Quality and reliability of vaccination documentation in the routine childhood immunization program in Burkina Faso: Results from a cross-sectional survey

Introduction: Accurate and timely vaccination data are important to the Expanded Program on Immunization (EPI) to assess individual vaccination status and to monitor performance and vaccine coverage (VC). Since 2013, Burkina Faso introduced several new vaccines into the routine childhood immunization schedule. However, sustained efforts for a timely update and alignment of immunization home-based (HBRs) and health facility-based records (FBRs) with the evolving schedule were not implemented.

Methods: In 2016-17, we conducted a 6-week cross-sectional survey in 30 health facilities (HFs) across 10 health districts (HDs), targeting children aged < 24 months and their caregivers. Data collected included sociodemographics, availability of vaccination recording fields in HBRs, and vaccination dates. We evaluated the characteristics, completion patterns, and concordance of HBRs and FBRs to determine their reliability as data sources in estimating VC. A standard HBR was defined as one that had recording fields for all recommended 17 vaccine doses of the schedule, and discordance between HBR and FBR as having different vaccination dates recorded, or vaccination information missing in one of the records. We computed proportions and concordance statistics, and used logistic regression to explore predictors of discordance.

Results: We recruited 619 children, including 74% (n = 458) aged 0-11 months. Half (50.6%) of HBRs were non-standard. About two-thirds (64.6%) of children were concerned with discordant information. Compared to HBRs, FBRs were generally associated with low negative predictive values (median: 0.41; IQR: 0.16-0.70). Multivariate logistic regression model showed that standard HBR was protectively associated with discordant information (OR = 0.46, 95% CI: 0.26-0.81, p = 0.010).

Conclusion: We documented a lack of standardization of HBRs and frequent information discordance with FBRs. There is a pressing need to update and standardize vaccination recording tools and ensure their continuous availability in HFs to improve data quality in Burkina Faso.