Adverse Events Following Immunization Will It Happen Again
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Evaluation of the adverse events following immunization surveillance organization, Ghana, 2019
- Eunice Baiden Laryea,
- Joseph Asamoah Frimpong,
- Charles Lwanga Noora,
- John Tengey,
- Delia Bandoh,
- George Sabblah,
- Donne Ameme,
- Ernest Kenu,
- Kwame Amponsa-Achiano
x
- Published: March 1, 2022
- https://doi.org/10.1371/journal.pone.0264697
Figures
Abstract
Background
With over 80% of children worldwide vaccinated, concerns about vaccine safety continues to be a public health outcome. Ghana's Adverse Events Following Immunization surveillance started in 1978 with the objective to promptly discover and manage AEFI cases either real or perceived. Periodic evaluation of the surveillance system is critical for optimal performance; hence we evaluated the organisation to appraise its attributes, usefulness and organization's operation in coming together its objectives.
Methods
A case of AEFI was defined equally any untoward medical event occurring within 28 days after vaccination and may non necessarily take causal relationship with the vaccine use. We reviewed surveillance information and procedures for the period 2014 to 2018 and interviewed key stakeholders. Adapting the CDC's Updated Guidelines for Evaluating Public Health Surveillance Systems, nosotros assessed the system'due south attributes and usefulness. We performed summary descriptive statistics on quantitative data and directed content analysis on information gathered from interviews.
Results
In all, 2,282 AEFI cases including 476 (21%) serious cases (life threatening events) were reported for the period. The highest case detection rates of 61.45 AEFIs per 100,000 surviving infants was recorded in 2018. Reporting forms were modified to accommodate new indicators without whatsoever disruption in the role of the system. At the national level, completeness of 100 randomly sampled reporting forms (100%) and was college than the region (27%) but timeliness (50%) was lower than the region (83%). All (16/xvi) Community Health Nurses interviewed indicated "fright of being victimized" as the reason for underreporting, nonetheless, the system was useful as it made them cautious when vaccinating children to prevent reactions. Data on AEFI surveillance was also useful in guiding training needs and provision of vaccination logistics.
Conclusion
The AEFI surveillance system is useful at all levels but partially meeting its objective due to underreporting. Nosotros recommend training and supportive supervision to ameliorate timeliness of reporting, information abyss and acceptability.
Commendation: Laryea EB, Frimpong JA, Noora CL, Tengey J, Bandoh D, Sabblah G, et al. (2022) Evaluation of the adverse events following immunization surveillance system, Ghana, 2019. PLoS ONE 17(three): e0264697. https://doi.org/ten.1371/journal.pone.0264697
Editor: Emma G. Kalk, University of Greatcoat Town, Due south AFRICA
Received: July 5, 2021; Accustomed: Feb 16, 2022; Published: March one, 2022
Copyright: © 2022 Laryea et al. This is an open access article distributed under the terms of the Artistic Eatables Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the newspaper and its Supporting Information files.
Funding: The author(south) received no specific funding for this work.
Competing interests: The authors have alleged that no competing interests be.
Introduction
Vaccination is an important public health tool that prevents about 2 to 3 million deaths worldwide yearly [1]. Generally, vaccines are rubber and constructive and undergo extensive safety monitoring prior to its usage in immunization programs. However, no vaccine is entirely without risk and Adverse Events Following Immunization (AEFI) may occur [1] which can be detected through Post market surveillance.
Adverse Events Following Immunization (AEFI) is any untoward medical occurrence that follows immunization and does non necessarily take a causal human relationship with usage of the vaccine [2]. The adverse event may be any unfavorable or unintended sign, abnormal laboratory finding, symptom or disease. AEFIs may range from mild reactions such as fever or rash to severe reactions such as convulsions, coma and even death [3]. Based on the outcome of the event, the World Health Organization (WHO) has classified AEFIs as Serious and Not-serious which is used for regulatory classification. AEFIs are further classified based on the cause of the event. These include, vaccine product-related, vaccine quality defect-related, immunization error-related, immunization anxiety-related, casual and unknown events [4]. Hence, AEFIs may exist true adverse reactions (ARs) to the vaccine, the vaccination procedure or may exist unrelated.
Though over 80% of children worldwide are vaccinated, vaccine hesitancy continues to exist a public health consequence [five]. Surveillance on immunization safety is hence crucial to build trust and to reassure the public that AEFIs are being monitored and actions are being taken to reduce risks. This volition reduce vaccine-hesitancy and sustain efforts past immunization programs [6]. Reporting rates of AEFIs are usually depression, particularly in developing countries [7]. This is due to over reliance on the routine system of reporting which is subject to underreporting and poor pharmacovigilance infrastructure in developing countries [eight]. To address the issue of underreporting the WHO therefore instituted the Global Vaccine Safe Initiative, which ready out indicators primarily for monitoring case reporting [9]. A case reporting target of 10 AEFI per 100,000 surviving infants per year was set in the Global Vaccine Action Program (GVAP) to monitor performance of AEFI surveillance systems [ten].
In 2015, the boilerplate reporting charge per unit was 549 AEFI per 100,000 surviving infants globally. The number of countries that reported rates greater than 10 per 100,000 surviving infants besides increased from 8 (4%) in 2000 to 81(42%) in 2015 [11]. Meanwhile, only half (51%) of the countries in the WHO African Region, reported AEFI cases in 2015, and the region recorded one of the lowest case reporting rates of 74 AEFIs per 100,000 surviving infants [11]. Studies washed in some African countries have also reported incidence of AEFI ranging from thirteen to 34% [iii, 12].
In Republic of ghana, routine reporting of AEFI began with the initiation of Expanded Program on Immunization in 1978 and also by the Food and Drugs Say-so (FDA) in 2001 upon institution of the National Pharmacovigilance Centre [4]. The surveillance system was established with an overall aim of promptly detecting and managing AEFI, existent or perceived. This would contribute to the credibility of immunization programme and prevent inappropriate responses to reports of AEFI that could lead to crises in the absence of a surveillance system.
We evaluated Ghana's AEFI surveillance system to assess its attributes, its usefulness and to determine whether the system is coming together its objectives.
Methods
Evaluation design
The evaluation was a cantankerous-sectional written report that involved collection of data through reviewing of surveillance data, observation of surveillance procedures and interviewing of central stakeholders. The evaluation was conducted in January 2019 and covered the catamenia from 2014 to 2018.
Written report area
The evaluation was done in Republic of ghana using Greater Accra Region as the focal region and Ga East Municipality, as the focal district. Interviews were done among selected stakeholders from the district, regional, and national levels, and surveillance records were sampled at all these level for the evaluation. In 2018, Ghana's population of children under 5 years of age targeted for routine and supplementary childhood immunization was 5,922,867 with 912,194 fully immunized. The Greater Accra Region also had an nether 5 years population of 579,805 with 136,150 fully immunized, while Ga East District which is one of the 26 districts in Greater Accra Region had under 5 years population of 22,431 with 3,455 children fully immunized. The district has 16 health facilities, i health centre, one polyclinic and 1 Quasi Government. It besides has xiv private wellness centres and 15 Community-based Health Planning and Services (CHPS) zones of which one has a compound. There is one wellness care worker to every 132 children under 5 who offer immunization and related services. Health worker training on AEFI is washed prior to every supplemental immunization activity.
Data collection tools and methods
We adjusted the Center for Disease Command and Prevention Updated Guidelines for Evaluating Public Health Surveillance Systems [13]. This tool provides indicators to measure the qualities of a surveillance system. Using these indicators, we developed an interview guide and checklist to adapt the objectives of the evaluation and depict system's operations. Xxx key informants from health facilities (19) district (6), regional (3) and national (2) levels were purposively selected and interviewed based on their part in AEFI surveillance. Questions were asked regarding operations of the surveillance arrangement. Nosotros observed surveillance processes and reviewed data (both paper and electronic-based) from 2014 to 2018 at all levels. Data was nerveless on the number and type AEFI, timeliness and abyss in reporting among others. The sources of data were; a) case-based forms, b) weekly and monthly Integrated Affliction Surveillance c) Response (IDSR) reports, d) DHIMS 2 and eastward) Technical Advisory Commission for Vaccines and Biological Products (TAC-VBP) reports.
A case of AEFI was defined as whatsoever untoward medical result occurring within 28 days subsequently vaccination which does not necessarily have causal relationship with the vaccine utilise [14]. The adverse reaction was classified as Serious or Non-serious or Clustered [15].
Serious AEFI.
An AEFI was considered serious if; It is life threatening, results in inpatient hospitalization or prolongation of existing hospitalization, results in persistent significant disability/incapacity, results in death, or results in a birth defect/congenital anomaly.
Non-serious AEFI.
These are events that do not meet the definition of a serious AEFI and commonly include mild to moderate symptoms that are temporarily lived. Though common, these must be carefully monitored as they may signal a potentially larger problem with the vaccine or immunization every bit well every bit have negative impact on the public acceptance of the vaccine.
AEFI clusters.
Two or more AEFIs related in time and/or place or vaccine administered.
Assessment of performance of the AEFI surveillance system in coming together its objectives
We reviewed the objectives of the surveillance organization to substantiate its fulfilment or otherwise. Its objectives are to; detect, correct and prevent immunization error-related AEFIs, identify problems with vaccine lots or brands leading to vaccine reactions, prevent imitation blame arising from casual agin events, maintain confidence by properly responding to community concerns, generate new hypotheses almost vaccine reactions and estimate rates of occurrence of AEFIs. This was assessed through records review and interviews. Summary descriptive statistics, was used to determine number of AEFI cases detected and proportion investigated to determine its cause. Directed content analysis was used to summarize information on how AEFIs were managed at the facilities, power of the investigation process to abnegate imitation claims of vaccine-related reactions and use of information for signal consequence detection and cosmetic activity such as withdrawal of an implicated vaccine.
Assessment of usefulness of the AEFI surveillance system
We interviewed stakeholders on; the organization's effect on policy decisions and use of data for action, its contribution to the detection and prevention of AEFIs, and its effect on clinical practices. We besides assessed ability of the arrangement to accomplish its set objectives through records review and interviews. Directed content assay was used to summarize data gathered.
Cess of attributes of the AEFI surveillance system
Nosotros described and analyzed each attribute of the system equally shown in Tabular array one.
Ethical considerations
Permission was sought from the Ghana Wellness Service, Greater Accra Regional Health Advisers and Ga East Municipal Health Directorate. Permission was also sought from Nutrient and Drugs Authority and Expanded Program on Immunization for the employ of data. Informed written consent was sought from interviewees without any grade of duress. Information obtained was put into Microsoft excel which was password protected. This evaluation was washed as part of routine assessment by the Ghana Health Service and Ghana Field Epidemiology and Laboratory Training Program (GFELTP).
Results
Background characteristics of study participants
Thirty health staff were interviewed of which 21 (70%) were females. The hateful (SD) age and years of service among respondents was 38.7 (iv.1) years and 13.1(2.3) years respectively. At the facility level, sixteen (53.3%) community wellness nurses, two (6.7%) medical officers, one (3.3%) pharmacist were interviewed while at the district level, four (xiii%) disease command/surveillance officers, ii (6.7%) Health Information Officers were interviewed. At the regional level three (10%) cardinal informants; the Regional DCO, DSO and EPI focal person were interviewed and at the national level 2 (six.7%) key informants; from EPI Program Managing director and Head of Pharmacovigilance of FDA were interviewed.
Out of the 30 respondents, 26(87%) understood the purpose of the AEFI surveillance organisation and 28(93%) could define AEFI. All respondents knew at least 2 presenting signs/symptoms of AEFI, while 24(80%) knew the right timelines for submission of forms. Six (20%) did not know how to fill a reporting form all of which were community wellness nurses.
Operations of the surveillance organization
The operation of the AEFI surveillance organisation is a collaborative effort betwixt the Expanded Plan on Immunization of the Ghana Health Service and the Food and Drugs Authority (FDA). The organization involves drove and collation of routine data using the wellness structures of the Ghana Health Service. Example reporting is passive where caregivers/vaccinees report adverse events to health facilities. The wellness facilities tape reported events using a standard case reporting form and submits the written report to the Commune Wellness Directorate. The District focal person enters the data on the forms into District Health Information Management System 2 (DHIMS 2) and transmits the class to the National level through an intervening Regional Focal Point. Reports must be backed by case reporting forms and validated before entry into the DHIMS. Data are further aggregated at the regional and national levels. Also, some notifications are sent direct from the community or the health facility to the FDA through an electronic reporting organization. In one case such notification is received, focal points at the FDA complete the standard AEFI form (Fig one).
Investigation of an AEFI is initiated within 24 to 48 hours of receipt of report at the lowest level with the capacity to behave out that investigation. Causality cess is done on serious AEFI cases and AEFI clusters by a Technical Advisory Committee for Vaccines and Biological Products (TAC-VBP) constituted by the FDA. Meetings of the Committee are held at interval of at near ii months. Feedback dorsum on receipt of report is given inside 48 hours to the reporting facility/level. However, feedback on serious AEFI is given bimonthly when the TAC-VBP meets for causality assessment.
Sustainability of the system depends on the availability of acceptable resources at each level of the surveillance organisation. The Gavi Brotherhood is a major financier of the immunization Program and AEFI surveillance in Ghana. Other Partners include WHO and UNICEF. Tools for AEFI surveillance include AEFI reporting form, investigation form, guidelines for completing AEFI reporting form, electronic line list course, clinical laboratory form and the guideline for AEFI Epidemiological investigation.
Assessment of performance of the surveillance system in coming together objectives
Objective one: Detect, correct and prevent immunization error-related AEFIs.
The surveillance system detected a total of 2,282 AEFI cases including 21% (476/2282) serious cases during the 5-year menses (2014–2018) of which fifteen% (72/476) were immunization error related. All (16/16) CHNs interviewed acknowledged that the presence of AEFI surveillance makes them more cautions when vaccinating in order to prevent immunization error-related AEFIs. Wellness workers had also taken measures to prevent immunization error-related AEFIs which include stopping pupil nurses on attachment from administering vaccines.
Objective two: Identify problems with vaccine lots or brands leading to vaccine reactions.
The AEFI case-based form captures the lot/batch number of vaccines that the vaccinee took prior to the reaction. This aids to the identify whatever problems vaccine lot during investigation. About 97% (463/2282) of serious cases were investigated using the lot/batch number of vaccines.
Objective 3: Prevent false blame arising from coincidental agin events.
Past investigating deaths that followed vaccination and performing causality assessments the system has been able to preclude misinformation speculating that the vaccine attributed to the expiry.
Objective 4: Maintain confidence by properly responding to parent/community concerns.
The awareness campaigns and health educational activity given on AEFIs during immunization sessions increased public confidence. Likewise, all reported AEFIs were managed at no price to the affected individuals every bit this cost was captivated past the Expanded Plan on Immunization. This made caregivers more comfortable to vaccinate their children and report any events.
Objective 5: Generate new hypotheses most vaccine reactions and estimate rates of occurrence of AEFIs.
The system was able to monitor trends of AEFI cases and discover unusual trends in number of cases, however in that location was no documentation on incidence of AEFIs in Ghana.
Cess of usefulness of the AEFI surveillance system
The reporting grade captures demographic features of the vaccinee as well the characteristics of the vaccine taken. This informs the age groups at risk and the antigens causing the most adverse reaction for public health activeness to be taken. The EPI coordinators at the regional and national level revealed during interviews that information on AEFI surveillance was useful in guiding training needs and provision of vaccination logistics. Lastly, the system led to modify of clinical practices equally all CHNs indicated that the system made them extra careful during injection in order to forbid abscess and ensured that vaccines are stored properly and used inside required time.
Cess of attributes of the AEFI surveillance system
Simplicity.
Sequential relay of information in the organisation was clear and well structured. Ninety-3 percent (28/xxx) of stakeholders interviewed knew and understood the AEFI case definition. Identifying a example involved observing the individual and could exist captured through easily detectable symptoms requiring basic tools similar a thermometer. The instance reporting form was a i-page document, with 25 cadre variables which during interviews, fourscore% (24/xxx) stakeholders said it takes less than 15 mins to fill. On the other hand, serious cases required laboratory confirmation and causality assessment which had longer plough-around time especially for a coroner's case. The case investigation form is a 4-page document with many variables that required some level of expertise to fill. Additionally, the perfect characterization of AEFI is elusive due to absence of pathognomonic signs or available laboratory tests that would allow confirmation of diagnosis.
Acceptability.
Stakeholder participation at the national level was high, proven by periodic meetings to review information, analyze and discuss means to improve the system. Support from WHO, UNICEF and GAVI likewise demonstrated high credence of the organization by partners. Stakeholders interviewed at regional level revealed that the arrangement is essential and easy to run. Meanwhile, at the commune, all 16 community health nurses interviewed addressed concerns of existence victimized for reported events (Fig 2).
Sensitivity.
The case definition was sensitive, capturing any untoward medical event after vaccination whether caused by the immunization or not. At the national level, the GVAP case detection target of x AEFI/100,000 surviving infants /yr was met only in 2017 and 2018 with 35.69 and 61.45 AEFIs per 100,000 surviving infants respectively (Table 2). In 2018, 80% (8/10) of regions in Ghana achieved this target based on routine vaccination reports (Table 3). At the district level, the annual case detection rate for 2014, 2017 and 2018 was iv.54, five.83 and 4.54 AEFIs per 10,000 surviving infants respectively. No case was detected in 2015 and 2016 (Table four).
Positive Predictive Value (PPV).
PPV is the proportion of AEFIs that are actually caused past the vaccine. This was assessed at the national level since causality assessment is merely done at this level. For 2014 and 2015, PPV could non be calculated due unavailability of information, however in 2016, 2017 and 2018 the state recorded PPVs of 66.seven%, l% and 63.6% respectively.
Timeliness.
7 case reporting forms were found at the district of which two were submitted to the region on time. At the region, 83(83%) of 100 forms randomly selected were submitted past districts on time. At the national level, 50% (50/100) of reports were timely submitted (within 28 days from onset of symptom) in 2017 and 2018 and eighty% of forms were timely submitted in 2016. Upon interviewing surveillance staff at the district and sub-district levels, 88% (22/25) stated that they did non become feedback when they sent reports to college levels.
Stability.
The AEFI surveillance arrangement is run on the Republic of ghana Health Service (GHS) structures and health workers written report information as office of their routine work requiring no extra financial benefit. Cased-based forms were readily available either at the facility or online to exist downloaded and printed when needed. The AEFI surveillance guidelines was available at all levels. All levels also had surveillance focal persons for EPI who served equally the AEFI focal person. Surveillance data was stored electronically at all levels in the DHIMS ii which tin be assessed once authorized. This makes it easy to integrate the data into other systems. However, GAVI is the sole financier of immunization and vaccine prophylactic in the country.
Data quality.
All instance investigation forms randomly sampled at the national level had all the 25 core variables completely filled. At the region, merely 27(27%) of the 100 forms sampled were completely filled while at the commune none of the vii forms bachelor was completely filled. Data imputed into the DHMS were inconsistent with data available at each level of the system. For instance, Ga East recorded 92 AEFI cases in the DHMS in 2018, which proved to be a data entry mistake.
Representativeness.
Case reports were from both males and females, nevertheless, distribution of cases was mainly amid children nether five, excluding pregnant women and travelers who took tetanus and yellow fever vaccines respectively. All regions submitted case reports to national level for all years assessed. However, reporting rates among districts to the region was low as only 3 out of 26 districts in Greater Accra submitted AEFI case reports in 2014 and 2015, while v districts submitted in 2016 and 2017. At the district level, instance reports were mainly from wellness facilities in 2 out of 5 subdistricts for all years assessed, simply included both private and public facilities.
Flexibility.
The monthly vaccination report and example-based form were modified to adapt new indicators without any disruption in the office of the system. The AEFI case definition was also altered from a definition that implicated the vaccine utilize to a definition that the AEFI may or may non be caused by the vaccine. It required a day grooming for the disease control and surveillance officers at the district levels and on-job coaching for the stakeholder at the facility level. Broadcasting of reports is made flexible by inclusion of phone calls and through WhatsApp platforms for instances where paper report submission will delay response. However, the case-based form must be forwarded inside 48 hours or exist filled by the recipient so as not to compromise the completeness of reports. The reporting form also had a space for additional information to exist added.
Discussion
The surveillance system was plant to be functional and well-structured due to a collaborative endeavor among the Ghana Health Service, the FDA and Partners. Health workers had loftier knowledge of the arrangement which could be attributed to their longer years of work experience in service (hateful years in health service was 13.1). Yet loftier cognition amidst health workers did not reverberate reporting rates. This is because the organization is heavily reliant on voluntary reporting by caregivers and most of these caregivers were not reporting to the facilities. This may exist because caregivers were non educated enough to know that they have to report these events, as institute in a written report by Constantine et al. [3]. However, Chimusoro et al., had opposite findings where though caregivers had expert noesis on the surveillance organization, they still did not report [sixteen]. Information technology could as well be because caregivers may feel coming back to the health facility to study is burdensome. To curb this, an active, participant-centered system can be adapted as an adjunct to traditional passive AEFI surveillance. This is an innovation that allows caregivers employ advice technologies to written report an AEFI to a facility or a fundamental body such as the FDA and has proven to increase reporting rates in other countries [7, 17].
Another reason for low reporting rates was the fear of victimization amongst the vaccinators. Though most of these health workers knew the purpose of the surveillance arrangement, they all the same perceived that reporting AEFI will question their work proficiency. This makes the organisation less acceptable to the vaccinators. Zvanaka et al. had similar findings where health workers had high cognition on AEFIs yet refused to written report due to fright of victimization and fear of exposing work incompetency [18]. This shows that cognition and perception of wellness workers towards a surveillance system has neat influence on its success [19], hence training must be geared towards debunking this perception.
We constitute the AEFI case definition to exist sensitive equally information technology removes the demand to ascertain causality. This also confers a level of simplicity on the surveillance system. However, efforts made to make the system simple and sensitive, did non reverberate on case reporting rates specially for 2015 and 2016. Loftier reporting rates in 2018 notwithstanding could exist attributed to the frequent sensitization and training on AEFI during a Yellow fever and Measles-Rubella campaigns held in that year. This goes to prove that routine reporting of AEFI volition receive such boost if given like attending equally during campaigns.
Example reporting was simple but case investigation was cumbersome, partly due to the lack of pathognomonic signs and laboratory tests for perfect characterization of an AEFI [twenty]. Every bit a result of these complexities in the investigation process, assessment of causality is limited to serious AEFIs [4]. Thus, for AEFIs classified every bit non-serious, its cause may not exist identified for corrective actions to be taken.
Representativeness of the arrangement was threatened equally the system did not adequately capture AEFIs on Tetanus and xanthous fever vaccines received by the pregnant women and travelers respectively. Thus, the dues-natal clinic and the port health clinics must be engaged to report AEFIs. Also, the region had many silent districts which may mean these districts are not sensitized plenty to report. A study institute representative of the AEFI surveillance system in Kwekwe District in Zimbabwe to be threatened by failure of individual facilities to report. This was attributed to low noesis among health workers in the individual sector [sixteen]. This contradicts with our findings where both private and public facilities reported considering, immunization services provided at private facilities are mostly carried out by government staff from the various subdistricts as role of their routine work.
Errors in reporting into the DHIMS and inconsistencies in the number of case reports observed at all levels propose a weak data validation system, Meanwhile, accurate reporting is crucial in informing decision making.
The organization was stable with both human and material resources bachelor for functioning. Nevertheless, if GAVI withdraws its funding, the system may collapse. Hence the GHS/EPI and FDA must institute strategies to take over funding of the system if back up from GAVI is halted.
The system's flexibility in the utilize of telephone and WhatsApp platforms for reporting reduces the delays in reporting. Nonetheless, human negligence could lead to failure to fill up a form and hence gaps in reporting.
The AEFI surveillance system is very useful based on indicators assessed. However, lack of timely feedback from higher levels tin eclipse its usefulness. Surveillance staff could be discouraged from sending case-based forms to higher levels, which could impede the use of data for conclusion making. In Kwekwe District in Zimbabwe, 71.7% of health workers in a written report stated that they did not receive feedback from the upper levels and hence were discouraged to forward reports to these levels [xvi]. Zvanaka et al. also indicated that though the majority of health workers reported the arrangement to be useful, its usefulness is non evidenced past reported feedbacks especially at the district and subdistricts [18]. The usefulness of the system tin therefore be improved if national and regional levels requite timely and precise feedback on AEFI reports.
Unlike drugs, vaccines are given to seemingly salubrious individuals and in vast numbers particularly among infants. Thus, issues arising from vaccination are less tolerated by the general public. With this, a more robust surveillance system has to be accomplished to maintain public confidence in immunization services to sustain efforts by stakeholders.
This evaluation had a few limitations. There was the possibility of recall bias during interviews every bit study was conducted in 2019, but required investigation from yr 2014. As such, records had to be reviewed to confirm some of the facts obtained during the interviews. Also, near interview questions were asked again among other stakeholders to review the validity of the previous data collected. Once again, the researcher relied on AEFI case-based reports and secondary information which could be subject to reporting and data entry errors.
Conclusion
The AEFI surveillance organisation is well structured with standardized data drove tools. The system is useful in estimating magnitude of morbidity of AEFIs and improving clinical practices. The organization was flexible and stable, with a sensitive case definition all the same, reporting rates were depression due to underreporting. With this the system was partially meeting its objective to promptly detect and manage AEFIs. Acceptability and simplicity were fair, while representativeness, data quality and timeliness were inadequate. We recommended training of vaccinators on AEFI reporting by the AEFI focal persons to counter the fearfulness of being victimized for reported events. We also recommend periodic supportive supervision by Wellness Management Teams to reporting facilities to ensure improvement arrangement'due south attributes and employ of data for action.
- The West African Health Organization (WAHO)
- The Republic of ghana Field Epidemiology and Laboratory Preparation Plan
- The Disease Surveillance Section of the Republic of ghana Health Service.
- The Food and Drugs Say-so, Republic of ghana.
- The Expanded Program on Immunization, Republic of ghana.
- Dr. Basil Benduri Kaburi
- Dr Selorm Botwe (Ga Due east Municipal Managing director of Wellness Services)
- Mr. Bright Amoako (Health Data Officer, Ga East Municipal)
Supporting information
Acknowledgments
The authors would like to admit the following persons and institutions;
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Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264697
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