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International Journal of
Population Studies Accuracy of mother’s reporting on child immunization in Yemen

the population, namely, children’s vaccination coverage, campaign against polio in 1980. Despite all the advances,
in the case of this study. until the mid-1990s, the records of vaccination were not
From the clinical point of view, specificity is a more satisfactory. By the end of the 1980s, with the establishment
important characteristic, since it refers to a correct of the Brazilian Unified Health System, a movement of
diagnosis for which we do not wish to make a mistake (i.e., decentralization was initiated that placed the municipality
to assign a positive diagnosis when it is not true). However, as the direct executor of health actions; among them,
from the point of view of public health, actions are expected vaccination was included. It is worth mentioning that this
to be as sensitive as possible since it is more important to decentralization in the actions is based on the integration
ensure high coverage for disease screening or preventive between three levels — municipal, state and federal. With
action coverage. Thus, in the case of vaccination, the higher a national vaccination registration system, these three
the sensitivity, the better it is for the analysis of vaccine levels together discuss norms, definitions, goals, and
coverage because even though there is an overestimation results, providing the continued modernization of its
of the coverage, it is assumed that the target population is infrastructure and operation. In this scenario, the NIP has
covered by the action. ensured the provision of safe and effective vaccines with
extremely high vaccination coverage for children (Silva Jr,
The moderate sensitivity associated with a high PPV 2013).
indicated that the mother’s report is highly accurate when
identifying the proportion of children who were vaccinated However, for the Brazilian NIP to be such a success,
in the Yemen population. However, the low NPVs indicated in addition to the program being part of the WHO’s
that many children may be misclassified as not vaccinated program, the Brazilian government also had the support
when they have actually been vaccinated. However, it is of children’s rights organizations such as UNICEF and the
important to stress that although mothers’ reports should Pan-American Health Organization (Ministério da Saúde,
not be discarded while estimating vaccination coverage 2014). In addition, the Brazilian Ministry of Health defined
in Yemen (otherwise, coverage would be extremely the NIP as one of its priorities, allocating resources to it in
overestimated if only estimated based on vaccination the annual budget in a separate item and not subjected to
cards), this information should be used with caution. From budget cutting as per the Budget Guidelines Law of 2011
our results, we find that considering mother’s information (Domingues, Teixeira, and Carvalho, 2012). To reinforce
in estimating vaccination coverage in Yemen tends to the importance of maintaining high vaccination coverage
underestimate this indicator (for instance, BCG vaccination among children in Brazil, the Ministry of Health in 2004
coverage according to vaccination card is 77%, if based issued an ordinance making it mandatory to present
on mother’s report, coverage decreases to 64%). If, on the children’s vaccination cards in case of child enrollment
one hand, this finding may cause certain relief as the real in school, parent job hiring and receipt of social benefits.
situation of child vaccination in Yemen may actually be In case parents do not have the card in hand, the
better than the one based on the estimated coverage; on institution gives 2 months for them to present children’s
the other hand, there seems to be a waste of the already updated vaccination card. This shows the importance of a
scarce resources of the country. With this analysis alone, vaccination card, which should be reinforced in Yemen not
we are not able to estimate a correction factor for an official only among families but also among health professionals.
vaccination coverage estimate (based on mother’s report Vaccination cards can enhance health workers’ ability
and/or vaccination card), as this factor would be strongly to make decisions and empower caregivers on their
dependent on the prevalence of vaccination in Yemen, and child healthcare in addition to supporting public health
we have a sample of those with (consistent) information. In monitoring (Brown, 2012).
addition, it would be important to analyze the characteristics According to Yemen’s Planning Strategy for
of the families of children with vaccination card information Immunization Service Delivery in a Catchment Area
compared to those with only mother reports. Further (MPHP, 2005), every year, each health facility is
analysis is required to move forward at this point. responsible for conducting a house-to-house census of the
There are successful national immunization programs population eligible for immunization in their catchment
(NIPs) implemented in developing countries that could area. Among the purposes of the annual house-to-house
help other countries that still present low child vaccination census are (1) verifying the immunization status of
coverage and limited resources – such as Yemen – rethink children aged <1 year and women of childbearing age;
their immunization systems. Brazil has been considered (2) providing immunizations to eligible children and
an international case of success: eradicated smallpox in women and providing them with immunization cards;
1971, instituted the NIP in 1973, and held its first national (3) updating the records of immunizations given; and (4)

Volume 8 Issue 2 (2022) 12 https://doi.org/10.36922/ijps.v8i2.1274