估计疫苗接种覆盖率。然而，这些调查常常因普遍缺乏疫苗接种卡而变得复杂，这迫使研究人员依赖家长回忆。我们利用尼日利亚一项基于社区的家庭调查数据，评估了母亲回忆与家庭疫苗接种卡的一致性。
2020年7月在尼日利亚埃努古州对1254名12至23个月儿童的母亲进行了横断面调查。使用两种数据来源收集卡介苗、口服脊髓灰质炎疫苗、百白破疫苗、麻疹疫苗、黄热病疫苗和维生素A补充剂的疫苗接种状况数据：家庭疫苗接种卡和母亲回忆。我们评估了两种数据来源之间的一致程度；估计了母亲回忆的敏感性和特异性；并计算了多变量回归模型，以确定与母亲回忆偏差相关的社会人口学因素。
在接受访谈的1254名母亲中，本分析纳入了578名（46.1%）有疫苗接种卡的母亲。尽管基于回忆的数据通常低估了覆盖率，但各数据来源的疫苗接种覆盖率水平总体相似。两种数据来源之间的一致程度较高（所有疫苗类型均≥91.0%），漏报导致的回忆偏差通常高于多报导致的回忆偏差。所有疫苗类型的家长回忆敏感性都很高，而各疫苗类型的特异性都很低。在所有疫苗中，母亲的回忆偏差与农村居住和未接受产后护理显著相关。
在没有疫苗接种卡的情况下，母亲对其子女卡介苗、口服脊髓灰质炎疫苗、百白破疫苗、麻疹疫苗、黄热病疫苗和维生素A疫苗接种状况的回忆是估计尼日利亚该地区儿童疫苗接种覆盖率的有效工具。然而，需要进一步研究以在更高的次国家和国家层面证实这些发现。
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