{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:03:50Z","timestamp":1792811030670,"version":"4.5.0"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:00:00Z","timestamp":1697673600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Alliance for Health Policy and Systems Research, World Health Organisation"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nUganda, like many other developing countries, faces the challenges of unreliable estimates for its immunization target population. Strengthening immunization data quality and its use for improving immunization program performance are critical steps toward improving coverage and equity of immunization programs. The goal of this study was to determine the effectiveness of using community health workers (CHWs) to obtain quality and reliable data that can be used for planning and evidence-based response actions.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nAn implementation study in which 5 health facilities were stratified and randomized in two groups to (i) receive a package of interventions including monthly health unit immunization data audit meetings, and defaulter tracking and linkage and (ii) to serve as a control group was conducted between July and September 2020. Immunization coverage of infants in both arms was determined by a review of records three months before and after the study interventions. In addition, key informant and in-depth interviews were conducted among facility-based health workers and CHWs respectively, at the endline to explore the feasibility of the interventions.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nOverall, a total of 2,048 children under one year eligible for immunization were registered in Bukabooli sub-county by CHWs as compared to the estimated district population of 1,889 children representing a moderate variance of 8.4%. The study further showed that it is feasible to use CHWs to track and link defaulters to points of immunization services as more than two-thirds (68%) of the children defaulting returned for catch-up immunization services. At the endline, immunization coverage for the Oral Polio Vaccine third dose; Rotavirus vaccine second dose; Pneumococcal Conjugate Vaccine third dose increased in both the intervention and control health facilities. There was a decrease in coverage for the Measles-Rubella vaccine decreased in the intervention health facilities and a decrease in Bacillus Calmette\u2013Gu\u00e9rin vaccine coverage in the control facilities. Difference in difference analysis demonstrated that the intervention caused a significant 35.1% increase in coverage of Bacillus Calmette\u2013Gu\u00e9rin vaccine (CI 9.00\u201361.19; p<0.05)). The intervention facilities had a 17.9% increase in DTP3 coverage compared to the control facilities (CI: 1.69\u201334.1) while for MR, OPV3, and Rota2 antigens, there was no significant effect of the intervention.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nThe use of CHWs to obtain reliable population estimates is feasible and can be useful in areas with consistently poor immunization coverage to estimate the target population. Facilitating monthly health unit immunization data audit meetings to identify, track, and link defaulters to immunization services is effective in increasing immunization coverage and equity.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0292053","type":"journal-article","created":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T17:35:53Z","timestamp":1697736953000},"page":"e0292053","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":21,"title":["Engagement of community health workers to improve immunization coverage through addressing inequities and enhancing data quality and use is a feasible and effective approach: An implementation study in Uganda"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6501-3334","authenticated-orcid":true,"given":"Pamela","family":"Bakkabulindi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Immaculate","family":"Ampeire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lillian","family":"Ayebale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Mubiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Feletto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Muhumuza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,19]]},"reference":[{"key":"pone.0292053.ref001","first-page":"1","volume-title":"Immunization agenda 2030: a global strategy to leave no one behind","author":"World Health Organization","year":"2020"},{"issue":"17","key":"pone.0292053.ref002","doi-asserted-by":"crossref","first-page":"2434","DOI":"10.1016\/j.vaccine.2021.03.044","article-title":"Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries","volume":"39","author":"I Dadari","year":"2021","journal-title":"Vaccine"},{"issue":"47","key":"pone.0292053.ref003","doi-asserted-by":"crossref","first-page":"8477","DOI":"10.1016\/j.vaccine.2011.08.048","article-title":"Researching routine immunization\u2013do we know what we don\u2019t know?","volume":"29","author":"CJ Clements","year":"2011","journal-title":"Vaccine"},{"key":"pone.0292053.ref004","author":"M Jain","year":"2018","journal-title":"registration for a systematic review: Use of community participation to improve child immunisation in low-and middle-income countries: a systematic review"},{"issue":"2","key":"pone.0292053.ref005","doi-asserted-by":"crossref","first-page":"1800204","DOI":"10.2807\/1560-7917.ES.2019.24.2.1800204","article-title":"Towards equity in immunisation","volume":"24","author":"T Boyce","year":"2019","journal-title":"Eurosurveillance"},{"issue":"1","key":"pone.0292053.ref006","first-page":"1012","article-title":"Root Causes of Poor Immunisation Data Quality and Proven Interventions: A Systematic Literature Review","volume":"2","author":"O Wetherill","year":"2017","journal-title":"Ann Infect Dis Epidemiol"},{"issue":"1","key":"pone.0292053.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-021-06633-8","article-title":"A realist systematic review of evidence from low-and middle-income countries of interventions to improve immunization data use","volume":"21","author":"AL Osterman","year":"2021","journal-title":"BMC health services research"},{"issue":"2","key":"pone.0292053.ref008","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1080\/00220388.2014.968138","article-title":"The political economy of bad data: Evidence from African survey and administrative statistics","volume":"51","author":"J Sandefur","year":"2015","journal-title":"The Journal of Development Studies"},{"issue":"1","key":"pone.0292053.ref009","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12961-018-0312-2","article-title":"How can the use of data within the immunisation programme be increased in order to improve data quality and ensure greater accountability in the health system? 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