title: Home-based record prevalence among children aged 12-23 months from 180 demographic and health surveys.
abstract: BACKGROUND
  There is currently a re-focus at the global level on the importance of the home-based record within vaccination service delivery as an important information resource but there are few reports of ever and current home-based record prevalence across countries.
  
  
  METHODS
  We considered all Demographic and Health Surveys (starting with DHS round 3) conducted between 1993 and 2013 for which a final dataset was available in the public domain at the time of the analysis. Ever and current prevalence of home-based records for recording vaccination was estimated for children aged 12-23 months at the time of the survey through a secondary analysis of data from 180 Demographic and Health Surveys conducted in 67 countries derived from questions asked of women aged 15-49 years for their children on home-based record availability and retention. Ever home-based record prevalence is the proportion of children aged 12-23 months who have ever received a home-based record. Current home-based record prevalence is the proportion of children aged 12-23 months for whom a home-based record was available for viewing by the surveyor at the time of the survey.
  
  
  RESULTS
  Estimated ever home-based record prevalence was ≥90% in 116 surveys from 52 countries and was <70% in 15 surveys from 7 countries. Estimated current home-based record prevalence was ≥80% in 31 surveys from 23 countries and was <50% in 51 surveys from 24 countries. Current home-based record prevalence was <80% as of the most recent survey during 2010-2013 for five (Bangladesh, Ethiopia, Nigeria, Indonesia and Pakistan) of the ten countries with the largest birth cohorts globally. Among 34 countries that conducted three or more DHS, we observed improvements in both ever and current home-based record prevalence of >10% points in six countries. Current home-based record prevalence increased >10% points in six countries where the ever prevalence was maintained at ≥90% across the period of observation. And, no meaningful change was observed in estimated ever and current home-based record prevalence in 11 countries, five of which maintained ever prevalence ≥90% across the period of observation. High home-based record loss rates were observed in many countries.
  
  
  CONCLUSIONS
  The results here show that despite improvements in the availability, utilization and retention of home-based records for recording vaccination history in some countries, opportunities remain to change the mind-set in many national immunization programmes around the importance of the home-based record, particularly in countries with large birth cohorts. Immunization programmes are encouraged to monitor ever and current home-based record prevalence. Nationally representative household surveys collecting information on immunization coverage should include ever and current home-based record prevalence in the standard survey reports and tables to better enable programme managers to identify problems and target corrective action.
authors.affiliation: United Nations Children's Fund, New York, NY, USA. Electronic address: dbrown@unicef.org.
authors.forename: David W
authors.initials: DW
authors.lastname: Brown
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Marta
authors.initials: M
authors.lastname: Gacic-Dobo
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D003710:Demography; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D055991:Health Records, Personal; D006306:Health Surveys; D006801:Humans; D017589:Immunization Programs; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D013997:Time Factors; D014611:Vaccination; D055815:Young Adult
keywords: Health records, Personal; Home-based record; Immunization; Immunization card; Immunization systems; Medical records; Monitoring; Record; Recording; Vaccination; Vaccination card