Countdown worked with Gavi to improve 26 African countries’ use of immunization data. The study’s objectives were to:
- Enhance country analytical capacity for coverage and equity of immunization;
- Produce annual reports on immunization coverage and equity, using all available data sources, with a focus on subnational levels, that could be used to inform country, regional and global monitoring; and
- Produce annual reports summarising progress and achievements. This included a small set of quantitative indicators to facilitate learning about the new approach.
The study officially launched in May 2024. Analytical work took place from June through August, and country reports were developed in October, with further advanced analysis continuing through December.
Background and rationale
Immunization is one of the most cost-effective and safest methods to curb the spread of communicable diseases and reduce neonatal and child morbidity and mortality. In addition to offering protection from preventable diseases, immunization facilitates contact between families and health systems, providing a channel for the delivery of other basic health services. Ensuring universal access to vaccines is a critical entry point for universal health coverage (UHC).
However, disparities in vaccine coverage and childhood mortality persist. In 2021, globally approximately 25 million children did not receive basic vaccinations. The sub-Saharan African region has the highest under-five mortality rate globally, and basic childhood vaccination coverage remains low in many countries.
Methods
While household surveys such as the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) provide important population-based coverage estimates, they are conducted infrequently. Routine health information system (RHIS) data reported through national platforms such as DHIS2 offer a continuous and geographically detailed source of information that can complement survey data when data quality is adequately assessed. For this study, routine immunization data were extracted from national DHIS2 systems using a harmonized extraction module linked to a standardized template. Data quality was assessed through indicators of reporting completeness, missingness, and composite data quality scores.
Coverage estimates were generated for standard immunization coverage indicators such as Penta-1, Penta-3, BCG, OPV1, and Measles-1. When feasible, the analysis compared estimates based on RHIS and those based on household surveys estimates. The analytical workflow was implemented through the CD2030 DataSuite, a zero-coding analytical platform designed to facilitate country-led analysis of routine immunization data.
Access the Multi-country synthesis report
Participating countries:
The participating countries are 26 countries with existing Countdown collaborations, plus four countries that are in the process of establishing Countdown collaborations (Central African Republic, Madagascar, Mauritania and Somalia):
Eastern and Southern Africa (11): Ethiopia, Kenya, Madagascar, Malawi, Mozambique, Rwanda, Somalia, Tanzania, Uganda, Zambia, and Zimbabwe.
West and Central Africa (15): Burkina Faso, Cameroon, Central African Republic Chad, Côte d’Ivoire, Democratic Republic of Congo, Ghana, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, and Sierra Leone.