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Rahmadhan MAWP, Handayani PW. Integrated Immunization Information System in Indonesia: Prototype Design Using Quantitative and Qualitative Data. JMIR Form Res 2023; 7:e53132. [PMID: 38096005 PMCID: PMC10755663 DOI: 10.2196/53132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/03/2023] [Accepted: 11/24/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND As the volume of immunization records increases, problems with fragmented records arise, especially since the majority of records in developing countries, including Indonesia, remain paper based. Implementing an immunization information system (IIS) offers a solution to this problem. OBJECTIVE In this study, we designed an integrated IIS prototype in Indonesia using the design science research (DSR) methodology. METHODS The stages of the DSR methodology followed in this study included identifying problems and motivating and defining objectives for a solution, design and development, demonstration, evaluation, communication, and drawing conclusions and suggestions. Specifically, this study began with problem formulation and a literature review. We then applied quantitative (questionnaire with 305 members of the public) and qualitative (interviews with 15 health workers including nurses, midwives, and doctors) data collection approaches. RESULTS The resulting high-fidelity prototype follows the 8 golden rules. There are 2 IIS designs, one for the public as immunization recipients and another for health workers. The functionalities include immunization history, schedule, recommendations, verification, certificates, reminders and recalls, coverage, monitoring, news, and reports of adverse events. Evaluation of the prototype was carried out through interviews and a questionnaire designed according to the System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ). The SUS value was 72.5 or "Good (Acceptable)," while the system usefulness, information quality, interface quality, and overall value on the PSSUQ were 2.65, 2.94, 2.48, and 2.71, respectively, which indicate it has an effective design. CONCLUSIONS This provides a guide for health facilities, health regulators, and health application developers on how to implement an integrated IIS in Indonesia.
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Pinkney JA, Carroll KN, Rich KM, Hurtado RM, Ciaranello AL, Bogart LM, Ojikutu BO, Hyle EP. Need for open data on COVID-19 vaccine uptake among pregnant people in the Caribbean: a call to action. Rev Panam Salud Publica 2023; 47:e155. [PMID: 37937312 PMCID: PMC10627431 DOI: 10.26633/rpsp.2023.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 11/09/2023] Open
Abstract
Pregnant people with coronavirus disease 2019 (COVID-19) have a higher risk of adverse maternal and fetal outcomes compared with pregnant people without COVID-19. In 2021, large increases in maternal mortality were reported in Jamaica, almost half of which were attributable to COVID-19. COVID-19 vaccination has been shown to reduce these risks, but low- and middle-income countries lack free, publicly available data, known as open data, on COVID-19 vaccine uptake for their pregnant populations. The objectives of this paper were to: review how high-income countries use open data to detect trends in COVID-19 vaccine uptake among pregnant people and develop vaccination distribution strategies; outline barriers to making open data available for maternal COVID-19 vaccination in the Caribbean; and propose a multipronged strategy that would increase the availability of open data on maternal COVID-19 vaccination in the Caribbean. A multipronged strategy to fill the data void would involve: (i) utilizing existing Caribbean maternal immunization data collection entities; (ii) adapting digital software tools to establish maternal electronic immunization registries; and (iii) collaborating with local partners skilled in data analytics. Making open data available for COVID-19 vaccine uptake among pregnant people in the Caribbean could offer substantial benefits, including the development of measurable maternal COVID-19 vaccination goals and the facilitation of vaccine decision-making discussions between providers and pregnant people.
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Affiliation(s)
- Jodian A. Pinkney
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonUnited States of AmericaMedical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, United States of America.
| | - Kamali N. Carroll
- University of the West IndiesMonaJamaicaUniversity of the West Indies, Mona, Jamaica.
| | - Katherine M. Rich
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonUnited States of AmericaMedical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, United States of America.
| | - Rocio M. Hurtado
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General HospitalBostonUnited States of AmericaDivision of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, United States of America.
| | - Andrea L. Ciaranello
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonUnited States of AmericaMedical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, United States of America.
| | - Laura M. Bogart
- RAND CorporationSanta MonicaUnited States of AmericaRAND Corporation, Santa Monica, United States of America.
| | - Bisola O. Ojikutu
- Boston Public Health CommissionBostonUnited States of AmericaBoston Public Health Commission, Boston, United States of America.
| | - Emily P. Hyle
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonUnited States of AmericaMedical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, United States of America.
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Rahmadhan MAWP, Handayani PW. Challenges of vaccination information system implementation: A systematic literature review. Hum Vaccin Immunother 2023; 19:2257054. [PMID: 37747287 PMCID: PMC10619519 DOI: 10.1080/21645515.2023.2257054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023] Open
Abstract
Globally, healthcare services have begun to show interest in switching from paper-based to electronic-based vaccination records through Vaccination Information Systems (VIS). VIS have been implemented in various countries, but the study on the challenges of implementing VIS in these countries is still limited. The challenges of implementing VIS need to be understood to become a subject of discussion and anticipation by other countries that are just starting to implement VIS. We analyzed 32 selected publications from 634 initially retrieved. Fourteen challenges were successfully identified when implementing VIS, including interoperability, data quality, security and privacy, standardization, usability, internet connectivity, infrastructure, workflow, funding, government regulations, awareness, skeptical response, computer literacy, and staff-related challenges. The challenges of interoperability and data quality were found to be the most widely discussed by previous studies. In addition to identifying the challenges, this study includes a series of solutions that can be applied to overcome each challenge.
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Jalloh MF, Sengeh P, Ibrahim N, Kulkarni S, Sesay T, Eboh V, Jalloh MB, Abu Pratt S, Webber N, Thomas H, Kaiser R, Singh T, Prybylski D, Omer SB, Brewer NT, Wallace AS. Association of community engagement with vaccination confidence and uptake: A cross-sectional survey in Sierra Leone, 2019. J Glob Health 2022; 12:04006. [PMID: 35265325 PMCID: PMC8876869 DOI: 10.7189/jogh.12.04006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background The 2014-2016 Ebola epidemic disrupted childhood immunization in Sierra Leone, Liberia, and Guinea. After the epidemic, the Government of Sierra Leone prioritized community engagement to increase vaccination confidence and uptake. To support these efforts, we examined potential drivers of vaccination confidence and uptake in Sierra Leone. Methods We conducted a population-based household survey with primary caregivers of children in a birth cohort of 12 to 23 months in four districts with low vaccination coverage in Sierra Leone in 2019. Modified Poisson regression modeling with robust variance estimation was used to examine if perceived community engagement in planning the immunization program in the community was associated with vaccination confidence and having a fully vaccinated child. Results The sample comprised 621 age-eligible children and their caregivers (91% response rate). Half of the caregivers (52%) reported that it usually takes too long to get to the vaccination site, and 36% perceived that health workers expect money for vaccination services that are supposed to be given at no charge. When mothers were the decision-makers of the children’s vaccination, 80% of the children were fully vaccinated versus 69% when fathers were the decision-makers and 56% when other relatives were the decision-makers. Caregivers with high confidence in vaccination were more likely to have fully vaccinated children compared to caregivers with low confidence (78% versus 53%). For example, caregivers who thought vaccines are ‘very much’ safe were more likely to have fully vaccinated children than those who thought vaccines are ‘somewhat’ safe (76% versus 48%). Overall, 53% of caregivers perceived high level of community engagement, 41% perceived medium level of engagement, and 6% perceived low level of engagement. Perceiving high community engagement was associated with expressing high vaccination confidence (adjusted prevalence ratio (aPR) = 2.60; 95% confidence interval (CI) = 1.67-4.04) and having a fully vaccinated child (aPR = 1.67; 95% CI = 1.18-2.38). Conclusions In these four low coverage districts in Sierra Leone, the perceived level of community engagement was strongly associated with vaccination confidence among caregivers and vaccination uptake among children. We have provided exploratory cross-sectional evidence to inform future longitudinal assessments to further investigate the potential causal effect of community engagement on vaccination confidence and uptake.
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Affiliation(s)
- Mohamed F Jalloh
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Shibani Kulkarni
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tom Sesay
- Expanded Program on Immunization, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Victor Eboh
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Harold Thomas
- Health Education Division, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Reinhard Kaiser
- Sierra Leone Country Office of U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Tushar Singh
- Sierra Leone Country Office of U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Dimitri Prybylski
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Saad B Omer
- Yale Institute of Global Health, Yale University, New Haven, Connecticut, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aaron S Wallace
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ishizumi A, Sutton R, Mansaray A, Parmley L, Eleeza O, Kulkarni S, Sesay T, Conklin L, Wallace AS, Akinjeji A, Toure M, Lahuerta M, Jalloh MF. Community Health Workers' Experiences in Strengthening the Uptake of Childhood Immunization and Malaria Prevention Services in Urban Sierra Leone. Front Public Health 2021; 9:767200. [PMID: 34938707 PMCID: PMC8687740 DOI: 10.3389/fpubh.2021.767200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Community health workers (CHWs) play an integral role in Sierra Leone's health systems strengthening efforts. Our goal was to understand CHWs' experiences of providing immunization and malaria prevention services in urban settings and explore opportunities to optimize their contributions to these services. Methods: In 2018, we conducted an exploratory qualitative assessment in the Western Area Urban district, which covers most of the capital city of Freetown. We purposively selected diverse health facilities (i.e., type, ownership, setting) and recruited CHWs through their supervisors. We conducted eight focus group discussions (FGD) with CHWs, which were audio-recorded. The topics explored included participants' background, responsibilities and priorities of urban CHWs, sources of motivation at work, barriers to CHWs' immunization and malaria prevention activities, and strategies used to address these barriers. The local research team transcribed and translated FGDs into English; then we used qualitative content analysis to identify themes. Results: Four themes emerged from the qualitative content analysis: (1) pride, compassion, recognition, and personal benefits are important motivating factors to keep working as CHWs; (2) diverse health responsibilities and competing priorities result in overburdening of CHWs; (3) health system- and community-level barriers negatively affect CHWs' activities and motivation; (4) CHWs use context-specific strategies to address challenges in their work but require further support. Conclusion: Focused support for CHWs is needed to optimize their contributions to immunization and malaria prevention activities. Such interventions should be coupled with systems-level efforts to address the structural barriers that negatively affect CHWs' overall work and motivation, such as the shortage of work supplies and the lack of promised financial support.
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Affiliation(s)
- Atsuyoshi Ishizumi
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Roberta Sutton
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States
| | - Anthony Mansaray
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States
| | - Lauren Parmley
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States
| | - Oliver Eleeza
- ICAP at Columbia University, Mailman School of Public Health, Freetown, Sierra Leone
| | - Shibani Kulkarni
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tom Sesay
- Child Health and Immunization Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Laura Conklin
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Aaron S Wallace
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Adewale Akinjeji
- ICAP at Columbia University, Mailman School of Public Health, Freetown, Sierra Leone
| | - Mame Toure
- ICAP at Columbia University, Mailman School of Public Health, Freetown, Sierra Leone
| | - Maria Lahuerta
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, United States.,Department of Epidemiology, Mailman School of Public Health, New York, NY, United States
| | - Mohamed F Jalloh
- Immunization Systems Branch, Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
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Lahuerta M, Sutton R, Mansaray A, Eleeza O, Gleason B, Akinjeji A, Jalloh MF, Toure M, Kassa G, Meshnick SR, Deutsch-Feldman M, Parmley L, Friedman M, Smith SJ, Rabkin M, Steinhardt L. Evaluation of health system readiness and coverage of intermittent preventive treatment of malaria in infants (IPTi) in Kambia district to inform national scale-up in Sierra Leone. Malar J 2021; 20:74. [PMID: 33549098 PMCID: PMC7866768 DOI: 10.1186/s12936-021-03615-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment of malaria in infants (IPTi) with sulfadoxine-pyrimethamine (SP) is a proven strategy to protect infants against malaria. Sierra Leone is the first country to implement IPTi nationwide. IPTi implementation was evaluated in Kambia, one of two initial pilot districts, to assess quality and coverage of IPTi services. METHODS This mixed-methods evaluation had two phases, conducted 3 (phase 1) and 15-17 months (phase 2) after IPTi implementation. Methods included: assessments of 18 health facilities (HF), including register data abstraction (phases 1 and 2); a knowledge, attitudes and practices survey with 20 health workers (HWs) in phase 1; second-generation sequencing of SP resistance markers (pre-IPTi and phase 2); and a cluster-sample household survey among caregivers of children aged 3-15 months (phase 2). IPTi and vaccination coverage from the household survey were calculated from child health cards and maternal recall and weighted for the complex sampling design. Interrupted time series analysis using a Poisson regression model was used to assess changes in malaria cases at HF before and after IPTi implementation. RESULTS Most HWs (19/20) interviewed had been trained on IPTi; 16/19 reported feeling well prepared to administer it. Nearly all HFs (17/18 in phase 1; 18/18 in phase 2) had SP for IPTi in stock. The proportion of parasite alleles with dhps K540E mutations increased but remained below the 50% WHO-recommended threshold for IPTi (4.1% pre-IPTi [95%CI 2-7%]; 11% post-IPTi [95%CI 8-15%], p < 0.01). From the household survey, 299/459 (67.4%) children ≥ 10 weeks old received the first dose of IPTi (versus 80.4% for second pentavalent vaccine, given simultaneously); 274/444 (62.5%) children ≥ 14 weeks old received the second IPTi dose (versus 65.4% for third pentavalent vaccine); and 83/217 (36.4%) children ≥ 9 months old received the third IPTi dose (versus 52.2% for first measles vaccine dose). HF register data indicated no change in confirmed malaria cases among infants after IPTi implementation. CONCLUSIONS Kambia district was able to scale up IPTi swiftly and provide necessary health systems support. The gaps between IPTi and childhood vaccine coverage need to be further investigated and addressed to optimize the success of the national IPTi programme.
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Affiliation(s)
- Maria Lahuerta
- ICAP at Columbia University, Mailman School of Public Health, New York, USA. .,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
| | - Roberta Sutton
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| | | | | | - Brigette Gleason
- United States Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | | | - Mohamed F Jalloh
- Immunization Systems Branch, Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Mame Toure
- ICAP at Columbia University, Freetown, Sierra Leone
| | - Getachew Kassa
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| | - Steven R Meshnick
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Molly Deutsch-Feldman
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Lauren Parmley
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| | - Michael Friedman
- United States Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Samuel Juana Smith
- National Malaria Control Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Miriam Rabkin
- ICAP at Columbia University, Mailman School of Public Health, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Laura Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
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