AEFI data management training course

1. Using the basic tools of AEFI surveillance to extract and process data AEFI data management training course

2. Aspects discussed

3. The AEFI reporting form • What is it? • A guidance document to collect the bare minimum information of an AEFI case about 4 aspects, i. Patient, ii. Event, iii. Vaccine and iv. Reporter • An ideal reporting form should be in a simple language (local language if necessary) and have less technical terms and more locally accepted terminology for events • Not more that a single page • Include the 25 core variables (as far as possible) recommended by the WHO

4. The AEFI reporting form Important: • All AEFI (minor and severe) data should be case based • a reporting form should have to be completed and/ or the case should be linelisted.

5. The AEFI reporting form • What is its purpose? • This form is the “First Information Report”  informing the occurrence of the event to the health care system i.e. to the first and higher levels of decision making • The idea is to • RAPIDLY/ INSTANTLY inform the different levels of the occurrence of the event as well as • To collate data from all cases reported in a given geographic area to determine if there is a pattern in the occurrence of the event

6. The AEFI reporting form • Who should complete it? • The first person in the health care system (or outside the health care system – as per country policy) who becomes aware of the AEFI • It can be a peripheral health care worker, nurses, pharmacists, drug inspectors, trained or partially trained health care providers, doctors in health clinics, students or teachers in Medical Colleges, Nursing colleges, all categories of hospitals, health centres, including administrative staff or management staff (or even lay persons if the country’s policy permits)

7. The AEFI reporting form • What should be the quality? • The person completing the form should incorporate information that is as accurate as possible • (S)He, should be aware of the following • Information on the type of vaccine, diluents used, the batch numbers, expiry date MUST be accurate • Details pertaining to the identifier, address of the patient as well as the contact details as well the reporters’ own details SHOULD be correct • Some not so accurate details are permissible, particularly related to describing the event; for example the clinical features entered in the reporting form can be corrected later if necessary based on additional inputs

8. The AEFI reporting form • What should be the routing? • The reporting form itself may be transmitted to the different levels of hierarchy or the details of the reporting form may be entered into a linelist for transmission of the data • Depending on the country, a paper reporting form or an electronic reporting form (or both) can be used • The reporter should be clear about whom to report to based on the prevailing policy • Reports may be sent to the immediate supervisor or to multiple levels at the same time • Ideally a copy of the reporting form(s) should be retained by the reporter

9. The AEFI reporting form • What should be the timing? • Reports of deaths should be first informed to the next level (over telephone) even before the reporting form is completed • For serious AEFI, the reporting form should be completed and transmitted to the next level(s) within 24 hours of being informed about the occurrence of the event • For non-serious cases, the same may be transmitted as per the existing policy of the country • The form itself or • Collated as a linelist

10. The AEFI reporting form • What decisions should be made? • All deaths and serious AEFI should have a full fledged investigation with a team/ responsible focal person visiting the locality and making detailed enquires so that the cause can be ascertained • For other AEFI depending on the local policy, a detailed investigation may be initiated for selected non-serious AEFI (eg minor AEFI that are clustered, parental demand, events that have raised community concerns etc)

11. The AEFI linelisting form • What is it? • This is a spreadsheet that is derived from data included in the AEFI reporting form • The columns include the variables of interest • Each row is dedicated to a single AEFI case • Linelists summarize the key facts of all AEFI cases in a given area into a single spreadsheet document for processing

12. The AEFI linelisting form • How to use it? • At the district and subdistrict levels where the number of AEFI cases (both minor and severe) are likely to be 15 to 20 cases annually, a simple spreadsheet on paper will suffice to provide all information at a glance • When dealing with larger numbers a simple excel sheet with filters on a computer is helpful • For interpreting very large data, the spreadsheet needs data processing

13. The AEFI linelisting form • What is the information that can be extracted? • Basically 2 types • Descriptive epidemiology: That helps to obtain and display information on the AEFIs and help to identify patterns in their occurrence • Surveillance performance: That helps the reviewer to determine if the quality of surveillance is within accepted parameters

14. The AEFI linelisting form • Descriptive epidemiology: • Provides information related to the occurrence of the AEFI in relation to the • Time - When is the event(s) occurring? • Place - Where is the event occurring ? • Person – Who are affected (male/ female; infants/ older persons), which vaccine is involved, what is the common events that are manifested, what is the outcome • The information is displayed through Reporting forms, Linelists, Graphs, Tables and Maps

15. National overview Period: 01.01.2015 to 31.12.2016 Descriptive Epidemiology

16. National overview Period: 01.01.2015 to 31.12.2016 Descriptive Epidemiology

17. AEFI line list National overview Period: 01.01.2015 to 31.12.2016 Descriptive Epidemiology DOO

18. National overview Period: 01.01.2015 to 31.12.2016 Descriptive Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Spot Map of Minor and Serious AEFI cases 01.01.2015 to 31.12.2016 . . . . . . . North . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . West . . . . . . . . . . . . . . . . . . . . . . . Capital . . . . . . . . . . . . East . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . South East . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . South West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . South . . . . . . . . . . . . . . Province HQ . . . . . . . . . . . . . . National HQ . State Boundary Minor N = 1929 Serious N = 42 District Boundary

19. The AEFI linelisting form • Surveillance performance: • Provides information related to the quality of surveillance (timeliness and completeness) data that is collected • Timeliness – Are the reports received as per the predetermined stipulated time? E.g. reporting within24 hours of notification, decision on investigation within 24 hours of receiving the investigation form at the supervisory levels, timely “Zero” reports (if a country has such a system in place) • Completeness – Are all the elements that need to be completed included in the report? Or is the information partial? • The information is displayed through, Graphs, Tables and Maps

20. National overview Period: 01.01.2015 to 31.12.2016 Surveillance performance

21. National overview Period: 01.01.2015 to 31.12.2016 Surveillance performance . Timeliness of AEFI reports 01.01.2015 to 31.12.2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Timely reports . . . . . . . . . . . . . . . North . . . . Late reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Delayed reports . . . . . . . . . . . . . . . . . . NE . . . . . . . No reports . . . . . . . . . . . . . . . . . . . . . . West . . . . . . . . . . . . . . . . . . . . . . . Capital . . . . . . . . . . . . East . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . South East . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . South West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . South . . . . . . . . . . . . . . Province HQ . . . . . . . . . . . . . . National HQ State Boundary . Minor N = 1929 District Boundary Serious N = 42

22. Exercise • Using the provided simulated information, • Answer the questions at the end of the scenario • Fill a reporting form and use the information in the reporting form to populate a linelist • Append the data electronically into a database and review and interpret the graphs generated