BACKGROUND: Measuring vaccination coverage permits evaluation and appropriate targeting of vaccination services. The cluster survey methodology developed by the World Health Organization, known as the 'Expanded Program on Immunization (EPI) methodology', has been used worldwide to assess vaccination coverage; however, the manner in which households are selected has been criticized by survey statisticians as lacking methodological rigor and introducing bias. METHODS: Thirty clusters were selected from an urban (Ambo) and a rural (Yaya-Gulelena D/Libanos) district of Ethiopia; vaccination coverage surveys were conducted using both EPI sampling and systematic random sampling (SystRS) of households. Chi-square tests were used to compare results from the two methodologies; relative feasibility of the sampling methodologies was assessed. RESULTS: Vaccination coverage from a recent measles campaign among children aged 6 months through 14 years was high: 95% in Ambo (both methodologies), 91 and 94% (SystRS and EPI sampling, respectively, P-value = 0.05) in Yaya-Gulelena D/Libanos. Coverage with routine vaccinations among children aged 12-23 months was <20% in both districts; in Ambo, EPI sampling produced consistently higher estimates of routine coverage than SystRS. Differences between the two methods were found in demographic characteristics and recent health histories. Average time required to complete a cluster was 16h for EPI sampling and 17 h for SystRS; total cost was equivalent. Interviewers reported slightly more difficulty conducting SystRS. CONCLUSIONS: Because of the methodological advantages and demonstrated feasibility, SystRS would be preferred to EPI sampling in most situations. Validating results in additional settings is recommended.
BACKGROUND: Measuring vaccination coverage permits evaluation and appropriate targeting of vaccination services. The cluster survey methodology developed by the World Health Organization, known as the 'Expanded Program on Immunization (EPI) methodology', has been used worldwide to assess vaccination coverage; however, the manner in which households are selected has been criticized by survey statisticians as lacking methodological rigor and introducing bias. METHODS: Thirty clusters were selected from an urban (Ambo) and a rural (Yaya-Gulelena D/Libanos) district of Ethiopia; vaccination coverage surveys were conducted using both EPI sampling and systematic random sampling (SystRS) of households. Chi-square tests were used to compare results from the two methodologies; relative feasibility of the sampling methodologies was assessed. RESULTS: Vaccination coverage from a recent measles campaign among children aged 6 months through 14 years was high: 95% in Ambo (both methodologies), 91 and 94% (SystRS and EPI sampling, respectively, P-value = 0.05) in Yaya-Gulelena D/Libanos. Coverage with routine vaccinations among children aged 12-23 months was <20% in both districts; in Ambo, EPI sampling produced consistently higher estimates of routine coverage than SystRS. Differences between the two methods were found in demographic characteristics and recent health histories. Average time required to complete a cluster was 16h for EPI sampling and 17 h for SystRS; total cost was equivalent. Interviewers reported slightly more difficulty conducting SystRS. CONCLUSIONS: Because of the methodological advantages and demonstrated feasibility, SystRS would be preferred to EPI sampling in most situations. Validating results in additional settings is recommended.
Authors: Muhammad Umair Mushtaq; Muhammad Ashraf Majrooh; Mohsin Zia Sana Ullah; Javed Akram; Arif Mahmood Siddiqui; Mushtaq Ahmad Shad; Muhammad Waqas; Hussain Muhammad Abdullah; Waqar Ahmad; Ubeera Shahid; Usman Khurshid Journal: BMC Public Health Date: 2010-02-09 Impact factor: 3.295
Authors: Lp Galway; Nathaniel Bell; Al Shatari Sae; Amy Hagopian; Gilbert Burnham; Abraham Flaxman; Wiliam M Weiss; Julie Rajaratnam; Tim K Takaro Journal: Int J Health Geogr Date: 2012-04-27 Impact factor: 3.918
Authors: B Mao; K Chheng; K Wannemuehler; E Vynnycky; S Buth; S C Soeung; S Reef; W Weldon; L Quick; C J Gregory Journal: Epidemiol Infect Date: 2014-11-06 Impact factor: 4.434
Authors: Thomas P Eisele; Dale A Rhoda; Felicity T Cutts; Joseph Keating; Ruilin Ren; Aluisio J D Barros; Fred Arnold Journal: PLoS Med Date: 2013-05-07 Impact factor: 11.069