Triangulation and Use of Immunization Data

District Health Information Software 2 and data triangulation to improve the national information system performance and strengthen data use at all levels of the Cote d’ Ivoire immunization programme

Dr Ruth Coulibaly, Head of the monitoring and evaluation department, National EPI, Cote d’Ivoire

Thursday June, 23rd at 10.30 “Triangulation and Use of Immunization Data” session

Background: Multiple information systems supporting Cote d’Ivoire Expanded Program on Immunization (EPI) data were used until 2021 including e-District Vaccine Data Management Tool [coverage, vaccine-preventable disease (VPD) surveillance and stock data], EpiInfoTM (coverage and VPD surveillance data), and Stock Management Tool (vaccine stock data). The multiplicity of tools and data sources for each data type resulted in ineffective data use, as shown by the 2019 data quality assessment results conducted at the district and health facility levels.

Methods: In an effort to improve the performance of its information system and strengthen data use at all administrative levels, the national EPI decided to 1) migrate to District Health Information Software 2 (DHIS2) for the management of coverage, VPD surveillance, and vaccine stock data, and 2) pilot the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and U.S. Centers for Disease Control (US-CDC) guidance on Triangulation for Improved Decision-Making in Immunization Programmes and provide triangulation training to sub-national level immunization and VPD surveillance staff.

Results: Since February 2022, DHIS2 is being used by Cote d’Ivoire immunization and VPD surveillance staff at all levels of the health system (national, all 33 regions, all 113 districts, 20 reference and 117 general hospitals) after a data harmonization process to incorporate historical data into DHIS2 and a series of trainings on the WHO EPI and the WHO Integrated Disease Surveillance and Response aggregate data packages. Although a country pilot of the WHO VPD case-based surveillance tracker showed promising results, it remains to be integrated in DHIS2.
In parallel, national immunization and VPD surveillance staff conducted a triangulation exercise to identify measles immunity gaps at the sub-national levels after compiling coverage, aggregate and case-based VPD surveillance, and vaccine stock data from 2009 to 2019. The analytical and interpretative process identified data quality issues and the populations and geographic areas with immunity gaps. These findings helped inform decisions on introducing measles vaccine second dose and revising target population estimates. Two triangulation trainings were subsequently conducted and addressed to 129 regional and district level immunization and VPD surveillance data managers (all 33 regions, 35 districts). Discussions among peers revealed the need to integrate triangulation across data sources, and to have access to a dashboard that triangulates data, particularly within DHIS2 since the system has those capabilities.

Conclusion: With the use of DHIS2, Cote d’Ivoire immunization and VPD surveillance staff are better equipped to conduct monitoring, data analyses, and triangulation to help inform programme management and planning at all levels of the health system. Future triangulation activities using DHIS2 are being planned.

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Félicitations :+1: ! Thanks for sharing @Sople_Ruth_Coulibaly :slightly_smiling_face:

That’s a very useful exercise. Congrats!
I am interested in seeing the results of the triangulation.