The challenge of identifying eligible girls for HPV vaccination: HPV mapping data verification in Malawi.

PURPOSE: Malawi introduced the human papillomavirus (HPV) vaccine nationwide in January 2019, with a target population of nine-year-old girls. Early in rollout, some health facilities reported stockouts, raising questions about the accuracy of the age eligibility of girls registered during the initial population mapping exercise. Mapping results showed that the estimated number of nine-year-old girls registered for vaccination was significantly higher than National Statistical Office (NSO) estimates, resulting in questions about enumeration of the target population. Consequently, the Ministry of Health of Malawi's Expanded Programme on Immunization (MOH-EPI) and immunization partners conducted a post-introduction data verification exercise to validate the eligibility of girls registered during mapping. RESULTS: Data were collected by immunization partners and representatives from national, zonal, and district levels. Dates of birth (DOB) were validated in HPV vaccine mapping registers and compared with information obtained from individual registered girls during school visits and their parents during home visits. HPV vaccine mapping registers were reviewed, showing that 76 percent of girls (n = 957) had DOBs within the vaccination eligibility range. A subset of the 957 girls (414) were interviewed; of them 74 percent (307) provided DOBs within the eligible period. Parents of the remaining eligible girls (543) were interviewed; 55 percent (297) of them, provided DOBs that were within the eligible period, indicating that, when using parents as an information source, 45 percent of the girls were outside the target age group. CONCLUSION: The eligibility verification exercise reviewed the accuracy of the mapping exercise and provided lessons for future target setting. Findings validate using NSO population estimates for target setting, incorporating the identification and registration of girls for HPV vaccination into RI microplanning headcounts, and verifying with parents the age and eligibility of girls registered before HPV vaccination is conducted.

Integrated Family Planning and Immunization Service Delivery at Health Facility and Community Sites in Dowa and Ntchisi Districts of Malawi: A Mixed Methods Process Evaluation.

The Government of Malawi's Health Sector Strategic Plan II highlights the importance of service integration; however, in practice, this has not been fully realized. We conducted a mixed methods evaluation of efforts to systematically implement integrated family planning and immunization services in all health facilities and associated community sites in Ntchisi and Dowa districts during June 2016-September 2017. Methods included secondary analysis of service statistics (pre- and postintervention), focus group discussions with mothers and fathers of children under age one, and in-depth interviews with service providers, supervisors, and managers. Results indicate statistically significant increases in family planning users and shifts in use of family planning services from health facilities to community sites. The intervention had no effect on immunization doses administered or dropout rates. According to mothers and fathers, benefits of service integration included time savings, convenience, and improved understanding of services. Provision and use of integrated services were affected by availability of human resources and commodities, community linkages, data collection procedures and availability, sociocultural barriers, organization of services, and supervision and commitment of health surveillance assistants. The integration approach was perceived to be feasible and beneficial by clients and providers.

Monitoring coverage of fully immunized children.

Immunization programs monitor 3rd dose of DPT-containing vaccine coverage as a principal indicator; however, this does not inform about coverage with other vaccines. A mini-survey was conducted to assess the status of monitoring coverage of fully immunized children (FIC) in Eastern and Southern African countries. We designed and distributed a structured self-administered questionnaire to all 19 national program managers attending a meeting in March 2014 in Harare, Zimbabwe. We learned that most countries already monitor FIC coverage and managers appreciate the importance of monitoring this as a national indicator, as it aligns with the full benefits of immunization. This mini-survey concluded that at national level, FIC coverage could be used as a principal indicator; however, at global level DPT3 has some additional advantages across all countries in standardizing the capacity of the immunization program to deliver multiple doses of the same vaccine to all children by 12 months of age.