Abstract: The Feasibility of utilizing DHIS2 in decreasing child vaccination dropout rate in Duhok Governorate

Child immunization program is a worldwide cost-effective program in decreasing disabilities and death among under-five children. Despite its major benefits, its performance measures have not yet been to the globally accepted level of more than 90% immunization coverage in Iraq and the Kurdistan Region due to the challenges faced in identifying and tracing child vaccination uptake using paper-based immunization registries, leading to a high immunization dropout rate and insufficient quality data that is required to assist in shaping the strategies of enhancing the child immunization program with data-driven decision-making.

This research aimed to investigate the capabilities of utilizing the District Health Information System (DHIS-2) in developing an individual-based electronic immunization registry (EIR), combined with short messaging service (SMS) reminders, in decreasing the child immunization dropout rate in the Duhok Governorate.

A multimethod approach for data collection was used consisting of a quantitative survey targeting health staff at all vaccination units at primary healthcare centers in Duhok Governorate and a quasi-experimental study on the effect of applying the EIR developed by the DHIS-2 platform and SMS reminders on the dropout rate for the three consecutive doses of the Pentavalent vaccine (PENTA-1 to PENTA-3) among 390 children under one year of age distributed on two arms (intervention and control).

The results showed a statistically significant decrease in the PENTA-1 to PENTA-3 dropout rate among the intervention arm 5.7% compared to the control arm 29.7% (p-value< 0.001), concluding that the EIR system developed using the DHIS-2 platform has demonstrated crucial advantages in accelerating the identification of the dropout children and tracking individual-based vaccine uptakes. Hence, it is recommended to scale up its use to cover a broader range of health facilities with comprehensive planning and consideration of staff skills in information technology and health facility readiness.