Task 1. Flag all suspicious values ( Outliners, repetitions etc ) Suspicious data

Suspicious_20data_20flagged.xlsx

Suspicious data highlighted in excel sheet.

Task 2. Review the national and subnational coverage for MR1. Your data manager produces the following tables. What can you conclude from the administrative data?

Conclusion :- At national level the data indicate overall high coverage over a period ranging from 89%-95% but there are inconsistencies and substantial differences in coverage at subnational level ranging from 61%-122% coverage.

 1.  More than 100% coverage in three subnational areas (Alu, Grandtown, Remo) this could be explained by either an over reporting  or an underreporting of the target population.
2. Medium coverage, insufficient to achieve herd immunity in four subnational areas (Eastan, Nemo, Chello, Grandtan, Westtan) which constitute a risk factor for an outbreak
3. Low coverage in Westtan over consecutive years. due to contineous low coverage area there is high risk for large outbreak
 

Task 3. Review coverage evaluation survey data. You remember that in 2013, there was a coverage evaluation survey. You pull up the data for that. Does this change your view about coverage at national level? For any of the regions?

Yes. From the coverage evaluation survey It can be concluded that Vacciland performed below the set coverage target for MR1 (89.2% as against 90%) whereas the administrative data shows the national coverage at 92%. Also at regional level tha that were thought to have very high coverages based on the administrative data did not in reality as revealed by the coverage evaluation survey data. Those regions include Alu, Eastan, Grandtown, Remo and Grandtan. The survey data also revealed that regions that were judged as poor performing regions based on the administrative data actually exceeded their coverage targets in reality (Nemo and Westan).

Task 4. Review the chart with the age distribution of measles cases. Does that tell you anything additional about coverage?

Based on the immunization schedule in Vacciland, children eligible for measles vaccination fall within the age group of less than one to two years. In the current outbreak this age group constitutes almost 37% of the measles cases. This suggests that eligible children are being missed for measles vaccination in Vacciland i.e all eligible children are not being vaccinated. Thus national MR1 coverage is currently lesser than it should be in Vacciland.

Task 5. Brief the Minister (spend max 1/2 hour on this section). Summarize the situation in three bullet points.

There is a confirmed outbreak of measles in Grandtown. 625 cases have been confirmed so far, more than half within Grandtown. 80% of cases are unvaccinated or have unknown vaccination status
At national level administrative data indicate overall high coverage over a period of several years ranging from 89%-95% but there are inconsistencies and substantial differences in coverage at subnational level ranging from 61%-122% coverage
When reviewing subnational level administrative data with the survey data (2013) several regions indicate insufficient coverage of measles vaccination and are at risk of a measles outbreak

Task 6. Brief the Minister. Propose three actions to respond to the outbreak.

1. Plan for a mass vaccination campaign in Grantan and plan for subsequent SIA in the other at risk regions

2. Improve status of MCV 1 in Routine immunization

3. Include a second routine dose of MCV (MCV2) in the national vaccination schedules regardless of the level of MCV1 coverage

Task 7. Formulate recommendations. List your top 3-5 recommendations specific to data strengthening you would prioritize as the EPI and surveillance teams in Vacciland

Recommendations :-

1. Conduct in detailed data quality assessment (systems review, data desk review, field review) and a reason analysis.

2. Develop a data improvement plan and prioritize interventions

3. Make an action plan and plan for required resources (ICT, HR, training and supervision)