Number of vulnerable children who are fully immunized

How to use this indicator

Immunization programs are one of the most cost-effective ways to reduce child mortality. They aim to reduce vaccine-preventable diseases among children. Immunization coverage is more likely to occur in children during their first year of life when the child’s biological parents are alive and living with the child, making children orphaned by HIV particularly vulnerable to preventable diseases. This indicator tracks vaccination coverage among children vulnerable to or affected by HIV and tracks vulnerable children program efforts to link children to immunization services. Programs can ensure that immunization services are accessible to those at heightened vulnerability to HIV, and this information can inform questions of access at the community level. Vaccination services for children under one year old are an essential component of maternal and child healthcare provision and should be incorporated into child-focused activities by programs for vulnerable children. Community presence is necessary to ensure children have access to routine vaccinations, because certain vaccinations can be administered by community workers themselves, and vaccination health events are mechanisms by which coverage can be achieved.

Numerator

Number of vulnerable children ages 12–23 months supported during the reporting period who received all vaccinations before their first birthday

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

Depending on country context, vulnerable children may be defined as follows: a child below the age of 18, who because of circumstances, lacks access to the basic needs and resources in the areas of safety or protection, stability, education, and health that are necessary for optimal growth and development. This category can also include the following subpopulations of children, depending on the population a project targets: children who have lost one or both parents; children with chronically ill parent(s); children of members of key populations; child victims of abuse and exploitation; abandoned children; children living on the street; children born out of wedlock; unaccompanied and separated children; internally displaced and refugee children; children of migrant workers; children of asylum-seekers; children in labor camps; child victims of sexual exploitation; children in armed forces; children in residential care facilities; children in alternative care; or children who engage in illegal behavior, are stigmatized, or under the control of others.

A child can be defined as fully immunized if they have received a Bacillus Calmette-Guerin (BCG) vaccination; three doses of the Diphtheria, Pertussis, and Tetanus (DPT) vaccine; three doses of the polio vaccine; and a measles vaccine, and should be fully immunized within the first year of life. Full immunization during the first year should be based on the national schedule.

Community workers can track this information by asking the caregiver to present the child’s health card, including their immunization record. If the health card is filled out incorrectly, the community worker should ask the caregiver questions about each vaccination, because it has been shown that a mother’s recall of her child’s immunization history can be quite accurate. However, mothers may not recall the names of the vaccines, or the number of doses received, nor the exact dates of those vaccinations. This could lead to a biasing of results, so it is best for community workers to work with vulnerable children households to ensure that their vaccination information is adequately filled out on their health card.

The suggested question for this indicator is as follows:

Do you have a card where [NAME’s] vaccinations are written down? 

If YES —  May I see it please?

Record immunizations from vaccination card and probe about any missing records.

• Has [NAME] received a vaccine against tuberculosis, that is, an injection in the arm or shoulder, that usually causes a scar? (BCG)

• Has [NAME] received the polio vaccine, that is, drops in the mouth?

• Has the child received OPV0, that is the first polio vaccine normally received in the first two weeks after birth?

• Has the child received OPV1, that is the second polio vaccine?

• Has the child received OPV2, that is the third polio vaccine?

• Has the child received OPV3, that is the fourth polio vaccine?

• Has the child received the DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?

• How many times was the DPT vaccine received?

• Has the child received a measles injection, that is, a shot in the arm at the age of 9 months or older – to prevent him or her from getting measles?

Data source

This information is often tracked in forms for child care monitoring, monthly registration, evaluation of the child’s index, and community family folders.

Disaggregation

  • Age (<1 year, 1–4 years, 5–9 years, 10–14 years, and 15–17 years for children; 18–24 years, 25+ years)
  • Sex

Data quality considerations

Mother recall of the child’s vaccination history can be a source of bias and inaccuracy in regular monitoring of immunization coverage by community workers. No child should be counted if the child did not receive all necessary vaccinations as dictated by national protocol before his or her first birthday. The number reported for this indicator should equal the sum of individuals in each disaggregation category. Only one type of age disaggregation should be used throughout, and overlap should be avoided.

Reporting frequency

Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a quarterly basis.

Data element

Vulnerable children fully immunized

Category

Vulnerable Children

References and resources

Chapman, J. (2014). Core OVC program impact indicators. Retrieved from https://www.measureevaluation.org/resources/publications/ms-13-61

Vinod, M., & Bignami-Van Assche, S. (2008). Orphans and vulnerable children in high HIV-prevalence countries in sub-Saharan Africa (English). Calverton, Maryland, USA: Macro International Retrieved from https://www.dhsprogram.com/publications/publication-AS15-Analytical-Studies.cfm

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