Immunization data management practices and data quality in Ethiopia.

BACKGROUND: High-quality immunization data is critical for making evidence-based decisions, ensuring effective program implementation, and achieving intended outcomes. Conversely, low-quality data hinders program monitoring and evaluation activities. Despite efforts to improve data quality in the health sector, the status of immunization data quality in Ethiopia is not well-known. This national study examined immunization data quality status and its challenges in Ethiopia. METHODS: A mixed-method study was conducted on health facilities and all levels of administrative units, including the Ministry of Health, 12 regional health bureaus, 51 zonal health departments, 233 district health offices, 395 health facilities, and 267 health posts from April 15 to July 30, 2023. In-depth interviews were conducted with 74 purposefully selected key informants across these levels. The quality of immunization data was assessed based on accuracy, timeliness, and completeness. Open Data Kit (ODK) was used to collect quantitative data, and STATA statistical software was used for analysis. Qualitative data were analyzed using the thematic analysis approach with ATLAS.ti. RESULTS: Out of 4062 immunization data elements expected to be reported in the months under review, only 2413 (59.4%) were available. One-third of health facilities had acceptable reporting accuracy, while 27% had inaccurate reports. 41% of health facilities had inadequate documentation for verifications. Complete documentation and accuracy of reporting were better in hospitals than in health centers and health posts, but lower in pastoralist settings and some regions. Report timeliness ranged from 94% in the Oromia region to 37% in Gambella. The main reasons for low immunization data quality were inadequate skilled data management personnel, lack of standard data management and data quality assessment tools, and irregular data quality assessments at health facilities. CONCLUSIONS: The study identified a significant immunization data quality problem in Ethiopia's health institutions, with data accuracy, timeliness and completeness rates falling far below the standard. To improve immunization data quality and informed decision-making, it is crucial to strengthen data quality improvement strategies starting from the point of data collection.