Challenges and solutions of immunization safety surveillance in Assosa Zone, Ethiopia: Mixed methods

Abstract   Background: Adverse Events Following Immunizations (AEFIs) reporting has increased over the past sixteen years worldwide, and requires strengthening in majority of Low Middle-Income Countries (LMICs) including Ethiopia. Additional efforts are needed to ensure and improve data quality, AEFI reporting and surveillance of immunisation safety in every country. Immunisation Safety Surveillance (ISS) is vital to identify AEFIs. Objective: to assess challenges and solutions of immunisation safety surveillance in Assosa zone, Ethiopia, Methods: Health facility based parallel convergent quantitative and qualitative data collected from 300 and nine respondents respectively. Result: Only 14 (4.7%) respondents had ever reported AEFI case to a higher level and 69 (23%) ever treated it. All the zone and woreda level experts mentioned the performance related immunization safety surveillance is very minimal. The major challenges stated by respondents were; in-availability or denial of AEFI case presence (60%), no clarity on how to do immunisation safety surveillance (22%), no standard reporting forms (20.7%), thinking AEFI is mild problem which could resolve by itself or care takers could manage it at home (14.6%), there is no road and electricity access (9.3%), and health care providers has the ability to treat the case at health facility level (8.3%). Similarly, the in-depth interview participants mentioned that the performance related to immunisation safety surveillance was minimal due to poor infrastructure, lack of adequate information about AEFI, absence of proper AEFI reporting system; no training for AEFI, community members are not informed to report AEFI and experience of home treatment for mild cases. A total of 40 possible solutions to improve AEFI surveillance were proposed from one time to 185 times. The first five top solutions were; Providing   training for health care workers (185), Sharing information or Create Awareness (129), Provide training for Health Development Armies or involve HDAs (100), Strengthening supervision (76), and Avail supplies (drugs, manpower, kits) for AEFI reporting (75) Conclusion:  the major obstacles for immunization safety surveillance were; lack of clarity on how to report, lack of attention from higher bodies, lack of ownership for the work and unavailability of reporting formats. The responsible bodies need to solve the existing challenges in line with the proposed solutions. &nbsp