Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jul 28, 2021
Date Accepted: Oct 15, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Added value of electronic immunization registries: an observational case study in Tanzania
ABSTRACT
Background:
There is growing interest and investment in electronic immunization registries (EIRs) in low- and middle-income countries (LMICs). EIRs provide ready-access to patient- and aggregate-level service delivery data which can be used to improve patient care, identify spatiotemporal trends in vaccination coverage and dropout, inform resource allocation and program operations, and target quality improvement measures. The Government of Tanzania introduced the Tanzania Immunization Registry (TImR) in 2017, and the system has since been rolled out in 3,736 facilities in 15 regions.
Objective:
The aims of this study were to 1) conceptualize the additional ways that EIRs can add value to immunization programs (beyond measuring vaccine coverage) and 2) assess the potential value-add using EIR data from Tanzania as a case study.
Methods:
This study was comprised of two sequential phases. First, a comprehensive list of ways EIRs can potentially add value for immunization programs was developed through stakeholder interviews. Second, the added value was evaluated using descriptive and regression analyses of TImR data for a prioritized subset of program needs.
Results:
Analysis areas prioritized through stakeholder interviews were: population movement, missed opportunities for vaccination (MOVs), continuum of care, and continuous quality improvement (CQI). Included TImR data consisted of 958,870 visits for 559,542 patients from 2,359 health facilities. Our analyses revealed that few patients sought care outside their assigned facility (5.4%) but that this varied by region; facility urbanicity, type, ownership, patient volume, and duration of TImR system use; density of facilities in the immediate area; and patient age. Analyses further showed that MOVs were highest among children <12 months (25.9% of visits included an MOV) but there were few significant differences by other individual or facility characteristics. Nearly half (45.7%) of children aged 12-27 months were fully vaccinated or had received all doses except MCV-1 of the 14-dose under-12-month schedule (i.e., through MCV-1) and facility and patient characteristics associated with dropout varied by vaccine. The CQI analysis showed that the majority of quality issues (e.g., MOVs) were concentrated in under 10% of facilities, indicating the potential for EIRs to target quality improvement efforts
Conclusions:
EIRs have potential to add value to immunization stakeholders at all levels of the health system. Individual-level electronic data can enable new analyses to understand service delivery or care seeking patterns, potential risk factors for under-immunization, and where challenges occur. To achieve this potential, however, country programs need to leverage and/or strengthen capacity to collect, analyze, interpret, and act on the data. As EIRs are introduced and scaled in LMICs, implementers and researchers should continue to share real-world examples and build the evidence base for how EIRs can add value to immunization programs, particularly for innovative uses. Clinical Trial: immunization; immunization information systeimmunization; immunization information system; electronic immunization registry; digital health; eHealth m; electronic immunization registry; digital health; eHealth
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