Micro-planning in a wide age range measles rubella (MR) campaign using mobile phone app, a case of Kenya, 2016.

INTRODUCTION: A Measles rubella campaign that targeted 9 months to 14 year old children was conducted in all the 47 counties in Kenya between 16th and 24th of May 2016. Micro-planning using an android phone-based app was undertaken to map out the target population and logistics in all the counties 4 weeks to the campaign implementation instead of 6 months as per the WHO recommendation. The outcomes of the micro-planning exercise were a detailed micro-plan that served as a guide in ensuring that every eligible individual in the population was vaccinated with potent vaccine. A national Trainer of Trainers training was done to equip key officers with new knowledge and skills in developing micro-plans at all levels. The micro planning was done using a mobile phone app, the doforms that enabled data to be transmitted real time to the national level. The objective of the study was to establish whether use of mobile phone app would contribute to quality of sub national micro plans that can be used for national level planning and implementation of the campaign. METHODS: There were 9 data collection forms but only forms 1-7 were to be uploaded onto the app. Forms 8A and 9A were to be filled but were to remain at the implementation level for use intra campaign. The forms were coded; Form 1A&B, 2A, 3A, 4A, 5A, 6A, 7A, 8A and 9A The Village form (form 1A&B) captured information by household which included village names, name of head of household, cell phone contact of head of household, number of children aged 9 months to 14years in the household, possible barriers to reaching the children, appropriate vaccination strategy based on barriers identified and estimated or proposed number of teams and type. This was the main form and from this every other form picked the population figures to estimate other supplies and logistics. On advocacy, communication and social mobilization the information collected included mobile network coverage, public amenities such as churches, mosques and key partners at the local level. On human resource and cold chain supplies the information collected included number of health facilities by type, number of health workers by cadre in facilities within the village, number of vaccine carriers and icepacks by size, refrigerators and freezers. All these forms were to be uploaded onto the phone app. except form 8A, the individual team plan, which was to be used during implementation at the local level. Android phone application, doforms, was used to capture data. Training on micro planning, data entry and doforms app was conducted at National, County, Sub-county and ward levels using standardized guidelines. An interactive case study was used in all the trainings to facilitate understanding. The App was also available on Laptops through its provided web-application. The app allowed multiple users to log in concurrently. Feedback on all the variables were obtained from the team at the Ward level. The ward level team included education officers or teachers, village elders, community health workers and other community stakeholders. Only the Ward level was allowed to collect information on paper and that information was subsequently transferred to the phone-based app, doforms, by health information officers. The national, county and sub county were able to access their data from the app using a password provided by the administrator. RESULTS: Real time data was received from 46 of 47 counties. One county (Marsabit) did not participate in the micro plan process. Over 97% (283/290) of the sub counties responded and shared various information via the app. Different data forms had different completion rates. There was 100% completion rate for the data on villages and target population. Much valuable information was shared but there was no time for the national and county level to interrogate and harmonize for proper implementation. The information captured during the campaign can be used for routine immunization and other community based interventions. Electronic data collection not only provided the number of children but provided the locations also where these children could be found. CONCLUSION: Despite the limitations of time to harmonize the micro plans with the national plan, the micro planning process was a great success with 46/47 counties responding through the mobile phone app. Not only did it provide the numbers of the target children, it further provided the places where these children could be found. There was timely data transfer, data integrity, tracking, real time data visualization reporting and analysis. The app enabled real time feedback to national focal point by data entry clerks as well as enabling trouble shooting by the administrator. This ensured campaign planning was done from the lowest level to the national level.

Intussusception Cases Among Children Admitted to Referral Hospitals in Kenya, 2002-2013: Implications for Monitoring Postlicensure Safety of Rotavirus Vaccines in Africa.

To describe the epidemiology of intussusception before introduction of the rotavirus vaccine, we reviewed the records of 280 patients younger than 5 years who were hospitalized in Kenya between 2002 and 2013. The patients who died (18 [6.4%]) had sought care later after symptom onset than the patients who survived (median, 5 vs 3 days, respectively; P = .04). Seeking prompt care may improve therapeutic outcomes.