LWANGA - 1987 



 


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2005

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20 Nov 2005

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METHODOLOGY

  Lwanga SK, Abiprojo N. Immunization coverage surveys: methodological studies in Indonesia. Bull World Health Organ 65(6), 847-53, 1987.

PIP: A field study was conducted in rural and urban areas of Indonesia to quantify the relative costs of surveys using the standard Expanded Program on Immunization (EPI) methodology or using 7 randomly selected households within each cluster. Specifically, the objectives were: to assess whether immunization schedules were being adhered to in the study areas; to quantify the differences in survey time and cost for a rural and urban setting between the standard EPI survey method and the statistically rigorous approach, whereby 7 starting households were selected randomly within each cluster; and to assess the applicability of Lot Quality Assurance techniques as a managerial tool in immunization programs. The 2 areas of study were the Gianyar "kapupaten"(district) of Bali and the "timur"(east) municipality of Jakarta. In both places reliable population data were available from the 1980 census and, in Bali, these had been continually updated through regular reporting of births, deaths, and migrations. Gianyar district was chosen because it is rural, has a fairly good immunization reporting system, up-to-date household lists, and is logistically convenient. Both types of surveys. the standard EPI method and the SRS method in which a randomly selected starting household is used for each child, were conducted in each of the study areas during September and October 1986. Children's ages were calculated, in months, with respect to the 1st day of the survey. The age and the date of immunization of each child were then used to compute the age at immunization in months. In Gianyar, 207 children aged from 15 months to less than 24 months had their immunization status properly recorded using the EPI survey method; 209 children were successfully recorded by the SRS method. Using the EPI method, it was estimated that 75.4% of the children had received 8 immunizations. Use of the SRS method gave an estimate of 86.6%. In Jakarta, 207 children were properly surveyed by the epi method, with an overall complete immunization rate of 25.1%. The SRS method, which properly surveyed 209 children, gave a rate of 24.4%. The survey results show that the majority of the children were not vaccinated according to the national immunization schedule. Failure to follow the schedule also was independent of coverage levels. Individual clusters can be correctly classified according to their immunization level using Lot Quality Assurance methods.

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