Comparison of two survey methodologies to assess vaccination coverage.
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.
Luman
Elizabeth T
ET
Global Immunization Division, National Immunization Program, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA. ECL7@cdc.gov
Worku
Alemayehu
A
Berhane
Yemane
Y
Martin
Rebecca
R
Cairns
Lisa
L
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005002:Ethiopia; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000592:standards; D007223:Infant; D008297:Male; D008457:Measles / Q000517:prevention & control; D008458:Measles Vaccine; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data*
D008458:Measles Vaccine