Recording Errors in Homemade Home-Based Records to Record Vaccination Services: Results from the 2016 Kenya Missed Opportunities for Vaccination Assessment

"Unfortunately, policies on the best course of action in the event of a HBR stock-out are rare, but such guidance is critical for health workers."

The home-based record (HBR) serves both as a place for recording dates of vaccination (and other primary care services) by health workers and as a communication tool that extends the health worker / caregiver relationship beyond their direct contact during a health encounter. Homemade HBRs, which may be created using notebooks or loose-leaf paper, are often used to replace official HBRs during stock-outs. (See Related Summaries, below, for more on HBR stock-outs.) By their nature, homemade HBRs are often ad hoc in form and lack structure. Concerned about immunisation service delivery recording errors, these researchers reviewed photographic images taken of HBRs presented by caregivers attending primary care clinics with children aged under 24 months in selected Kenyan communities located in Bungoma, Kajiado, Kiambu, Kitui, Migori, Mombassa, Nakuru, Taita Taveta, Trans-Nzoia, and West Pokot counties.

The study was a secondary analysis of information collected during the 2016 Kenya Missed Opportunities for Vaccination (MOV) Assessment conducted by the Kenya Expanded Programme on Immunization alongside its partners. Of 512 unique HBR images for review, 9% were of homemade records, which most often were a simple, ruled notebook on which the services delivered and dates of service were recorded by health workers. The image review identified several examples of errors related to the absence of standardised vaccine naming in record and the absence of structured areas for recording each recommended vaccine dose.

In short, the study found that homemade HBRs identified in Kenya, likely used due to HBR stock-outs reported in 2014 and 2015, compromised data integrity and may have resulted in health workers acting on inaccurate information. The researchers say: "Deviations from well organized, structured HBRs can create inefficiencies, perhaps unnecessary re-vaccination, missed opportunities for vaccination...or missed opportunities to discuss the benefits and importance of immunization and extend the health worker / caregiver relationship. For example, when a health worker encounters multiple HBRs where layout and recording fields differ across records, recording errors may be more likely to occur and coordination of care may be compromised if she is unable to identify necessary information. The absence of structured areas and language for vaccine names and doses required may impair a caregiver's knowledge of what vaccines their child has or has not received....Legible handwriting may impact the overall effectiveness of any HBR....Also, homemade HBRs on notebook or loose-leaf paper are often more susceptible to damage than officially issued HBRs which tend to be printed on heavier card stock paper or (less frequently) water-proof, tear-resistant paper products that improve the durability of the document."

In conclusion: "Whenever possible, use of photocopies of the official HBR is preferred to homemade HBRs."