The challenge of identifying eligible girls for HPV vaccination: HPV mapping data verification in Malawi

Abstract

Purpose: Malawi introduced the human papillomavirus (HPV) vaccine nationwide in January 2019, with a target population of nine-year-old girls. Early in rollout, some health facilities reported stockouts, raising questions about the accuracy of the age eligibility of girls registered during the initial population mapping exercise. Mapping results showed that the estimated number of nine-year-old girls registered for vaccination was significantly higher than National Statistical Office (NSO) estimates, resulting in questions about enumeration of the target population. Consequently, the Ministry of Health of Malawi's Expanded Programme on Immunization (MOH-EPI) and immunization partners conducted a post-introduction data verification exercise to validate the eligibility of girls registered during mapping.

Results: Data were collected by immunization partners and representatives from national, zonal, and district levels. Dates of birth (DOB) were validated in HPV vaccine mapping registers and compared with information obtained from individual registered girls during school visits and their parents during home visits. HPV vaccine mapping registers were reviewed, showing that 76 percent of girls (n = 957) had DOBs within the vaccination eligibility range. A subset of the 957 girls (414) were interviewed; of them 74 percent (307) provided DOBs within the eligible period. Parents of the remaining eligible girls (543) were interviewed; 55 percent (297) of them, provided DOBs that were within the eligible period, indicating that, when using parents as an information source, 45 percent of the girls were outside the target age group.

Conclusion: The eligibility verification exercise reviewed the accuracy of the mapping exercise and provided lessons for future target setting. Findings validate using NSO population estimates for target setting, incorporating the identification and registration of girls for HPV vaccination into RI microplanning headcounts, and verifying with parents the age and eligibility of girls registered before HPV vaccination is conducted.

Keywords: Eligibility; Human papillomavirus; Immunization; Mapping; Target population; Verification.