Evaluating the vaccination coverage: validity of household-hold vaccination booklet and caregiver’s recall

Figures & data

Table 1. The definitions of measurements in this study

Agreement		Percentage of fully immunized children based on medical records
		Yes	No
Percentage of fully immunized children based on household source (immunization booklet and recall)	Yes	True positive (TP)	False positive (FP)
	No	False negative (FN)	True negative (TN)

Table 2. Estimated percentage (95% CI) of children fully immunized as estimated by various data sources

Data source	VC and 95% CI for age group (%)
	1 year old	2 years old	6 years old
Medical records	93.7(82.3-97.2)	91.5(86.0-93.4)	83.2(69.5-89.6)
Card	90.3(85.9-94.6)	84.7(78.2-88.7)	66.5(57.2-79.3)
Recall	91.2(86.4-93.9)	82.3(75.5-89.3)	58.7(50.2-62.4)
Card+recall	92.7(87.2-95.1)	86.5(80.3-91.0)	70.0(61.6-79.2)
Card among holders	94.1(90.3-97.6)	88.9(82.5-93.4)	72.0(63.8-80.5)

Notes (1) Children aged 1 year should receive 1 dose of BCG, 3 doses of HBV, 3 doses of DTP, 3 doses of PV, 1 dose of MCV, 1 dose of JEV and 2 doses of MenV-a; Children aged 2 years should receive 1 dose of BCG, 3 doses of HBV, 4 doses of DTP, 3 doses of PV, 2 dose of MCV, 2 dose of JEV, 2 doses of MenV-a and 1 dose of HAV; Children aged 6 years should receive 1 dose of BCG, 3 doses of HBV, 4 doses of DTP, 4 doses of PV, 2 dose of MCV, 2 dose of JEV, 2 doses of MenV-a, 1 dose of HAV, 2 doses of MenV-ac and 1 dose of DT. (2) Medical records meant the immunization status was determined based on ZJIIS; Card meant the immunization status was determined based on the vaccination booklet; Recall meant the immunization status was determined based on the response to survey question “In your opinion, has this child received all recommended shots for his/her age?”; Card+recall meant the immunization status was determined based on the vaccination booklet or recall for children without a vaccination booklet; Card among holders meant the immunization status was determined based on the vaccination booklet among children with vaccination booklets.

Table 3. Estimated percentage of children fully immunized by demographic characteristic and data sources

Demographic characteristic	1 year old						2 years old						6 years old
	n	%	Medical records	Card	Recall		n	%	Medical records	Card	Recall		n	%	Medical records	Card	Recall
Overall	600	-	93.7	90.3	91.2		600	-	91.5	84.7	82.3		600	-	83.2	66.5	58.7
Child’s gender
Male	304	50.7	93.1	89.8	90.5		301	50.2	91.4	84.4	82.4		297	49.5	83.5	66.7	58.6
Female	296	49.3	94.3	90.9	91.9		299	49.8	91.6	84.9	82.3		303	50.5	82.8	66.3	58.7
Siblings
1	388	64.7	97.7	95.1	95.9		457	76.2	96.3	89.1	87.7		519	86.5	86.5	69.2	60.9
2	144	24.0	91.0	86.8	88.2		108	18.0	82.4	75.9	69.4		62	10.3	72.6	56.5	50.0
≥3	68	11.3	76.5	70.6	70.6		35	5.8	62.9	54.3	51.4		19	3.2	26.3	26.3	26.3
Maternal age (years)
<30	103	17.2	95.1	94.2	94.2		138	23.0	94.2	91.3	90.6		387	64.5	85.0	68.5	62.0
≥30	497	82.8	93.4	89.5	90.5		462	77.0	90.7	82.7	79.9		213	35.5	79.8	62.9	52.6
Maternal education
No/primary	8	1.3	62.5	62.5	62.5		26	4.3	46.2	42.3	46.2		82	13.7	51.2	46.3	46.3
Second level	72	12.0	84.7	79.2	80.6		109	18.2	88.1	64.2	63.3		195	32.5	83.1	66.7	58.5
College level	520	86.7	95.6	92.3	93.1		465	77.5	94.8	91.8	88.8		323	53.8	91.3	71.5	61.9
Maternal employment status
Home fulltime	199	33.2	95.0	93.5	94.0		225	37.5	94.2	88.0	87.1		75	12.5	89.3	77.3	66.7
Employed	401	66.8	93.0	88.8	89.8		375	62.5	89.9	82.7	79.5		525	87.5	82.3	65.3	57.5
Residence
Urban	318	53.0	90.3	86.2	87.4		286	47.7	85.3	79.4	76.9		306	51.0	74.8	61.4	52.9
Rural	282	47.0	97.5	95.0	95.4		314	52.3	95.5	89.5	87.3		294	49.0	91.8	71.8	64.6
Immigration status
Resident	198	33.0	96.5	93.4	93.4		196	32.7	96.4	89.3	89.8		255	42.5	89.8	74.1	67.5
Migrant	402	67.0	92.3	88.8	90.0		404	67.3	89.1	82.4	78.7		345	57.5	78.3	60.9	52.2

Notes (1) Children aged 1 year should receive 1 dose of BCG, 3 doses of HBV, 3 doses of DTP, 3 doses of PV, 1 dose of MCV, 1 dose of JEV and 2 doses of MenV-a; Children aged 2 years should receive 1 dose of BCG, 3 doses of HBV, 4 doses of DTP, 3 doses of PV, 2 dose of MCV, 2 dose of JEV, 2 doses of MenV-a and 1 dose of HAV; Children aged 6 years should receive 1 dose of BCG, 3 doses of HBV, 4 doses of DTP, 4 doses of PV, 2 dose of MCV, 2 dose of JEV, 2 doses of MenV-a, 1 dose of HAV, 2 doses of MenV-ac and 1 dose of DT. (2) Medical records meant the immunization status was determined based on ZJIIS; Card meant the immunization status was determined based on the vaccination booklet; Recall meant the immunization status was determined based on the response to survey question “In your opinion, has this child received all recommended shots for his/her age?”; (3) Values in bold indicate P < 0.05.

Table 4. Agreement of vaccination status between household sources and medical records

Age group	Household sources	Concordance	Sensitivity	Specificity	Positive predictive value	Negative predictive value	Kappa
1 year old	Card	36.4	32.7	90.4	92.6	11.9	0.13
	Recall	79.6	81.6	39.5	93.9	12.7	0.24
	Card+recall	55.7	54.2	70.9	91.5	20.5	0.16
	Card among holders	46.5	46.8	63.8	95.7	11.8	0.42
2 years old	Card	45.5	33.6	89.2	92.5	22.6	0.09
	Recall	77.6	85.4	42.6	88.3	46.1	0.05
	Card+recall	60.5	57.7	68.4	87.5	30.6	0.12
	Card among holders	59.2	49.3	86.7	92.1	33.9	0.17
6 years old	Card	32.5	16.8	89.2	83.6	22.0	0.02
	Recall	76.5	96.8	14.5	75.5	40.5	0.07
	Card+recall	52.6	55.1	51.2	78.6	22.8	0.04
	Card among holders	35.8	27.5	72.5	80.5	19.5	0.15

Notes (1) Children aged 1 year should receive 1 dose of BCG, 3 doses of HBV, 3 doses of DTP, 3 doses of PV, 1 dose of MCV, 1 dose of JEV and 2 doses of MenV-a; Children aged 2 years should receive 1 dose of BCG, 3 doses of HBV, 4 doses of DTP, 3 doses of PV, 2 dose of MCV, 2 dose of JEV, 2 doses of MenV-a and 1 dose of HAV; Children aged 6 years should receive 1 dose of BCG, 3 doses of HBV, 4 doses of DTP, 4 doses of PV, 2 dose of MCV, 2 dose of JEV, 2 doses of MenV-a, 1 dose of HAV, 2 doses of MenV-ac and 1 dose of DT. (2) medical records from ZJIIS were considered as the gold standard; (3) Card meant the immunization status was determined based on the vaccination booklet; Recall meant the immunization status was determined based on the response to survey question “In your opinion, has this child received all recommended shots for his/her age?”; Card+recall meant the immunization status was determined based on the vaccination booklet or recall for children without a vaccination booklet; Card among holders meant the immunization status was determined based on the vaccination booklet among children with vaccination booklets.