Part 1. Data analysis

Task 1. Flag all the suspicious values. (Outliers, repetitions, etc.) (spend max 15 minutes)

Suspicious values

Task 2. Review the national and subnational coverage for MR1. Your data manager produces the following tables. What can you conclude from the administrative data?

• From the MR1 analysis is, the data shows that 1baby in every 10 babies is not protected by the vaccine (not immunisesed and that the on average, the country has reached 90% coverage of MR1 vaccination

Task 3. Review coverage evaluation survey data. You remember that in 2013, there was a coverage evaluation survey. You pull up the data for that. Does this change your view about coverage at national level? For any of the regions?

• From the data, it is seen that the actual coverage was above the estimated target in 2013. This means that there was good performance in the year compared to what was estimated by the survey. However, only one region Grantan performed below the estimated coverage target by 5.1%

Task 4. Review the chart with the age distribution of measles cases. Does that tell you anything additional about coverage?

• Yes, the data shows that measles affected more of children aged 1-4 years, 20-29 years and 30+ years compared to other age groups

Part 2. Brief the Minister

Task 5. Brief the Minister (spend max 1/2 hour on this section). Summarize the situation in three bullet points.

• Despite the last major measles outbreak in Vacciland occurring in 2011 where after which a national high quality SIA was implemented, covering all children under 5, in 2018 however, an outbreak has occurred where 625 cases have been confirmed so far.
• The possible causes of outbreak include;
• It is has been found out that more than half population within Grandtown, the capital, 80% of cases are unvaccinated or have unknown vaccination status.
• Much as Immunisation is free of charge for everyone, it is not mandatory. The private sector is growing in Vacciland, with an estimated 10-15% of the population accessing services regularly through private clinics that may not be vaccinating all the eligible children. Also, most data collection and reporting in Vacciland is paper-based and a recent EPI and VPD surveillance review highlighted some issues related to outdated registries, weak capacities among lower level staff and denominator challenges. Also, based on a 2017 KAP survey, we are aware that vaccine hesitancy appears to be growing in Vacciland.

Task 6. Brief the Minister. Propose three actions to respond to the outbreak.

• First of all, there is need to first clean the data to estimate the true situation in terms of actual cases. If the problem was data quality then an immediate solution will be found to stop the alarm.
• Secondly, much as the stock status has been reported to be stable there is need to evaluate this especially in private clinics to ensure that probably this was not caused by shortage of measles vaccines and if so then vaccines will be supplied to help stop the situation.
• Thirdly if the situation is true that the outbreak is real, then there is need for emergency where all th children should be screened and those found with measles be treated, those not vaccinated but eligible be vaccinated to prevent future occurrence

Task 7. Formulate recommendations. List your top 3-5 recommendations specific to data strengthening you would prioritize as the EPI and surveillance teams in Vacciland

• Build the capacity of health facility teams to be able to rightly document correct information and finally report it
• Regularly conduct data cleaning/and or review meetings to assess the data before it is submitted into the database and even after it has been entered to ensure it is reliable
• Regularly conduct data quality assessments to ensure that accurate data is reported all the time
• Engage the district teams to use their data routinely so as to detect such epidemics as soon as possible
• Work with all the data management stakeholders to put in place quality assurance measures right from the health facility to the national level