Improving Timeliness and Completeness of Adverse Events Following Immunization (AEFI) Surveillance through Dedicated Training and E-mail Reporting in Urban Bangladesh: A Quasi-Experimental Study

Background: Strong Adverse Events Following Immunization (AEFI) surveillance is critical for sustaining a high vaccine coverage. Ensuring the rapid detection, investigation, and communication of adverse events, reinforces public trust in vaccine safety and prevents avoidable declines in immunization uptake. In Bangladesh, AEFI from seven cities have been reported weekly on paper forms to the national vaccination program. An AEFI surveillance evaluation in 2014 concluded that 75% of reports were submitted late and the reporting rate was 5.4/100,000 vaccinations, much lower than other countries in the region. Our study objectives were to find out whether the dedicated AEFI training and electronic reporting improved the timeliness of reports and decreased underreporting. Methods: We conducted a quasi-experimental study among seven reporting cities from January to August 2015; four cities received the intervention, and three did not. In the intervention cities, we trained vaccinators in AEFI management and reporting and also implemented electronic reporting. We compared the percentage of on-time reports, the percentage of complete reports, and the reported AEFI rate per 100,000 vaccinations before and after interventions, using the z-test for two proportions. We compared the reporting delay for using the median test. Results: In the intervention cities, the percentage of timely reports increased from 11% to 46% (p