Optimising reporting of adverse events following immunisation by healthcare workers in Ghana: A qualitative study in four regions

PLoS One. 2022 Dec 20;17(12):e0277197. doi: 10.1371/journal.pone.0277197. eCollection 2022.


Introduction: Despite the emphasis on reporting of Adverse Events Following Immunisation (AEFIs) during didactic training sessions, especially prior to new vaccine introductions, it remains low in Ghana. We explored the factors underlying the under-reporting of AEFI by healthcare workers (HCWs) to provide guidance on appropriate interventions to increase reporting.

Methods: We conducted an exploratory descriptive in-depth study of the factors contributing to low reporting of AEFI among HCWs in four regions in Ghana. Key informant interviews (KII) were held with purposively selected individuals that are relevant to the AEFI reporting process at the district, regional, and national levels. We used KII guides to conduct in-depth interviews and used NVivo 10 qualitative software to analyse the data. Themes on factors influencing AEFI reporting were derived inductively from the data, and illustrative quotes from respondents were used to support the narratives.

Results: We conducted 116 KIIs with the health managers, regulators and frontline HCWs and found that lack of information on reportable AEFIs and reporting structures, misunderstanding of reportable AEFIs, heavy workload, cost of reporting AEFIs, fear of blame by supervisors, lack of motivation, and inadequate feedback as factors responsible for underreporting of AEFIs. Respondents suggested that capacity building for frontline HCWs, effective supervision, the provision of motivation and feedback, simplification of reporting procedures, incentives for integrating AEFI reporting into routine monitoring and reporting, standardization of reporting procedures across regions, and developing appropriate interventions to address the fear of personal consequences would help improve AEFI reporting.

Conclusion: From the perspectives of a broad range of key informants at all levels of the vaccine safety system, we found multiple factors (both structural and behavioural), that may impact HCW reporting of AEFI in Ghana. Improvements in line with the suggestions are necessary for increased AEFI reporting in Ghana.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adverse Drug Reaction Reporting Systems* / standards
  • Ghana
  • Health Personnel
  • Humans
  • Vaccination* / adverse effects
  • Vaccines* / adverse effects


  • Vaccines

Grants and funding

• Initials of the authors who received each award: RAA • Grant numbers awarded to each author - Subcontract No: AF-NRC001/2019 • The full name of each funder: Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease, Atlanta, USA, Through the African Field Epidemiology Network (AFINET) • URL of each funder website: https://www.cdc.gov • Did the sponsors or funders play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript? YES - Specify the role(s) played.: They participated in study design and in the decision to publish.