Performance of small cluster surveys and the clustered LQAS design to estimate local-level vaccination coverage in Mali.
BACKGROUND
Estimation of vaccination coverage at the local level is essential to identify communities that may require additional support. Cluster surveys can be used in resource-poor settings, when population figures are inaccurate. To be feasible, cluster samples need to be small, without losing robustness of results. The clustered LQAS (CLQAS) approach has been proposed as an alternative, as smaller sample sizes are required.


METHODS
We explored (i) the efficiency of cluster surveys of decreasing sample size through bootstrapping analysis and (ii) the performance of CLQAS under three alternative sampling plans to classify local VC, using data from a survey carried out in Mali after mass vaccination against meningococcal meningitis group A.


RESULTS
VC estimates provided by a 10 × 15 cluster survey design were reasonably robust. We used them to classify health areas in three categories and guide mop-up activities: i) health areas not requiring supplemental activities; ii) health areas requiring additional vaccination; iii) health areas requiring further evaluation. As sample size decreased (from 10 × 15 to 10 × 3), standard error of VC and ICC estimates were increasingly unstable. Results of CLQAS simulations were not accurate for most health areas, with an overall risk of misclassification greater than 0.25 in one health area out of three. It was greater than 0.50 in one health area out of two under two of the three sampling plans.


CONCLUSIONS
Small sample cluster surveys (10 × 15) are acceptably robust for classification of VC at local level. We do not recommend the CLQAS method as currently formulated for evaluating vaccination programmes.
Epicentre, Paris, France. andrea.minetti@epicentre.msf.org.
Andrea
A
Minetti
Margarita
M
Riera-Montes
Fabienne
F
Nackers
Thomas
T
Roederer
Marie Hortense
MH
Koudika
Johanne
J
Sekkenes
Aurore
A
Taconet
Florence
F
Fermon
Albouhary
A
Touré
Rebecca F
RF
Grais
Francesco
F
Checchi