MICS4 Survey Design Workshop Multiple Indicator Cluster Surveys Survey Design Workshop Questionnaire for Children Under Five: Immunization

MICS4 Survey Design Workshop International goals and targets Millennium Development Goals MDG 4: Reduce Child Mortality by two thirds among children under five Indicator Proportion of 1 year old children immunized against measles

MICS4 Survey Design Workshop International goals and targets World Fit for Children By 2005, reduction in infant and under-five mortality rate by at least 1/3, in pursuit of the goal of reducing it by 2/3 by 2015 Ensure full immunization of children under one year of age at 90% nationally, with at least 80% coverage in every district or equivalent administrative unit - Extend the benefits of new and improved vaccines and other preventive health interventions to children in all countries (Hepatitis B, Hib, Yellow Fever, etc)

International goals and targets World Fit for Children Achieve sustainable elimination of vitamin A deficiency by 2010 Indicator Proportion (%) under fives who received at least one high dose vitamin A supplement within the last 6 months. MICS4 Survey Design Workshop

Global proportion of one year old children vaccinated against measles; Source: WHO/UNICEF National Coverage Estimates

MICS4 Survey Design Workshop MICS Indicators In MICS4, immunization indicators are defined as: -The percentage of children aged months who received each specific vaccine: BCG, Polio, DPT, Measles, Hepatitis B and Yellow Fever before their first birthday (# 3.1 through 3.6) -The module also collects information on Vitamin A supplementation for children under age 5

MICS4 Survey Design Workshop Content Data on immunization are collected from: Vaccination cards Mothers report (when card is not available)

MICS4 Survey Design Workshop Preparation (1) Obtain country specific child immunization card(s)

MICS4 Survey Design Workshop Preparation (2) Obtain the most current national immunization schedule for children Age GroupVaccine Usual location of delivery At birth or by 2 monthsBCG and OPV (zero dose) Left shoulder By mouth 2 months or 8 weeks1 st dose of Oral polio Vaccine (OPV) 1 st dose of pentavalent (Hepatitis B, DPT + Hib) By mouth Began Pentavalent in 1999 Upper thigh 4 months or 16 weeks2 nd dose of OPV 2 nd dose of pentavalent By mouth Upper thigh 6 months or 24 weeks3 rd dose of OPV 3 rd dose of Pentavalent By mouth Upper thigh 12 months or 1 yearMeasles Mumps Rubella (MMR) Yellow Fever (YF) Upper right arm 18 months or 1 year 6 months Booster OPV and DPT vaccine By mouth Upper thigh 45 months or 3 years 9 months Booster OPV, DPT, MMR By mouth Upper Thigh Upper right arm 15 years plusDT vaccines for pregnant women Upper right arm

MICS4 Survey Design Workshop Preparation (3) Find out about the most recent immunization campaigns Polio National Immunization Days Measles campaigns Other vaccine campaigns (e.g., Yellow Fever) Others (to distinguish between antigens and probe for answers)

Preparation (4) Obtain samples of Vitamin A capsules to show respondent WHO/UNICEF recommendation: All children between the ages of 6 to 59 months living in affected areas should receive one high-dose vitamin A supplement every four to six months Ages 6-11 mos – 100,000 IU Ages mos – 200,000 IU MICS4 Survey Design Workshop

Customization of the questionnaire

MICS4 Survey Design Workshop Customization of the questionnaire Change order for dates according to common practices

MICS4 Survey Design Workshop EXAMPLE: Month/Day/Year Customization of the questionnaire DayMonth

MICS4 Survey Design Workshop Remove any that do not appear on vaccination cards and are not in use in your country Customization of the questionnaire

MICS4 Survey Design Workshop Customization of the questionnaire Eligibility for VAS Program Countries with an under five mortality rate higher than 70 per 1000, or Where vitamin A deficiency is a public health problem

MICS4 Survey Design Workshop Correct combinations if necessary In countries where only MMR is used instead of measles vaccine alone, leave only MMR in the list Customization of the questionnaire MMR DPTHepHib1 DPTHepHib2 DPTHepHib3 DPTH1 DPTH2 DPTH3

MICS4 Survey Design Workshop If both vaccines are in use, retain both items (insert new row in order to separate them) Customization of the questionnaire MMR M EASLES Measles Y ELLOW FEVER YF V ITAMIN A (M OST RECENT ) VitA

MICS4 Survey Design Workshop Changes need to be reflected in questions IM7 through IM17 administered only to mothers/primary caretakers of children for whom vaccination cards were not shown Customization of the questionnaire

MICS4 Survey Design Workshop Customization of the questionnaire List most recent immunization campaigns

MICS4 Survey Design Workshop Methodological issues Ensure a vaccine is given nationwide before including it on the questionnaire Ensure a vaccine is given during last couple of years. Dont include vaccines that started to be administered just recently In some countries, vaccination cards are kept at health centres and are not given to mothers –In these countries, if necessary, health centres should be visited to record information from the childs health card –However, the module should be used in its entirety during the interview