Investigator(s)
| WHO Technical Officer |
Thelge Sudath Rohana Peiris WHO country office, Timor-Leste Thelge Sudath Rohana Peiris 
|
| Principal Investigator |
Manuel Mausiry Ministry of Health, Timor-Leste Manuel Mausiry
|
| Co-Investigator(s) |
Caetano Gusmao National Health Institute, Ministry of Health, Timor-Leste Caetano Gusmao
|
Title(s) and abstract
| Scientific title | National Expanded Programme on Immunization Coverage Evaluation Survey: Timor-Leste 2023 |
| Public title | National Expanded Programme on Immunization Coverage Evaluation Survey: Timor-Leste 2023 |
| Background | The Expanded Programme on Immunization (EPI) was first established in 1978 during the Indonesian time and were disrupted at the end of Indonesian period. During the United Nations transitional administration in Timor-Leste, the EPI was restructured in March 2020. After becoming a sovereign state in 2002, Timor-Leste progressively improved its health infrastructure, which also included the service delivery related to EPI. Nonetheless, estimation of immunization coverage in Timor-Leste is extremely challenging owing to lack of comprehensive birth registration system and data quality issues of the national HMIS. The administrative vaccine coverage estimations are based on the projected population denominators of the census data. The change in the denominator led to the sudden rise of administrative coverages of routine vaccination to unrealistically high values of 100% or above. The last comprehensive EPI coverage survey in Timor-Leste was conducted in 2018. With this background, the Ministry of Health, Timor-Leste and its partners have requested the World Health Organization (WHO) to support in conducting an EPI coverage survey to estimate the true national vaccination coverages. |
| Objectives | General objective To estimate the national coverages of routine immunization, tetanus toxoid vaccine coverage among mothers of children who completed their first year of life, MR/OPV/PCV Supplementary Immunization Activity, and dropout rates in routine immunization with specific reasons for the dropout Specific objectives 1. To evaluate infant immunization coverage of children 0-11 months of age, including their immunization status particularly before their first birthday including evaluation of coverage for valid doses as per the TLS immunization schedule 2. To evaluate 2nd year immunization coverage of children 12-23 months of age, including their immunization status particularly before their 2nd birthday including evaluation of coverage for valid doses as per the schedules 3. To assess the Tetanus Toxoid coverage of mothers of infants from (0-11 moths) of age 4. To evaluate coverage of MR/OPV/PCV SIA conducted in January/February 2023 5. To assess dropout rates in routine immunization for all antigens with more than one dose 6. To determine specific reasons for incomplete immunization |
| Study Methods | The methodology was developed based on the WHO Vaccination Coverage Cluster Surveys: Reference Manual 2018. A nationally representative sample from all 14 municipality areas during April 2023 will be surveyed. The sample sizes for the RI coverage (0-11 months and 12-23 months) and the SIA coverage (0-59 months) are 582 and 1158 respectively. This proposed survey will cover 194 Enumeration Areas (EAs) selected randomly of 2384 EAs in the 2022 census (sampling frame), maintaining the proportion of EA distribution across the 14 municipalities. Randomly pre-selected 26 households in each EA will be visited for the survey data collection (total 4902 households). Four questionnaires will be used (in Tetum) for data collection using tablets and digital questionnaires will be used to data capture using DHIS2. Trained medical officers will be employed as data collectors and altogether there will be 64 teams. |
| Expected outcomes and use of results | The data analysis will be using the plan described by the WHO vaccination coverage survey manual and using definitions described in the user guide for vaccine coverage quality indicators (version 2.5). Unweighted and weighted estimates will be calculated. All the weighted point estimates will include a 95% confidence interval. The data analysis plan will cover three main aspects for routine immunization. 1. Description of the selected sample using descriptive statistics 2. Standard analysis a. Crude coverage b. Valid coverage c. Fully vaccinated d. Immunization system access e. Immunization system utilization (dropout rates f. Immunization card retention 3. Additional analysis a. Gender equality in receiving immunization b. Missed opportunity analysis c. Immunization providers d. Mothers knowledge on vaccine names administered to their children e. Reasons for non-vaccination f. Reported Adverse Events Following Immunization The data analysis for the SIA campaign will cover following aspects. 1. Unweighted and weighted vaccine coverage at the national level 2. Percentage coverage differences in vaccine to assess gender equality 3. Methods of awareness on the campaign 4. Reasons for not vaccination at campaign 5. Percentage of reported Adverse Events Following Immunization |
| Keywords | Expanded Programme on Immunization, Coverage Evaluation Survey, Timor-Leste |
Research Details
| Student research | No |
| Start Date | 19-Mar-2023 |
| End Date | 16-May-2023 |
| Key Implementing Institution | Ministry of Health, Timor-Leste |
| Multi-country research | No |
| Nationwide research | Yes |
| Research Domain(s) | Health Systems Research |
| Research field(s) | Immunization/Vaccine Preventable Disease |
| Involves human subjects | Yes |
| Population-Based Survey | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | Final decision available |