Validity of Expanded Program on Immunization Contact Method health behavior estimates in Mali.
BACKGROUND
In the developing world, household surveys provide high-quality health behavior data integral to public health program management. The Expanded Program on Immunization Contact Method (EPI-CM) is a proposed, less resource-intensive method in which health center staff incorporate health behavior questions into routine vaccination activities. No systematic evaluation of EPI-CM validity has yet been conducted.


METHODS
We used concurrent household survey and EPI-CM to collect data on 4 infant health behaviors in Mali at 2 time points (8 total comparisons). Studied health behaviors were bednet use, obtaining care for fever, obtaining care for a respiratory complaint, and using oral rehydration solution for diarrhea. Household survey and EPI-CM estimates were considered equivalent if a 95% confidence interval about the difference in estimated proportions fell within the interval (-.10, .10).


RESULTS
EPI-CM estimates were higher than household survey estimates for 7 of 8 unadjusted paired estimates; estimates of bednet use in 2009 met a priori equivalence criteria in a setting of high bednet use (90.5%). When we restricted household survey data to infants up-to-date on vaccinations, estimates for behaviors other than bednet use remained substantially different.


CONCLUSIONS
We were unable to demonstrate that EPI-CM, as implemented, consistently produces data comparable with household survey data.
Preventive Medicine Residency Program, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Stanley C
SC
Wei
Jodi L
JL
Vanden Eng
Amy E
AE
Patterson
Seydou
S
Doumbia
David G
DG
Kleinbaum
Tove K
TK
Ryman
Mahamoudou B
MB
Touré
Meredith L
ML
McMorrow
D015438:Health Behavior; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D008302:Mali