Table 2.
Description of changes initiated by QI teams and associated outcomes including data on number of DPT doses administered
| Improvement team | Examples of changes initiated (June 2011–Feb 2012) | Associated outcomes at intervention end (Feb 2012) | Average monthly number of doses of DPT antigens: comparing baseline with project implementation and follow-up periods (June 2010–May 2012) | ||||
|---|---|---|---|---|---|---|---|
| Antigen | HU typea | BL avgb | PIF avgc | Sigd | |||
| Bukeeri | Reallocated existing budget to pay a local motorcycle driver to take staff to outreach sites to provide RI services; established partnerships between staff and VHTs to improve access to population; met with and engaged religious leaders | Four outreach sites opened and providing RI on a regular basis at times negotiated with community; VHTs mobilized mothers and visiting households to check status of child health cards; tally sheets and registration forms developed to monitor outreach | DPT3 | Static | 23.3 | 31.0 | p = 0.038 |
| DPT3 | OR | 2.6 | 33.7 | p < 0.001 | |||
| DPT1 | Static | 25.2 | 33.3 | p = 0.036 | |||
| DPT1 | OR | 3.5 | 28.3 | p < 0.001 | |||
| Butende | Incorporated VHTs into data collection and improvement process; changed existing staffing pattern to increase RI staff from one to two on RI days; improved staff arrival time at outreaches; directly involved VHTs in mobilizing families; met with religious leaders | VHTs now provide input to improvement process; VHTs making home visits to “difficult areas”; staff arrival time at outreaches becoming more consistent; in-charge actively working with religious leaders | DPT3 | Static | 4.8 | 8.7 | p = 0.008 |
| DPT3 | OR | 29.4 | 28.8 | NS | |||
| DPT1 | Static | 4.8 | 9.3 | p = 0.002 | |||
| DPT1 | OR | 30.4 | 35.2 | NS | |||
| Kiyumba | Cross-trained 17 staff on RI techniques; put two vaccinators on duty on days when RIs are administered; reorganized process of RI; expanded involvement of VHTs | Decreased wait time for RI to less than 1 hour from 80% of clients to 20%; VHTs making home visits and identifying unimmunized children | DPT3 | Static | 28.7 | 22.1 | NS |
| DPT3 | OR | 20.5 | 21.6 | NS | |||
| DPT1 | Static | 22.7 | 25.7 | NS | |||
| DPT1 | OR | 18.6 | 22.7 | NS | |||
| Kyannamukaka | Ensured that all children receiving services had a child health card; implemented use of registers which included phone numbers, home visits by VHTs, and plan for staff to f/u with caregivers using phone | VHTs visited at least 25 households; have held village meetings; engaged other stakeholders in learning about RI, are referring children to HU; 60 VHTs have been trained by staff; one outreach site has become a static site | DPT3 | Static | 22.8 | 20.3 | NS |
| DPT3 | OR | 34.4 | 33.8 | NS | |||
| DPT1 | Static | 23.4 | 20.4 | NS | |||
| DPT1 | OR | 31.3 | 30.3 | NS | |||
| MMC | Increased the number of RI staff to three on most days of the week and to two on outreach days; VHTs were to visit 25 homes, screen all children at static unit for RI status | Improved communication among caregivers, VHTs and staff; developed system for tracking home visits; VHTs identify cases of resistant families and successfully got them to RI; HU working with District leadership to engage other resistant families | DPT3 | Static | 39.1 | 65.3 | p < 0.001 |
| DPT3 | OR | 11.7 | 13.0 | NS | |||
| DPT1 | Static | 47.0 | 69.7 | p = 0.001 | |||
| DPT1 | OR | 12.8 | 10.4 | NS | |||
| District health team | Reallocated existing primary care budget to accommodate the purchase of 22 gas cylinders; advocated for purchase by showing no unintended consequences to other services; developed a tracking system to monitor location and use of cylinders | 22 gas cylinders purchased and distributed to HUs with tracking system in place | NA | NA | NA | NA | NA |
NA not applicable, as the District Health Team did not directly engage in administration of vaccinations. Their efforts supported the processes for vaccine delivery and storage.
aHU type: Static units are the actual physical location of the health unit building. Outreach sites (OR) are places in surrounding villages where immunizations are routinely provided on scheduled days during the month.
bBL avg: Baseline average number of antigens administered from June 2010 to May 2011.
cPIF avg: Project implementation and follow-up average number of antigens administered during project intervention and follow-up periods from June 2011 to May 2012.
dSig: significance of changes noted: two-tailed unpaired t-test comparing BL and PIF periods; NS means that p > 0.05 in antigens administered during the life of the project.