Validity of reported vaccination coverage in 45 countries

Lancet. 2003 Sep 27;362(9389):1022-7. doi: 10.1016/S0140-6736(03)14411-X.


Background: Monitoring and assessment of coverage rates in national health programmes is becoming increasingly important. We aimed to assess the accuracy of officially reported coverage rates of vaccination with diphtheria-tetanus-pertussis vaccine (DTP3), which is commonly used to monitor child health interventions.

Methods: We compared officially reported national data for DTP3 coverage with those from the household Demographic and Health Surveys (DHS) in 45 countries between 1990 and 2000. We adjusted survey data to reflect the number of valid vaccinations (ie, those administered in accordance with the schedule recommended by WHO) using a probit model with sample selection. The model predicted the probability of valid vaccinations for children, including those without documented vaccinations, after correcting for bias from differences between the children with and without documented information on vaccination. We then assessed the extent of survey bias and differences between officially reported data and those from DHS estimates.

Findings: Our results suggest that officially reported DTP3 coverage is higher than that reported from household surveys. This size of the difference increases with the rate of reported coverage of DTP3. Results of time-trend analysis show that changes in reported coverage are not correlated with changes reported from household surveys.

Interpretation: Although reported data might be the most widely available information for assessment of vaccination coverage, their validity for measuring changes in coverage over time is highly questionable. Household surveys can be used to validate data collected by service providers. Strategies for measurement of the coverage of all health interventions should be grounded in careful assessments of the validity of data derived from various sources.

MeSH terms

  • Child
  • Child, Preschool
  • Cohort Studies
  • Data Collection / standards
  • Diphtheria-Tetanus-Pertussis Vaccine / administration & dosage*
  • Guideline Adherence
  • Health Care Surveys / statistics & numerical data
  • Humans
  • Immunization Programs / statistics & numerical data*
  • Immunization Schedule
  • Infant
  • Mass Vaccination / statistics & numerical data*
  • Mass Vaccination / trends
  • National Health Programs / organization & administration*
  • National Health Programs / statistics & numerical data
  • Selection Bias
  • World Health Organization / organization & administration


  • Diphtheria-Tetanus-Pertussis Vaccine