This page features selected resources that were created by the UI-FHS team.

Note: UI-FHS resources are available for online viewing and download. Use the free Adobe Acrobat Reader program to view the PDF files on your computer.

Cover of Travassos et al 2016 journal articleImmunization Coverage Surveys and Linked Biomarker Serosurveys in Three Regions in Ethiopia

PLOS ONE, 11(3), March 2016

Mark A. Travassos, Berhane Beyene, Zenaw Adam, James D. Campbell, Nigisti Mulholland, Seydou S. Diarra, Tassew Kassa, Lisa Oot,  Jenny Sequeira, Mardi Reymann, William C. Blackwelder, Yukun Wu, Inna Ruslanova, Jaya Goswami, Samba O. Sow, Marcela F. Pasetti, Robert Steinglass, Amha Kebede, Myron M. Levine

Abstract: Demographic and health surveys, immunization coverage surveys and administrative data often divergently estimate vaccination coverage, which hinders pinpointing districts where immunization services require strengthening. We assayed vaccination coverage in three regions in Ethiopia by coverage surveys and linked serosurveys. Households with children aged 12–23 (N=300) or 6–8 months (N=100) in each of three districts (woredas) were randomly selected for immunization coverage surveys (inspection of vaccination cards and immunization clinic records and maternal recall) and linked serosurveys. IgG-ELISA serologic biomarkers included tetanus antitoxin ≥ 0.15 IU/ml in toddlers (receipt of tetanus toxoid) and Haemophilus influenzae type b (Hib) anti-capsular titers ≥ 1.0 mcg/ml in infants (timely receipt of Hib vaccine). Coverage surveys enrolled 1,181 children across three woredas; 1,023 (87%) also enrolled in linked serosurveys. Administrative data over-estimated coverage compared to surveys, while maternal recall was unreliable. Serologic biomarkers documented a hierarchy among the districts. Biomarker measurement in infants provided insight on timeliness of vaccination not deducible from toddler results. Neither administrative projections, vaccination card or EPI register inspections, nor parental recall, substitute for objective serological biomarker measurement. Including infants in serosurveys informs on vaccination timeliness.

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Cover of Travassos et al 2015 journal articleStrategies for Coordination of a Serosurvey in Parallel with an Immunization Coverage Survey

American Journal of Tropical Medicine and Hygiene, 2015 93:416-424, June 2015

Mark A. Travassos, Berhane Beyene, Zenaw Adam, James D. Campbell, Nigisti Mulholland, Seydou S. Diarra, Tassew Kassa, Lisa Oot, Jenny Sequeira, Mardi Reymann, William C. Blackwelder, Marcela F. Pasetti, Samba O. Sow, Robert Steinglass, Amha Kebede and Myron M. Levine

Abstract: A community-based immunization coverage survey is the standard way to estimate effective vaccination delivery to a target population in a region. Accompanying serosurveys can provide objective measures of protective immunity against vaccine-preventable diseases but pose considerable challenges with respect to specimen collection and preservation and community compliance. We performed serosurveys coupled to immunization coverage surveys in three administrative districts (woredas) in rural Ethiopia. Critical to the success of this effort were serosurvey equipment and supplies, team composition, and tight coordination with the coverage survey. Application of these techniques to future studies may foster more widespread use of serosurveys to derive more objective assessments of vaccine-derived seroprotection and monitor and compare the performance of immunization services in different districts of a country.

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Cover of UI-FHS How to GuideRED-QI How-to Guide

The RED-QI How-to Guide for Immunization Program Managers conveys the essential knowledge and tools needed to apply the Reaching Every District using Quality Improvement (RED-QI) approach. It is a practical resource intended for program managers at woreda health offices and primary health care units.

Download (PDF, 1.38 MB)



Cover of Costing Study Policy BriefCosting Study Policy Brief

This policy brief summarizes the key findings from a costing study that aimed to better understand the resources that will be required by the Expanded Program on Immunization to reach all populations with equity and quality.


Download (PDF, 529 KB)



Cover of UIFHS Desk ReviewUI-FHS Desk Review

This desk review, conducted in 2011, explored the health landscape in Ethiopia and aided in preparation of the strategy for implementation of the project. It summarizes the Expanded Program on Immunization (EPI) and maternal, neonatal, and child health (MNCH) strategies implemented over the past decade in Ethiopia, and it examines EPI performance and progress.

Download (Word, 3.19 MB)



Cover of UIFHS Rapid Assessment ReportRapid Assessment Report

The rapid assessment report highlights key programmatic and community/cultural issues and existing assets and promising practices in each of UI-FHS’s three learning woredas. This information was used to design woreda-specific quality improvement approaches to strengthen and sustain high levels of routine immunization performance.

Download the brief  (PDF, 1.36 MB)

Download the full report (PDF, 2.64 MB)



Cover of Woreda RED categorization databaseRED Categorization Database

This excel database allows woreda health office staff to analyze their coverage and drop-out rates to place their facility into one of four access- and utilization-related categories. Staff use the data to target routine immunization efforts and support.

Download (Excel, 0.76 MB)




Cover of PBSS ChecklistProcess Based Supportive Supervision Checklists

These are checklists for immunization supportive supervision at woreda, health center, and health post levels. Woreda health offices and primary health care units can utilize these checklist as an opportunity to provide on-job training and mentoring to health facility staff.

Download, woreda level (Word, 26 KB)

Download, health center level (Word, 28 KB)

Download, health post level (Word, 28 KB)



Cover of PDSA templatePDSA Template

The plan-do-study-act cycle is a useful quality improvement tool that helps health workers identify problems, brainstorm and test solutions, and analyze the results. This template is designed to help health extension workers solve routine immunization problems.

Download (Word, 15 KB)