Uncovering And Investigating Reasons for Inaccuracies in Vaccine Card Records in Kiyawa LGA Jigawa, Nigeria: A Mixed Method Study

Uncovering And Investigating Reasons for Inaccuracies in Vaccine Card Records in Kiyawa LGA Jigawa, Nigeria: A Mixed Method Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Uncovering And Investigating Reasons for Inaccuracies in Vaccine Card Records in Kiyawa LGA Jigawa, Nigeria: A Mixed Method Study Damola Bakare, Julius Salako, Funmilayo Shittu, Ayobami A Bakare, and 14 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7023550/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Accurately measuring vaccination coverage is crucial for programmatic and policy decision making, however accurate measurement of coverage can be challenging. We aimed to understand the extent of, and reasons for, inaccurate vaccination card records in a rural, low-income setting in Jigawa state, Nigeria. Methods We conducted an explanatory sequential mixed-methods study in Kiyawa Local Government Area, Jigawa State, from September 2022 to July 2023, using data from the INSPIRING Jigawa trial (ISRCTN39213655). Quantitative data was gathered from surveyed women aged 16–49 in sampled compounds, who presented their child’s vaccine card. Vaccine documentation was defined as inaccurate when the vaccine card is discordant with caregiver report. Adjusted logistic regression identified factors associated with inaccuracies. We conducted in-depth interviews with healthcare workers and focus groups with community members, analyzing transcripts using conventional content analysis, and triangulated findings with quantitative results. Results Records for 4258 children under five-years, from 3232 women, were examined. Of these children, 441 (10.4%) had vaccine cards that were deemed inaccurate by their caregivers. Inaccuracies were primarily attributed to cards being filled despite the child not receiving the vaccine, misplacement or loss of vaccine cards, vaccine stock-out when cards had already been filled, and vaccine card stock-out when the vaccine had been administered. We observed associations between education level, profession, and having co-wives, with the reporting of inaccurate vaccine cards. Women with business/professional/TBA occupations had higher odds of reporting vaccine card inaccuracies, along with more educated women. Our qualitative findings highlighted maternal lack of knowledge of vaccination schedule and forgetfulness about the vaccination schedule as common reasons for vaccine card inaccuracy. Conclusion We identified health system failures and caregiver barriers leading to inaccurate reports in vaccine cards. It is essential to sensitize caregivers and healthcare providers on the importance of accurately documenting vaccines and validating immunization recording systems. Vaccination card accuracy Healthcare worker Immunization records Mother’s recall Low- and middle-income countries Figures Figure 1 Figure 2 BACKGROUND Globally, immunization programs have made significant strides in reducing the burden of infectious diseases such as tuberculosis, polio, pneumonia, diphtheria, pertussis, tetanus, hepatitis B, and measles. However, persistent disparities in vaccine access and delivery, particularly in low- and middle-income countries (LMICs), continue to hinder progress. In 2023 an estimated 14.5 million infants failed to receive the first dose of the diphtheria-tetanus-pertussis (DTP) vaccine, with an additional 6.5 million children remaining only partially vaccinated. This gap in immunization coverage contributes to the 4.9 million under-five child deaths due to preventable causes each year ( 1 , 2 ). These gaps in coverage are most pronounced in sub-Saharan Africa, where weak health systems, socioeconomic inequities, cultural and logistical barriers exacerbate low vaccination coverage rates ( 3 , 4 ). Accurate and reliable vaccination coverage data is essential for addressing immunization gaps. Coverage estimates are generally derived from three primary sources: household surveys, routine administrative data, and immunization cards, each presenting unique strengths and limitations. Household surveys, such as the Demographic and Health Surveys (DHS), provide robust population-level estimates and are considered a gold standard, but their resource intensity and infrequent implementation limit their real-time utility. Routine administrative data offer timely updates, but are prone to inaccuracies due to reporting inconsistencies, population estimation errors, and potential data manipulation, impacting their reliability for program management ( 5 , 6 ). Immunization cards serve as vital tools for tracking individual vaccination histories, enabling informed clinical decision-making, preventing unnecessary vaccinations, and promoting caregiver adherence. Although immunization card data are essential for public health surveillance, pinpointing areas with low coverage, and directing targeted interventions, caregiver recall can serve as a necessary alternative for estimating childhood vaccination status when vaccination cards are unavailable or deemed unreliable. Studies suggest that caregiver recall can be a dependable method, although its accuracy varies depending on the context and type of vaccine ( 7 , 8 ). Nigeria is estimated to have the highest number of ‘zero dose’ children, and the highest number of absolute child deaths each year, linked to systemic weaknesses in Nigeria’s health infrastructure, shortages in the healthcare workforce, and logistical barriers in vaccine distribution ( 9 – 11 ). As a result, vaccination coverage remains critically low. The 2024 Nigeria Demographic and Health Survey (NDHS) reported that only 39% of under-5 children nationwide, and 56.9% in Jigawa State, received at least one dose of BCG vaccine for tuberculosis protection, three doses of polio vaccine, three doses of DPT-containing vaccine against diphtheria, pertussis, and tetanus, and one dose of measles-containing vaccine. The survey assessed vaccination coverage for these basic antigens by calculating the percentage of children who received specific vaccines at any time prior to the survey, as documented by either vaccination cards or maternal report. These figures indicate Nigeria is off track for achieving Sustainable Development Goal (SDG) 3.8 target of achieving universal health coverage for vaccination by 2030 ( 12 , 13 ). Jigawa State, in Northern Nigeria, faces distinct contextual challenges that severely compromise the reliability of immunization card data. The increased drive to improve vaccine coverage has led to reports of some unintended consequences. Financial incentives leading to increased demand has overburdened healthcare workers, leading to inadequate record-keeping and inaccurate card completion ( 14 , 15 ). Moreover, these incentives foster an environment where caregivers may coerce healthcare workers into falsifying vaccination records, resulting in distorted coverage estimates and a critical loss of data integrity ( 16 , 17 ). Given the absence of electronic registries, immunization cards are the exclusive tool for vaccination coverage estimation in Jigawa. Therefore, a thorough understanding of the underlying causes of card inaccuracies is essential for effective public health interventions. METHODS Study aim We aimed to quantify the prevalence of these inaccuracies and to explore the systemic and contextual factors that contribute to them. By identifying these factors, this research will generate evidence-based recommendations to strengthen immunization data quality, and support accurate monitoring of vaccination uptake and global health targets. Study design This study employed an explanatory sequential mixed-methods design. Initially, quantitative cross-sectional data was gathered from women aged 16–49 with children under five in the Kiyawa Local Government Area (LGA) of Jigawa State, Nigeria, between September 12, 2022, and January 25, 2023. This data was collected as part of the endline survey for the INSPIRING Jigawa cluster randomized controlled trial (ISRCTN39213655) ( 18 ). We then collected qualitative data to explore factors contributing to vaccine card inaccuracies through Focus Group discussions (FGDs) with male and female caregiver groups in selected Kiyawa LGA communities, and in-depth interviews (IDIs) with healthcare workers. These qualitative data collection activities occurred between May 6 and June 20, 2023, with follow-up validation and analysis completed in June and July 2023. Setting Kiyawa LGA, located in Jigawa State within Nigeria's northwest geopolitical zone. The socio-cultural landscape of Kiyawa LGA is notably homogeneous, with the Hausa-Fulani ethnic group representing 99% of residents. Agriculture serves as the primary livelihood for the majority of the population. Kiyawa LGA comprises three districts—Kiyawa, Shuwarin, and Abalago—divided into eleven electoral wards. Its population has grown from 172,952 in the 2006 census to an estimated 230,000 ( 16 ). Jigawa State has one of the lowest populations in the region, with a population of 4.3 million in 2006 and a projected 7.5 million in 2022 ( 19 , 20 ). The 2024 Nigeria DHS reported that only 32.9% of children aged 12–23 months in Jigawa State were fully immunized according to the national schedule. Population, Sampling and Recruitment Quantitative Population Eligible participants were women aged 16–49 years who are permanent residents of Kiyawa LGA and have at least one child aged 0–59 months and were able to present the child's vaccination card during a household visit. We excluded women who were unavailable at the time of visit and those who refused to give consent. Children of deceased or separated mothers were included if they remained in the same household and a caregiver was able to provide informed consent. Sampling The sampling methods have been described in detail previously published papers ( 16 , 21 ). We employed a multi-stage cluster sampling design, beginning with a community mapping exercise to enumerate all villages and their compounds. This process generated a complete sampling frame by recording the number of residential compounds in each village, ensuring a systematic approach to selecting potential sampling units. For compound enumeration, we adapted the Expanded Programme on Immunization (EPI) approach ( 22 ). First, a central point in each village was identified with the help of local gatekeepers. A random starting direction was then determined by spinning a pen, followed by sequentially numbering all residential compounds in a clockwise manner. Non-residential buildings were excluded from the count. Villages served as primary sampling units (clusters), selected through probability proportionate to size (PPS) sampling based on compound counts to ensure larger villages had a higher inclusion probability, improving representativeness. A minimum cluster size of 50 compounds was enforced to maintain statistical power. Finally, compounds were randomly selected using Stata version 16 for baseline surveys. Sample size The household survey sample size was based on the INSPIRING trial's primary outcome, which was originally powered to detect the primary outcome through sampling of 4,480 compounds (∼127 compounds/cluster) and 9,726 children. No additional power calculations were performed as this secondary analysis relied on the trial's established sample size ( 16 ). Qualitative To explore the factors influencing vaccine card inaccuracies, four FGDs and four IDIs were conducted. FGDs, comprising two groups of fathers and two groups of mothers of children under five, were held in two wards (Ward 1 and Ward 2) selected based on their proximity and high reported frequency of vaccination record inaccuracies, irrespective of the percentage of inaccuracy. Community gatekeepers facilitated participant recruitment, ensuring diverse socioeconomic and demographic representation. Each FGD included 8 to 9 participants. The inclusion of fathers aimed to provide insight into household decision-making and gender-related barriers to immunization. Four FGDs were deemed sufficient for thematic saturation, given the study population's homogeneity and focused research questions, aligning with qualitative research practices in similar settings and logistical feasibility. ( 23 ). Four IDIs were conducted with male Healthcare workers (HCWs), reflecting the gender composition of facility leadership in Kiyawa LGA. HCWs were selected from both FDG wards and other LGA wards using convenience sampling. These interviews aimed to capture HCW perspectives on vaccination record-keeping challenges and practices, including systemic and operational barriers contributing to inaccuracies. Data Collection Procedures Quantitative Compound survey The trial endline surveys consisted of questionnaires for three respondent types in each compound: ( 1 ) compound head, ( 2 ) household heads, and ( 3 ) eligible women. The compound head provided information on compound membership, structure, assets, income, and community cohesion. Women were asked about their socio-demographics, and then for each of their surviving children aged 0–59 months were requested to present their vaccination card. They were then asked to verify the accuracy of the documented information. In cases where discrepancies were noted, mothers were asked to provide the correct vaccination history based on their recall, and a picture of the vaccine card was taken. Data collection was conducted by 20 locally recruited female clinical data collectors, overseen by two field supervisors. Data collectors underwent a comprehensive one-month training which included practical sessions, home assignments, online webinars and a field pilot in a neighbouring LGA. The training included sessions on how to interpret vaccination cards, ask questions about maternal recall, and record discrepancies. Data were collected using a custom CommCare application on Android tablets, featuring integrated skip patterns and data cleaning rules to minimize errors. When vaccine cards were presented, data collectors extracted key details, including vaccination dates and vaccine types (BCG, DPT-HepB-Hib, oral polio, measles), into a data collection form. Mothers were asked to validate the card's accuracy. In cases where mothers reported discrepancies between the information on the vaccination card and their recollection (e.g. a vaccine documented on the card that the child did not receive), the data collector recorded the mother’s recollection of the vaccination details in the data collection form. To facilitate verification, the data collector then photographed the vaccine page of all presented cards, regardless of whether discrepancies were reported. Supervisors conducted periodic spot checks and reviewed photographed card images to verify the accuracy of data entry, ensuring consistency and reliability in the data collection process. Mothers were informed that their participation was voluntary and that their responses would be kept confidential. Qualitative Two clinical data collectors underwent a two-day training session. One collector facilitated the FGDs, while the other documented notes and posed supplementary questions. An FGD guide, informed by quantitative data findings and structured around vignettes addressing over- and under-reporting of vaccination coverage (Supplementary File S1: Vignette Scenarios used for FGDs and IDIs), was developed. These vignettes were based on real-life scenarios reported by caregivers during surveys, highlighting vaccine card inaccuracies. The HCW interview guide was subsequently developed using emerging FGD findings. Both FGDs and HCW interviews were conducted face-to-face, lasting 60–120 minutes. All discussions were audio-recorded, transcribed, translated from Hausa to English, and anonymized. Analysis Quantitative Descriptive statistics were used to present the sociodemographic characteristics of women and children, as well as vaccination coverage. Vaccine card documentation of “ever vaccinated” was used. Vaccine card accuracy was assessed against caregiver reports and discrepancies were flagged as inaccurate. To determine specific antigen discrepancies and their frequency, data were extracted from photographs of vaccine card records and cross-referenced with caregiver-reported vaccination status. Indecipherable information from the photographs was recorded as missing data. We defined inaccuracies as discrepancies between vaccine cards and caregiver reports, classifying them into two types: over-reporting (vaccines recorded on the card but not received by the child) and under-reporting (vaccines received by the child but missing from the card). The extent of inaccuracies was quantified by calculating the proportion of children with at least one inaccuracy and the average number of inaccuracies per child. This provided a measure of the magnitude and distribution of reporting errors. Next, we stratified inaccuracies by specific antigens (BCG, DPT-HepB-Hib, oral polio, measles) and by number of doses in order to identify patterns in reporting errors. This stratification revealed whether inaccuracies were more common for certain vaccines or doses, potentially pointing to systemic issues such as stockouts, recording errors, or challenges in vaccine administration. Findings were presented in bar charts to show the proportion of inaccuracies by antigen and dose. To determine factors associated with vaccine card inaccuracies, we conducted univariate and multivariate logistic regression analyses. The outcome variable, vaccine card inaccuracy, was binary (inaccurate = 1), and defined as any discrepancy, under-reporting or over-reporting in any recorded antigen. Explanatory variables included sociodemographic, healthcare access, educational, and financial incentive variables. The unit of analysis was the child (i.e., each child’s vaccine card) and to account for maternal-level clustering (multiple children per woman), we used mixed-effects models with random effects per woman. Variance inflation factor (VIF) tests were employed to ensure model stability by validating the absence of collinearity among predictors. Qualitative The analysis team (DB, JS, AAB and TC) conducted a conventional content analysis ( 24 ) of the interviews and FGDs using QDA Miner Lite software. DB and JS reviewed transcripts for completeness and accuracy and then independently read and coded the transcribed interviews. DB and JS then worked together to identify codes that support or contradict the reasons found in the quantitative data (Fig. 2 ). AAB and TC reviewed the codes and after multiple iterations of team discussion and refinement, the team agreed on the final codes which described reasons for inaccuracies in vaccine card records. Quantitative findings were integrated with qualitative results to provide context for observed inaccuracies in vaccination records. Reflexivity DB, JS and AAB are Nigerians. DB and JS hold master’s degrees in public health and were residents in Jigawa for the duration of the research project, while AAB is a community health physician and PhD candidate studying mixed methods research. TC is a professor of global health systems, epidemiology, and evaluation from the United Kingdom. We analysed viewpoints from the perspectives of a Nigerian caregiver and a healthcare professional. RESULTS Participant characteristics A total of 3,232 women were included in the quantitative analysis (Supplementary Fig. 1: Participant inclusion flow diagram). Among them, 37.0% were between the ages of 16 and 24, 62.8% of the women were married before reaching the age of 16, 64.0% had at least two children under the age of 5, and only 10.4% had received formal education. Most respondents (52.4%) identified as farmers or labourers, and although 84.5% earn something, only 0.6% earned a monthly income exceeding 30,000 naira (approx. 30 US dollars) - Table 1 . Overall, 4,258 children’s vaccination cards were presented, out of the 9,726 children surveyed, from 3,232 mothers/caregivers. Of these the 4,258 eligible children, 51.8% were male and 48.1% were 25 months and above. 441 (10.4%) of the child vaccination cards were reported to be inaccurate by the caregiver (Table 1 ). For the qualitative data, we had 33 participants across the 4 FGDs, 17 female and 16 males. The men’s ages ranged from 33–55 years, and women from 16–49 years (Supplemental Table 1: Characteristics of FGD and IDI participants). Table 1 Demographic Characteristics of children and caregivers in Kiyawa LGA, Jigawa State Maternal characteristics (N = 3,232) (%) Age group* Less than 25 years 25–34 years 1,197 1,346 (37.0) (41.7) 35–49 years 688 (21.3) Age at first marriage Less than 16 years 16 years and above 2,031 1,201 (62.8) (37.2) Highest Level of Education** None Informal/religious/formal 861 2,368 (26.7) (73.3) Marital status Married Others 3,219 13 (99.6) (0.4) Islam 3,229 (99.9) Religion Others 3 (0.1) Number of surviving children Less than 3 3–4 children 943 1,078 (29.2) (33.4) 5 children and above 1,211 (37.5) Number of under-5 children 1 1,165 (36.0) 2 and above 2,067 (64.0) Not working/Housewife 567 (17.5) Occupation Farming/Manual Labour 1,693 (52.4) Business/Professional/TBA 972 (30.1) Nothing 497 (15.5) Actual Income*** < 30,000 naira 2,700 (83.9) ≥ 30,000 naira 19 (0.6) Marriage type**** Only wife More than one 1,579 1,639 (49.1) (50.9) Characteristics of care-seeking facilities according to women (N = 3,232) (%) Main Careseeking facility¤ PHC 2,722 (87.2) Secondary 325 (10.4) Tertiary 76 (2.4) Number of facility’s visit last 3 months 0 381 (11.8) 1 or 2 2,622 (81.1) ≥ 3 229 (7.1) Characteristics of children who presented card (N = 4,258) (%) Child’s sex Male Female 2,206 2,052 (51.8) (48.2) Child’s age 0–11 months 12–24 months 1,181 1,030 (27.7) (24.2) 25 months and above 2,047 (48.1) Multiple birth Singleton Multiple 4,138 120 (97.2) (2.8) Child sick in the last two weeks Yes No Don’t know 884 3,370 4 20.8 79.1 0.1 Has the caregiver confirmed that the vaccine card is accurate? Not accurate Accurate Missing 441 3,609 208 (10.4) (84.7) (4.9) *Missing age (n = 1); **Missing education (n = 3); ***Missing monthly income (n = 16); ****Missing marital status (n = 14), ¤Missing care facility (n = 109); all other variables had no missing data; TBA = Traditional Birth Attendant Vaccines coverage among under 5 children, based on information provided by the caregiver. Analysis of immunization records (Table 2 ) revealed high reported coverage for most basic vaccines among the 4,258 children with available vaccination cards. Nearly all mother’s recall and card information indicated receipt of BCG (mother’s recall = 98.3%; card information = 98.3%), polio-0 (mother’s recall = 99.1%; card information = 98.2%), and Penta-1 (mother’s recall = 93.1%; card information = 93.2%), while measles 2 vaccination rates were notably lower (mother’s recall = 17.7%; card information = 17.6%). Maternal recall data showed similar coverage patterns to card records, with minimal discrepancies between the two sources. The agreement between maternal recall and card information was high, exceeding 99% concordance for all vaccines assessed. Table 2 Comparison of Vaccine Coverage Estimates from Vaccination Cards and Maternal Recall among Children Under 5 in Kiyawa LGA (N = 4258) Vaccine type Mother’s recall % recall coverage Card information % card coverage Discrepancy between mother’s recall and card coverage % BCG 4186 98.3 4186 98.3 0.0 POLIO 0 4220 99.1 4180 98.2 -0.9 POLIO 1 3930 92.3 3945 92.6 0.4 POLIO 2 3661 86.0 3668 86.1 0.2 POLIO 3 3226 75.8 3232 75.9 0.1 PCV 1 3939 92.5 3953 92.8 0.3 PCV 2 3681 86.4 3682 86.5 0.0 PCV 3 3374 79.2 3369 79.1 -0.1 PENTA 1 3963 93.1 3968 93.2 0.1 PENTA 2 3697 86.8 3695 86.8 0.0 PENTA 3 3384 79.5 3379 79.4 -0.1 MEASLES 1 2600 61.1 2590 60.8 -0.2 MEASLES 2 754 17.7 748 17.6 -0.1 Discrepancies by wards Table 3 presents the prevalence of inaccuracies in vaccine cards across different wards, revealing that while the majority of cards were accurate (84.8% overall), there was notable variation by ward: Kiyawa (97.3%) and Kwanda (97.7%) exhibited the highest proportions of accurate cards, while Garko (15.5%), Katanga (13.1%), Katuka (14.6%), and Shuwarin (15.1%) showed the highest percentages of inaccurate cards. The proportion of respondents who were "not sure" about the accuracy of their cards also varied, with Balago (11.5%) and Tsirma (14.8%) having the highest percentages in this category. Table 3 Prevalence of inaccuracies in vaccine cards by wards Wards Not accurate % Not accurate Accurate % Accurate Not sure % Not sure Total % Total (row) Andaza 34 8.2 353 85.3 27 6.5 414 100 Balago 7 1.8 333 86.7 44 11.5 384 100 Fake 75 10.5 603 84.7 34 4.8 712 100 Garko* 50 15.5 264 82 8 2.5 322 100 Katanga 60 13.1 377 82.1 22 4.8 459 100 Katuka* 81 14.6 448 80.6 27 4.9 556 100 Kiyawa 2 2.7 72 97.3 0 0 74 100 Kwanda 4 1.8 215 97.7 1 0.5 220 100 Maje 13 6 204 94 0 0 217 100 Shuwarin 96 15.1 534 84 6 0.9 636 100 Tsirma 19 7.2 206 78 39 14.8 264 100 Total 441 10.4 3,609.0 84.8 208 4.9 4,258.0 100 *Selected for the formation of the FGD groups. Discrepancies by vaccine Analysis of vaccination recording accuracy revealed distinct patterns across vaccine types (Table 4 ; Fig. 1 ). BCG demonstrated the highest data consistency between cards and maternal recall, with minimal under-reporting (1.5%) and over-reporting (1.5%). For the Polio series, recording discrepancies showed more for two doses - OPV0 and OPV3 showed greater discrepancies of under-reporting (OPV0 = 11.3%; OPV3 = 12.8) and OPV3 showed substantial over-reporting (16.3%). The PCV and PENTA series exhibited moderate discrepancies, with slightly higher under-reporting for later doses. Most notably, Measles-2 vaccination showed the poorest agreement between sources, with a striking under-reporting (55.0%) and substantial over-reporting (25.0%) on cards, suggesting this vaccine was both frequently missed in practice and inconsistently documented when administered. Table 4 Differences in mother’s recall and card details of children whose mothers reported inaccuracy by vaccine, using the mother’s recall as reference (N = 439) Mother’s recall Card details Under reporting on card (Recall not Card) Over reporting on card (Card not Recall) Card extra % under reporting on card % over reporting on card BCG 409 409 6 6 0 1.5 1.5 Polio 0 423 383 48 8 -40 11.3 1.9 Polio 1 334 349 9 24 15 2.7 7.2 Polio 2 247 254 16 23 7 6.5 9.3 Polio 3 172 178 22 28 6 12.8 16.3 PCV 1 337 351 10 24 14 3.0 7.1 PCV 2 253 254 14 15 1 5.5 5.9 PCV 3 183 178 18 13 -5 9.8 7.1 PENTA 1 345 350 11 16 5 3.2 4.6 PENTA 2 257 255 14 12 -2 5.4 4.7 PENTA 3 184 179 19 14 -5 10.3 7.6 MEASLES 1 109 99 15 5 -10 13.8 4.6 MEASLES 2 20 14 11 5 -6 55.0 25.0 Total 213 193 Average 213/439 = 0.49 193/439 = 0.44 *2 cards have no record Factors associated with inaccuracy reports by caregivers The adjusted analysis found caregiver's age and age at first marriage, the number of children alive and number of under-five children, caregiver’s occupation, caregiver’s income, child birth order were not significantly associated with reporting card inaccuracies. However, a woman’s educational status, having a co-wife and child age were all significantly associated with reporting card inaccuracies. Women with any form of education had higher odds of reporting inaccuracies (OR = 1.33, p = 0.032); having a co-wife was associated with a decreased odds of recording inaccuracies (OR = 0.78, p = 0.038); while there was also higher odds of reporting inaccuracies for older children (12–24 months-OR = 2.70 and 25 months and above-OR = 2.30, both p < 0.001) compared to children under 1 year. Only health status of child in the last 2 weeks (OR = 1.39, p = 0.005) and facility where care was sought (OR = 1.92, p = 0.017) was significant in the unadjusted analysis but not significant in the adjusted analysis (Table 4 ). Table 4 Multivariable Logistic Regression Analysis of Inaccuracies in Child Vaccination Cards, adjusted for Maternal-Level Clustering Outcome: child vaccine card inaccurate (under- or over-reporting of any antigen) Unadjusted (each variable considered separately) Adjusted (all variables included in one multivariable model) Variables Odds ratio 95% confidence interval p-value Odds ratio 95% confidence interval p-value Caregiver’s age Less than 25 years ref Ref 25–34 years 0.91 (0.71 1.16) 0.449 0.95 (0.70 1.29) 0.724 35 years and above 1.09 (0.83 1.45) 0.511 1.05 (0.72 1.53) 0.816 Age at first marriage Less than 16 years ref Ref 16 years and above 1.14 (0.92 1.42) 0.232 1.13 (0.91 1.43) 0.263 Level of education None ref Ref Any education 1.34 (1.05 1.74) 0.021 1.33 (1.03 1.75) 0.032 Number of children alive Less than 3 ref Ref 3–4 0.80 (0.61 1.05) 0.104 0.87 (0.63 1.21) 0.417 5 or more 0.95 (0.74 1.23) 0.705 1.03 (0.71 1.49) 0.888 Number of under-5 children One ref Ref 2 or more 0.81 (0.65 1.00) 0.053 0.87 (0.68 1.10) 0.259 Occupation Not working/Housewife ref Ref Farming/Manual labour 0.84 (0.62 1.15) 0.286 1.38 (0.68 2.80) 0.373 Business/ professional/TBA 1.11 (0.81 1.55) 0.503 1.78 (0.86 3.70) 0.122 Earn Income Earn nothing ref Ref Earn something 0.80 (0.59 1.08) 0.147 0.51 (0.25 1.02) 0.056 Have co-wife None/Only wife ref Ref More than one 0.76 (0.61 0.94) 0.010 0.78 (0.62 0.98) 0.038 Child birth-order Singleton ref Ref Multiple 1.10 (0.52 2.35) 0.795 1.11 (0.48 2.61) 0.802 Child’s age Less than 1 year ref Ref 12–24 months 2.74 (2.00 3.75) < 0.001 2.70 (1.94 3.75) < 0.001 25 months and above 2.27 (1.70 3.04) < 0.001 2.30 (1.69 3.12) < 0.001 Morbidity (sick in the last 2 weeks) No ref Ref Yes 1.39 (1.11 1.74) 0.005 1.25 (0.98 1.59) 0.065 Care seeking facility type PHC ref Ref Secondary 0.82 (0.57 1.18) 0.290 0.79 (0.55 1.15) 0.219 Tertiary 1.92 (1.12 3.29) 0.017 1.49 (0.84 2.65) 0.170 Reasons for inaccuracy of child vaccination card according to caregivers’ response Lack of knowledge of vaccination schedule or forgetfulness about the vaccination schedule Among 441 caregivers reporting inaccuracies in their child’s vaccination cards, the most common reason cited was maternal lack of knowledge of vaccination schedule or forgetfulness about the vaccination schedule (19.5%; Fig. 2 ). While forgetfulness alone does not inherently cause card inaccuracies, it frequently led to missed vaccinations giving room for healthcare workers to completely fill the child’s vaccination card during follow-up visits or mop-up activities, even if the missed dose had not been administered, thus leading to over-reporting. The in-charge told me to go with him to do our quality survey before the supervisor comes. So, we used 2 days and visited all the communities under the ward to check their cards and we corrected any card we see error. We fill in any cards that is not fully immunized by age or by antigen according to the cards... The supervisor came the 3rd day and did the quality survey, and we passed greatly. (HCW 01) Caregiver refused vaccination Vaccine refusal by caregivers (11.2%) emerged as another significant contributor to vaccination card inaccuracies in our quantitative findings (Fig. 2 ). Qualitative data corroborated this observation, identifying vaccine hesitancy as a key underlying factor. In some cases, hesitant mothers permitted healthcare workers to complete their child's vaccination card despite non-administration of vaccines, primarily to avoid subsequent clinic visits, leading to over-reporting of vaccine received. This practice reflected both caregivers' desire to limit health system engagement and healthcare workers' reluctance to make repeat visits to remote villages with challenging accessibility due to poor road conditions. These findings may also account for the 2.6% of mothers who reported their children vaccine card was filled all at once during a single visit (Fig. 2 ). The government is not confronting this issue, because how can LGA team tell me to fill cards for defaulters knowing that they rejected the vaccine but I don't have choice than to just do as I was told. Because if I don't obey them, they will threaten me (HCW 04) There are households that don't accept immunization in this community the healthcare worker knows them, so the healthcare worker use to fill immunization card for their children and not immunize the children (Participant 8, Male, Ward 01) Healthcare workers refuse to vaccinate the children Similarly to caregiver’s vaccine hesitancy, our qualitative findings further elucidate the relationship between vaccination card inaccuracies and hesitancy among healthcare workers themselves who refuse to vaccinate the children (1.2%), leading to over-reporting. This phenomenon can directly compromise vaccination program integrity, as hesitant HCWs may complete vaccination cards without administering the actual vaccines. Such practices not only create inaccurate immunization records that may leave individuals unprotected but also erode community trust in vaccination programs. These concerning findings were corroborated by reports from both healthcare workers and community members. “Some of us healthcare workers we don't believe in this vaccines things oooo, there is one of my close friend I would not mentioned his name. But he is a community health extension worker and he is providing Immunization services but he doesn't give his children the immunization. He only fill card for them. He has two children now but all of them has never been immunized (HCW 01) ” Some healthcare workers were the ones discouraging people...So if healthcare worker who is supposed to encourage people are discouraging them, what do you expect from a common man who only act on instruction of healthcare workers (Participant 4, Male, Ward 02) Vaccine and vaccine card stockouts Our findings also identified systemic challenges contributing to vaccination card inaccuracies. Among caregivers, 10.4% reported vaccine stockouts during immunization sessions, while 5.7% attributed discrepancies to lost or forgotten cards, and 5.5% indicated their child received vaccines that were never documented (Fig. 2 ). These logistical barriers frequently lead to inaccurate record-keeping. Qualitative data also revealed that healthcare workers often improvise with temporary paper records when facing card stockouts or when mothers present without their vaccination cards. Although well-intentioned, these stopgap measures meant to preserve immunization histories often fail when temporary records aren't transferred to official cards, leading to under-reporting. Both healthcare workers and community members acknowledged this persistent documentation gap, underscoring the vulnerabilities in maintaining reliable vaccination records in resource constraints settings. " If a caregiver forgot the child's immunization card at home and if it is within community where the healthcare center is located she or he would be asked to go back home and bring the card before the child would be immunized, but if they are far from the healthcare centre, the healthcare worker would immunized the children and record the vaccine given to the child on a sheet of paper, which can easily be misplaced (Participant 4, Male, Ward 02) “ The healthcare worker told me there was no vaccines card available, but he used white sheet of paper and enter my baby's information and he also entered it into the immunization register (Participant 1, Female, Ward 02) What we normally do whenever we don't have vaccine cards is, I used to buy exercise book and then cut pieces of paper from it then use it for new visit and for those that lost their vaccine card (HCW 03) In some instances, as reported by a caregiver, even temporary paper documentation may be omitted entirely. For me I thought that, may be that was how the immunization of that day should be. To vaccinate the children without documenting (Participant 7, Female, Ward 02) Filled in vaccine card before administering vaccines Additionally, some vaccinators pre-emptively complete vaccination cards for all children that came to the facility for immunization before administering vaccines. Such practice that leads to inaccuracies when vaccine stockouts occur (10.4%) or caregivers leave before their child’s turn to receive the vaccine, leading to over-reporting. Inaccuracies are further compounded when documentation and vaccine administration are handled by separate healthcare workers, creating mismatches between records and actual vaccinations, and undermining the reliability of immunization data. The scenario I witness was that the immunization card was filled but the vaccines got finished so the caregiver was asked to come back the following week to receive the vaccines, which they don’t usually do (Participant 7, Female, Ward 01) Scenarios like this use to happen where the health care workers would fill the immunization card and register before administering the vaccines so in some cases the vaccines might finish and some children will not be immunized (Participant 2, Female, Ward 01) Financial incentives for receiving vaccines Financial incentives for receiving vaccines, just like in the quantitative study (2.4%), also emerged as a potential concern in the qualitative study. In this setting where immunization is incentivized, mothers may prioritize obtaining these incentives over accurate record-keeping, potentially leading to misuse of vaccine cards such as duplicate cards or borrowing another child’s documentation. Healthcare workers and caregivers alike reported these practices, underscoring how well-intentioned incentive programs can inadvertently compromise data integrity. I had one child that died who is older than the one alive and his immunization card was up-to-date so we concluded to give the supervisor the deceased child card for the one alive and that was what we did. He was so happy to see the card all up to date and he gave us 2,000 naira that day (Participant 2, Male, Ward 02) Now as it is we don't even know those whose card has actually been lost... Some women would take their children for the same immunization in different hospitals especially measle because they would receive 2,000 naira as incentives. You would hear a woman narrating beautiful lies just to receive 2,000 naira for 5th visit especially Measles vaccine (HCW 02) This statement by HCW 02 further explains why discrepancies is much higher for measles 2 vaccine compared to other vaccines, as shown in Fig. 1 . In addition, the absence of a centralized digital immunization registry further exacerbates documentation discrepancies. In the current fragmented system, healthcare workers cannot verify a child’s complete vaccination history when families relocate, particularly if the physical vaccine card is missing. For instance, when new residents present without documentation, providers must issue a new card that only captures vaccinations administered at their facility—resulting in incomplete records that compromise accurate immunization tracking and follow-up. He told me that I have to go back to Bauchi for them to fill the first and second dose. Because he doesn't know the exact date and I don’t know myself. That was how I completed the remaining immunization without filling the first two. The card is still like that half-filled till now because I have not gone back to Bauchi (Participant 7, Female, Ward 01) Other reasons we identified in the qualitative data include: Poor road infrastructure More also, Healthcare workers also highlighted significant logistical challenges in reaching remote settlements for outreach programs, primarily due to poor road infrastructure caused by poorly planned facility locations. The lack of motor vehicle access to these areas complicates outreach sessions and delays the delivery of essential vaccines. This not only impedes immunization efforts but also exposes healthcare workers to travel-related accidents. Additionally, such accidents risk the loss of vital antigens and vaccine cards, further jeopardizing public health initiatives. When such accidents occur and antigens or vaccine cards are lost or damaged, healthcare workers may resort to either administering vaccines without documenting them or recording doses without actual administration, compromising both accountability and immunization coverage. “There are communities that if not because of this work I wouldn't go there till I die. There was a day I was going to Barka community for outreach, I fell from the bike and the vaccination box also fell and some of the antigens broke. Similar thing happened to my friend last year during raining season when he was going to one of the communities in Kwanda ward. he fell inside the river with the vaccination box (HCW 01)” Missed opportunity Another key concern was the perceived "missed opportunity" when a child could not be vaccinated due to a lost vaccination card. In such cases, driven by the public health imperative to vaccinate, HCWs sometimes administered the vaccine even without the card, a practice corroborated by caregiver testimonies during focus group discussions. It is better to immunize a child without recording it than to record without giving the immunization because the most important thing is immunizing the child. In fact, that is exactly what our health care worker are doing in this area (Participant 1, Female, Ward 01) DISCUSSION Our study assessed inaccuracies in vaccine cards and explored underlying causes for discrepancies in vaccine card documentation. Our quantitative analysis showed that there are correlations between a woman's education, having a co-wife, child’s age, and reporting of inaccuracy in their child’s vaccination card, while the qualitative context provided by the FGDs and interviews sheds more light on the factors contributing to discrepancies between caregiver reports and vaccine card records. We observed that the reasons for inaccuracies in child’s vaccination card could be attributable to caregivers, HCWs, and the influence of health system factors on immunization service delivery ( 25 ). Our analysis reveals that maternal education level significantly influences the detection of discrepancies in vaccination records. Literate mothers, equipped with skills to critically evaluate immunization cards, demonstrated greater capacity to identify inconsistencies between documented and administered vaccines ( 26 ). This increased awareness stems not only from an ability to interpret card information but also from a stronger understanding of the card’s role in tracking immunization history. Such mothers were more likely to engage proactively with healthcare workers regarding irregularities, thereby serving as a corrective mechanism for record-keeping errors ( 26 , 27 ). However, while education enhances discrepancy detection, it represents just one factor among many contributing to vaccination record inaccuracies in Jigawa’s complex immunization ecosystem. The perceived or actual inaccuracies of vaccine cards from older children may be because older children may have experienced changes in caregivers or may have accessed immunization from different facilities, leading to fragmented records ( 28 ). However, this finding may be multi factoral, also stemming from time related card retention to caregiver recall challenges ( 8 ). These challenges underscore the need for improved electronic health records system and caregiver education on the importance of long term card retention. Our analysis also found that women with co-wives are more likely to report vaccine card accuracy compared to women who are sole wives of their husband. Women in polygamous homes may have greater support networks, more shared experiences, and increased social pressure to demonstrate good mothering, all of which encourages retention and use of vaccine cards ( 29 , 30 ). Furthermore, our study identifies vaccine card stockouts as a critical driver of reporting inaccuracies in Jigawa’s immunization system. During shortages, healthcare workers (HCWs) often resort to paper substitutes, which are prone to loss or damage before subsequent visits. Compounding this issue, mothers whose children complete their vaccination schedule during stockouts rarely return to transfer paper records to official cards once supplies are replenished. This gap systematically undermines data reliability, as demonstrated by Seror et al. 2023, found significantly higher coverage estimates among children with available vaccination cards ( 31 ). Wagner et al 2019 further highlights how cards serve as vital clinical decision-making tools by documenting vaccination histories ( 32 ). While electronic systems (common in high-income countries) and low-cost alternatives like vaccine bracelets ( 33 – 35 ) show promise, paper-based records remain essential in low-resource settings, particularly for mobile populations who may transition between different health systems. These findings underscore the urgent need to stabilize vaccine card supply chains to preserve data integrity in immunization program. This study also underscores the critical barriers to accurate vaccine card documentation in geographically remote areas of Jigawa, where logistical constraints exacerbate systemic data inaccuracies. Limited healthcare access, compounded by poor road infrastructure and long distances, forces healthcare workers to rely on motorcycles, the only feasible mode of transport for vaccine delivery. These conditions not only increase the risk of accidents but also jeopardize the integrity of vaccine carriers and immunization cards, leading to antigen spoilage, lost records, and incomplete vaccinations. Our findings align with evidence from Tefera (2018) ( 36 ) and Kwedi Nolna et al. (2018) ( 37 ), who identified distance and poor road networks as key determinants of low immunization coverage, with Nolna et al. (2018) further linking outreach service quality to incomplete vaccination rates ( 37 ). To mitigate these challenges, targeted policy interventions such as strategically relocating healthcare facilities to improve accessibility and investing in cold-chain resilience are urgently needed to enhance both service delivery and data reliability in underserved communities. Meanwhile, our study also reveals how vaccine misinformation fuels caregiver hesitancy, directly contributing to inaccuracies in immunization records ( 38 ). Despite refusing vaccines due to distrust, some caregivers still request completed vaccination cards, a contradiction that underscores the erosion of trust in vaccines, healthcare workers, and the broader health system. Compounding this issue, HCWs face immense pressure to meet coverage targets, which may incentivize overreporting of administered vaccines. This practice not only distorts data integrity but also risks further alienating caregivers, creating a vicious cycle of distrust and unreliable record-keeping, which undermines data integrity. This necessitates robust monitoring and evaluation (M&E) systems capable of detecting both data discrepancies and emerging trust issues among caregivers and health workers ( 39 ). Critical staffing shortages exacerbate these documentation challenges, with health workers reporting unsustainable patient loads during immunization sessions, sometimes exceeding 200 clients per provider. These overwhelming conditions directly contribute to record-keeping lapses, including missed card entries and omitted health education components. Existing research corroborates that such staffing constraints limit service quality and completeness ( 4 , 40 ), particularly in documentation practices. Addressing these personnel gaps must become an immediate priority, as accurate record-keeping fundamentally depends on having adequate, well-supported health workers to maintain proper procedures during vaccination sessions. Financial incentives designed to boost vaccination rates ( 41 ) may inadvertently compromise documentation accuracy and child safety. Our interviews revealed that caregivers facing economic hardship sometimes seek unnecessary vaccinations to obtain incentives, particularly for higher-value vaccines like measles-2, where incentive-linked discrepancies were most pronounced. This aligns with findings by Bakare et al. ( 42 ) and Moro et al. ( 43 ) on financial incentives driving excess vaccination. Additionally, campaign-based delivery of certain vaccines (e.g., measles ( 44 , 45 )) further complicates accurate record-keeping. These findings underscore how incentive structures can distort both vaccination practices and documentation. Implementing biometric-linked electronic systems could address these issues by maintaining reliable vaccination histories, preventing unnecessary doses ( 46 ), and eliminating card-related access barriers that currently compromise data integrity. Limitations of the study Our study has two key limitations. First, including all children under five years of age may introduce recall bias, particularly for vaccinations administered more than one year before the study (Supplemental Table 2: Caregiver’s recall by child’s age). When caregivers perceived vaccination card information as inaccurate, their judgment was prioritized, but their recall and understanding of vaccine types and schedules may have been limited, potentially affecting accuracy. Second, the quantitative component relied exclusively on maternal reports, which may reduce comparability with the qualitative findings. While maternal recall served as a pragmatic comparator for assessing vaccination card inaccuracies, its inherent limitations, such as potential memory errors or incomplete knowledge of immunization schedules, are acknowledged. Nevertheless, this approach aligns with the study’s objective of evaluating card accuracy in a setting without electronic immunization registries. CONCLUSION This mixed-methods study reveals that inaccuracies in Jigawa’s immunization records stem from interconnected health system weaknesses (particularly fragmented documentation practices) and caregiver-level factors (including vaccine hesitancy and limited health literacy). While financial incentives can improve vaccination rates, our findings caution against implementation strategies that prioritize documentation compliance over actual vaccine administration. Immediate solutions should combine innovations like vaccine bracelets to supplement paper records, SMS-based appointment reminders to reduce missed opportunities, and mandatory healthcare worker verification of immunization history during each visit, even as cloud-based digital systems remain the optimal long-term solution for comprehensive record-keeping. Future studies should employ multi-source data triangulation (e.g., facility registers, community health records and surveys) to enhance the validity of coverage assessments and better evaluate documentation accuracy in low-resource settings. Abbreviations Low- and middle-income countries – LMICs Diphtheria-tetanus-pertussis – DTP Demographic and Health Surveys – DHS Nigeria Demographic and Health Survey – NDHS Sustainable Development Goal – SDG Local Government Area – LGA Focus Group discussions – FGDs In-depth interviews – IDIs Expanded Programme on Immunization – EPI Probability proportionate to size – PPS Variance inflation factor – VIF Healthcare workers – HCWs Declarations Ethical approval We received ethical approval from the Jigawa State Government (ref: JPHCDA/ADM/GEN/073/V.I) and the University College London Research Ethics Committee (ref: 3433/004) in accordance with the Declaration of Helsinki. Additionally, we obtained approval from the Kiyawa Local Government Authority, District, Ward, and Village leaders in all communities before commencing data collection. Verbal consent was sought from all participants for both qualitative and quantitative aspect of the survey. Our study data collectors verbally explained the project, allowed participants to review the consent form, and encouraged them to ask questions. Moreover, the data collectors emphasized that participation was voluntary and assured that the collected data would be used solely for research purposes. Data availability Data will be made available on request. Declaration of competing interests The authors declare the following potential competing interests: Tim Colbourn received research funding from the Save the Children-GSK partnership and has served as a consultant for The Global Fund to Fight AIDS, Tuberculosis and Malaria and the United Nations Economic Commission for Africa. Within the INSPIRING Consortium, SA, CC, and PV are employees of Save the Children UK, which is part of the research funding partnership. TFO and MM are employees of GSK, a pharmaceutical company that manufactures vaccines. AAB, HRG and AGF are principal officers of Oxygen for Life Initiative, a Nigerian non-profit organization focused on medical oxygen systems. All other authors declare no competing financial interests or personal relationships that could influence this work. Funding This work was funded through the GlaxoSmithKline (GSK)–Save the Children partnership (grant reference: 82603743). Authors' contributions DB and JS led the study design, data analysis, and manuscript preparation, with equal contributions to conceptualization, investigation, methodology, visualization, and writing (original draft and revisions). FS, AAB, OU, AI, and RAB contributed to study conceptualization, data validation, and investigation, with additional input on manuscript revisions. HG, EDM, and AGF provided supervisory support, funding acquisition, and conceptual guidance, while also contributing to methodology development and manuscript review. JB and CK contributed to study design, data curation, and project administration, with critical input on methodology and manuscript revisions. TC supervised the overall project, secured funding, and contributed substantially to study conceptualization, methodology, data analysis, and manuscript preparation (original draft and revisions). All authors reviewed and approved the final manuscript. Acknowledgements We would also like to acknowledge all respondents and data collectors. References Immunization coverage [Internet]. [cited 2025 Mar 14]. Available from: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage Levels and trends in child mortality - UNICEF DATA [Internet]. [cited 2025 Mar 14]. Available from: https://data.unicef.org/resources/levels-and-trends-in-child-mortality-2024/ Mutua MK, Mohamed SF, Porth JM, Faye CM. Inequities in On-Time Childhood Vaccination: Evidence From Sub-Saharan Africa. Am J Prev Med [Internet]. 2021 Jan 1 [cited 2025 Mar 14];60(1):S11–23. Available from: https://www.ajpmonline.org/article/S0749-3797(20)30425-6/fulltext Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: A systematic review. BMC Public Health [Internet]. 2020 Jul 14 [cited 2025 Mar 14];20(1):1108. Available from: https://doi.org/10.1186/s12889-020-09169-4 Bakibinga P, Kabaria C, Kyobutungi C, Manyara A, Mbaya N, Mohammed S et al. A protocol for a multi-site, spatially-referenced household survey in slum settings: methods for access, sampling frame construction, sampling, and field data collection. BMC Med Res Methodol [Internet]. 2019 May 30 [cited 2025 Mar 14];19(1):109. Available from: https://doi.org/10.1186/s12874-019-0732-x Peabody JW, Luck J, Jain S, Bertenthal D, Glassman P. Assessing the Accuracy of Administrative Data in Health Information Systems. Med Care [Internet]. 2004 Nov [cited 2025 Mar 14];42(11):1066. Available from: https://journals.lww.com/lww-medicalcare/abstract/2004/11000/assessing_the_accuracy_of_administrative_data_in.5.aspx Porth JM, Wagner AL, Tefera YA, Boulton ML. Childhood Immunization in Ethiopia: Accuracy of Maternal Recall Compared to Vaccination Cards. Vaccines [Internet]. 2019 Jun 7 [cited 2025 Mar 14];7(2):48. Available from: https://www.mdpi.com/2076-393X/7/2/48 Binyaruka P, Borghi J. Validity of parental recalls to estimate vaccination coverage: evidence from Tanzania. BMC Health Serv Res [Internet]. 2018 Jun 13 [cited 2025 Mar 14];18(1):440. Available from: https://doi.org/10.1186/s12913-018-3270-z Breaking. barriers, building bridges: the collaborative effort to reach every child in Nigeria [Internet]. [cited 2025 Jun 22]. Available from: https://www.who.int/news-room/feature-stories/detail/breaking-barriers-building-bridges-collaborative-effort-nigeria Mohammed Y, Reynolds HW, Waziri H, Attahiru A, Olowo-okere A, Kamateeka M et al. Exploring the landscape of routine immunization in Nigeria: A scoping review of barriers and facilitators. Vaccine X [Internet]. 2024 Oct 1 [cited 2025 Jun 22];20:100563. Available from: https://www.sciencedirect.com/science/article/pii/S2590136224001360 Bakare AA, King C, Salako J, Bakare D, Uchendu OC, Burgess RA et al. Pneumonia knowledge and care seeking behavior for children under-five years in Jigawa, Northwest Nigeria: a cross-sectional study. Front Public Health [Internet]. 2023 Jul 18 [cited 2025 Jun 22];11:1198225. Available from: https://www.frontiersin.org/articles/ 10.3389/fpubh.2023.1198225/full Federal Ministry of Health and Social Welfare of Nigeria (FMoHSW). National Population Commission (NPC), [Nigeria], and ICF. Nigeria Demographic and Health Survey 2023-24 - Key Indicators Report (English) [Internet]. 2024 [cited 2025 Mar 14]. Available from: https://dhsprogram.com/publications/publication-PR157-Preliminary-Reports-Key-Indicators-Reports.cfm Targets of Sustainable Development. Goal 3 [Internet]. [cited 2025 Mar 15]. Available from: https://www.who.int/europe/about-us/our-work/sustainable-development-goals/targets-of-sustainable-development-goal-3 Cash Incentives for Vaccination New [Internet]. [cited 2025 Jun 22]. Available from: https://www.newincentives.org/cash-incentives-for-vaccination Campos-Mercade P, Meier AN, Pope D, Schneider FH. Motivating vaccination with financial incentives. Trends Cogn Sci [Internet]. 2023 Dec [cited 2025 Jun 22];27(12):1099–101. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1364661323001717 King C, Burgess RA, Bakare AA, Shittu F, Salako J, Bakare D et al. Integrated Sustainable childhood Pneumonia and Infectious disease Reduction in Nigeria (INSPIRING) through whole system strengthening in Jigawa, Nigeria: study protocol for a cluster randomised controlled trial. Trials [Internet]. 2022 Jan 31 [cited 2025 Mar 15];23(1):95. Available from: https://doi.org/10.1186/s13063-021-05859-5 Bakare AA, Akinsola KO, King C, Sogbesan AA, Bakare OR, Fadahunsi OY et al. Provider and community perceptions of integrated COVID-19 and routine childhood immunisation programmes in Nigeria: a qualitative exploratory study. BMC Health Serv Res [Internet]. 2024 Oct 21 [cited 2025 Mar 15];24(1):1262. Available from: https://doi.org/10.1186/s12913-024-11623-7 King C, Colbourn T. The INSPIRING Project – building capacity to reduce child deaths in Jigawa State, Nigeria [Internet]. [cited 2025 Mar 15]. Available from: http://www.isrctn.com/ISRCTN39213655 Jigawa State Government. | A New World [Internet]. [cited 2025 Mar 15]. Available from: https://www.jigawastate.gov.ng/thestate5.html Jigawa. (State, Nigeria) - Population Statistics, Charts, Map and Location [Internet]. [cited 2023 Jul 12]. Available from: https://www.citypopulation.de/en/nigeria/admin/NGA018__jigawa/ Salako J, Bakare D, Sogbesan A, Colbourn T, Shittu F, Bakare AA et al. COVID-19 knowledge and practices in Jigawa State, Nigeria: A cross-sectional survey conducted during the second wave. Menon GI, editor. PLOS Glob Public Health [Internet]. 2024 Jul 1 [cited 2025 Jun 22];4(7):e0003386. Available from: https://dx.plos.org/10.1371/journal.pgph.0003386 Bennett S, Woods T, Liyanage WM, Smith DL. A simplified general method for cluster-sample surveys of health in developing countries. World Health Stat Q Rapp Trimest Stat Sanit Mond. 1991;44(3):98–106. Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc Sci Med 1982. 2022;292:114523. Hsieh HF, Shannon SE. Three Approaches to Qualitative Content Analysis. Qual Health Res [Internet]. 2005 Nov [cited 2025 Feb 4];15(9):1277–88. Available from: https://journals.sagepub.com/doi/ 10.1177/1049732305276687 Fernández-Basanta S, Lagoa-Millarengo M, Movilla-Fernández MJ. Encountering Parents Who Are Hesitant or Reluctant to Vaccinate Their Children: A Meta-Ethnography. Int J Environ Res Public Health [Internet]. 2021 Jul 16 [cited 2025 Apr 23];18(14):7584. Available from: https://www.mdpi.com/1660-4601/18/14/7584 Kibreab F, Lewycka S, Tewelde A. Impact of mother’s education on full immunization of children aged 12–23 months in Eritrea: population and health survey 2010 data analysis. BMC Public Health [Internet]. 2020 Dec [cited 2024 Apr 24];20(1):267. Available from: https://bmcpublichealth.biomedcentral.com/articles/ 10.1186/s12889-020-8281-0 Odusanya OO, Alufohai EF, Meurice FP, Ahonkhai VI. Determinants vaccination coverage rural Nigeria. 2008;8:1–8. Maina LC, Karanja S, Kombich J. Immunization coverage and its determinants among children aged 12–23 months in a peri-urban area of Kenya. Pan Afr Med J [Internet]. 2013 Feb 1 [cited 2025 Jun 15];14(3). Available from: https://www.panafrican-med-journal.com//content/article/14/3/full Bove R, Valeggia C. Polygyny and women’s health in sub-Saharan Africa. Soc Sci Med 1982. 2009;68(1):21–9. Strassmann BI. Polygyny as a Risk Factor for Child Mortality among the Dogon. Curr Anthropol. 1997;38(4):688–95. Seror V, Cortaredona S, Ly EY, Ndiaye S, Gaye I, Fall M et al. Vaccination card availability and childhood immunization in Senegal. BMC Public Health [Internet]. 2020 Dec [cited 2023 Jul 11];20(1):658. Available from: https://bmcpublichealth.biomedcentral.com/articles/ 10.1186/s12889-020-08792-5 Wagner AL. The use and significance of vaccination cards. Hum Vaccines Immunother [Internet]. 2019;15(12):2844–6. Available from: https://doi.org/10.1080/21645515.2019.1625647 Siddiqi DA, Ali RF, Munir M, Shah MT, Khan AJ, Chandir S. Effect of vaccine reminder and tracker bracelets on routine childhood immunization coverage and timeliness in urban Pakistan (2017-18): a randomized controlled trial. BMC Public Health [Internet]. 2020 Dec [cited 2024 Apr 18];20(1):1086. Available from: https://bmcpublichealth.biomedcentral.com/articles/ 10.1186/s12889-020-09088-4 Yau IB, Zubair Mustapha M, Nwaze E, Nobila O, Maigoro A, Abdullah A et al. Improving the timeliness and completeness of childhood vaccination through color-coded bracelets: a pilot study among Fulani tribe populations in Nigeria. J Public Health Afr [Internet]. 2023 May 3 [cited 2024 Apr 18];14(5):2079. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334432/ Sampson S, Adenipekun A, Atobatele S, Ayodeji O, Omeje O, Oni F. An assessment of the effectiveness of an electronic wristband in improving routine immunization timeliness and reducing drop-out. J Public Health [Internet]. 2023 Dec 1 [cited 2024 Apr 18];45(4):947–56. Available from: https://doi.org/10.1093/pubmed/fdad134 Tefera YA, Wagner AL, Mekonen EB, Carlson BF, Boulton ML. Predictors and Barriers to Full Vaccination among Children in Ethiopia. Vaccines. 2018;6(2):22. Kwedi Nolna S, Bonono CR, Nsangou Moncher M, Bindé T, Nolna D, Ongolo Zogo P. Factors influencing the performance of routine immunization in urban areas: A comparative case study of two cities in Cameroon: Douala and Yaoundé. Vaccine [Internet]. 2018 Nov [cited 2024 Mar 20];36(49):7549–55. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0264410X18314142 Novilla MLB, Goates MC, Redelfs AH, Quenzer M, Novilla LKB, Leffler T et al. Why Parents Say No to Having Their Children Vaccinated against Measles: A Systematic Review of the Social Determinants of Parental Perceptions on MMR Vaccine Hesitancy. Vaccines [Internet]. 2023 May 2 [cited 2024 Mar 17];11(5):926. Available from: https://www.mdpi.com/2076-393X/11/5/926 Marzouk M, Omar M, Sirison K, Ananthakrishnan A, Durrance-Bagale A, Pheerapanyawaranun C et al. Monitoring and Evaluation of National Vaccination Implementation: A Scoping Review of How Frameworks and Indicators Are Used in the Public Health Literature. Vaccines [Internet]. 2022 Apr 6 [cited 2024 Mar 17];10(4):567. Available from: https://www.mdpi.com /2076-393X/10/4/567. Olaniyan A, Isiguzo C, Agbomeji S, Akinlade-Omeni O, Ifie B, Hawk M. Barriers, facilitators, and recommendations for childhood immunisation in Nigeria: perspectives from caregivers, community leaders, and healthcare workers. Pan Afr Med J [Internet]. 2022 [cited 2024 Mar 20];43. Available from: https://www.panafrican-med-journal.com/content/article/43/97/full Erdem O, Erdem S, Monson K. Children, vaccines, and financial incentives. Int J Health Econ Manag [Internet]. 2023 Dec [cited 2024 Mar 20];23(4):537–52. Available from: https://link.springer.com/ 10.1007/s10754-023-09343-2 Bakare AA, Akinsola KO, King C, Sogbesan AA, Bakare OR, Fadahunsi OY et al. Provider and community perspectives of integrated COVID-19 and routine childhood immunisation programmes in Nigeria: a qualitative exploratory study [Internet]. In Review; 2024 Feb [cited 2024 Mar 19]. Available from: https://www.researchsquare.com/article/rs-3952946/v1 Moro PL, Arana J, Marquez PL, Ng C, Barash F, Hibbs BF et al. Is there any harm in administering extra-doses of vaccine to a person? Excess doses of vaccine reported to the Vaccine Adverse Event Reporting System (VAERS), 2007–2017. Vaccine [Internet]. 2019 Jun [cited 2024 Mar 17];37(28):3730–4. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0264410X19305766 WHO | Regional Office for Africa [Internet]. 2024 [cited 2024 Apr 24]. As Nigerian government Flags-off 2017/2018 Measles Vaccination Campaign, Kaduna state Governor’s children get vaccinated against measles disease. Available from: https://www.afro.who.int/news/nigerian-government-flags-20172018-measles-vaccination-campaign-kaduna-state-governors Jean Baptiste AE, Van Der Schans J, Bawa S, Masresha B, Wagai J, Oteri J et al. The cost of implementing measles campaign in Nigeria: comparing the stand-alone and the integrated strategy. Health Econ Rev [Internet]. 2023 Jun 13 [cited 2024 Apr 24];13(1):36. Available from: https://healtheconomicsreview.biomedcentral.com/articles/ 10.1186/s13561-023-00441-y ACIP Timing and Spacing Guidelines for Immunization | CDC [Internet]. 2023 [cited 2023 Aug 21]. Available from: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html Additional Declarations Competing interest reported. The authors declare the following potential competing interests: Tim Colbourn received research funding from the Save the Children-GSK partnership and has served as a consultant for The Global Fund to Fight AIDS, Tuberculosis and Malaria and the United Nations Economic Commission for Africa. Within the INSPIRING Consortium, SA, CC, and PV are employees of Save the Children UK, which is part of the research funding partnership. TFO and MM are employees of GSK, a pharmaceutical company that manufactures vaccines. AAB, HRG and AGF are principal officers of Oxygen for Life Initiative, a Nigerian non-profit organization focused on medical oxygen systems. All other authors declare no competing financial interests or personal relationships that could influence this work. Supplementary Files SupplementaryMaterialVaccinecardinaccuracy.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7023550","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":482840991,"identity":"36fbfba3-5b92-4336-b86a-9e22b0348a74","order_by":0,"name":"Damola Bakare","email":"","orcid":"","institution":"University of Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Damola","middleName":"","lastName":"Bakare","suffix":""},{"id":482840992,"identity":"06e9f6eb-eae3-4d33-b70e-1a75749e5883","order_by":1,"name":"Julius Salako","email":"","orcid":"","institution":"University of Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Julius","middleName":"","lastName":"Salako","suffix":""},{"id":482840993,"identity":"554c69d4-a79b-42e0-8133-fe700911cf6e","order_by":2,"name":"Funmilayo Shittu","email":"","orcid":"","institution":"University of Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Funmilayo","middleName":"","lastName":"Shittu","suffix":""},{"id":482840994,"identity":"12b717a4-c4f5-4628-8052-225fe85beeee","order_by":3,"name":"Ayobami A Bakare","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Ayobami","middleName":"A","lastName":"Bakare","suffix":""},{"id":482840995,"identity":"094a216d-b683-44d4-8121-8dbe6d9b31ce","order_by":4,"name":"Obioma Uchendu","email":"","orcid":"","institution":"University College Hospital","correspondingAuthor":false,"prefix":"","firstName":"Obioma","middleName":"","lastName":"Uchendu","suffix":""},{"id":482840996,"identity":"094060fa-d66f-405a-bbc6-6b194d97403d","order_by":5,"name":"Hamish R Graham","email":"","orcid":"","institution":"University of Melbourne, Royal Children’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hamish","middleName":"R","lastName":"Graham","suffix":""},{"id":482840997,"identity":"d8d848a9-9f47-4516-acf1-12f13108de9a","order_by":6,"name":"Eric D McCollum","email":"","orcid":"","institution":"Johns Hopkins University","correspondingAuthor":false,"prefix":"","firstName":"Eric","middleName":"D","lastName":"McCollum","suffix":""},{"id":482840998,"identity":"5d4d718f-b5f6-4815-91a6-6ae45c6a3fda","order_by":7,"name":"Agnese Iuliano","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Agnese","middleName":"","lastName":"Iuliano","suffix":""},{"id":482840999,"identity":"44c1f0cc-abc4-4b9e-8968-42cc38bc08be","order_by":8,"name":"Rochelle A. Burgess","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Rochelle","middleName":"A.","lastName":"Burgess","suffix":""},{"id":482841000,"identity":"18aa516b-ad37-456d-8e6a-e4aa407883fa","order_by":9,"name":"Samy Ahmar","email":"","orcid":"","institution":"Save the Children UK","correspondingAuthor":false,"prefix":"","firstName":"Samy","middleName":"","lastName":"Ahmar","suffix":""},{"id":482841001,"identity":"173a1c13-cf86-4140-a8f2-bf4abf765eae","order_by":10,"name":"Tahlil Ahmed","email":"","orcid":"","institution":"Save the Children UK","correspondingAuthor":false,"prefix":"","firstName":"Tahlil","middleName":"","lastName":"Ahmed","suffix":""},{"id":482841002,"identity":"71fcb4a1-325e-4e9b-afa4-6f6f7c71cdf1","order_by":11,"name":"Adamu Isah","email":"","orcid":"","institution":"Save the Children Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Adamu","middleName":"","lastName":"Isah","suffix":""},{"id":482841003,"identity":"58de99c9-79fd-4e9d-bc64-9f8b995b1edf","order_by":12,"name":"Magama Abdullahi","email":"","orcid":"","institution":"Save the Children Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Magama","middleName":"","lastName":"Abdullahi","suffix":""},{"id":482841004,"identity":"c9f2fcf6-7e3a-4de3-913b-6aa54495c533","order_by":13,"name":"Osebi Adams","email":"","orcid":"","institution":"Save the Children Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Osebi","middleName":"","lastName":"Adams","suffix":""},{"id":482841005,"identity":"8f539374-865d-4055-8708-3f451b80e77e","order_by":14,"name":"James Beard","email":"","orcid":"","institution":"Independent Consultant","correspondingAuthor":false,"prefix":"","firstName":"James","middleName":"","lastName":"Beard","suffix":""},{"id":482841006,"identity":"70d90909-49d3-4bfc-af5d-eaebc3b67c46","order_by":15,"name":"Adegoke G Falade","email":"","orcid":"","institution":"University of Ibadan","correspondingAuthor":false,"prefix":"","firstName":"Adegoke","middleName":"G","lastName":"Falade","suffix":""},{"id":482841007,"identity":"ed25b8cc-41b2-4f5b-9784-a7579aa6cde4","order_by":16,"name":"Carina King","email":"","orcid":"","institution":"Karolinska Institutet","correspondingAuthor":false,"prefix":"","firstName":"Carina","middleName":"","lastName":"King","suffix":""},{"id":482841008,"identity":"9def0403-e5ba-4764-9502-45e6b91d681c","order_by":17,"name":"Tim Colbourn","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYLCChw0gkvkAA0MBmM+MVzUPiEgEa2FLYGAwIE0LjwFxWuwZmB8+SNxhk7h9ds83iR8GDPL8DTzGBvhtYTM2SDyTljjnztltkj0GDIYzDvAYJ+DXwsMmkdh2OHGGRO42aaDDGDcw8BgfIFJLzjOQFnuStLCBtCSCtOB32GGIX4xnSKQZW/YYSCTPOMxWjNf77O3NDx983GEjO0Mi+eGNHxU2tv3tzZsl8GlBjwMJQrEyCkbBKBgFo4AYAACZszx0wxa/cAAAAABJRU5ErkJggg==","orcid":"","institution":"University College London","correspondingAuthor":true,"prefix":"","firstName":"Tim","middleName":"","lastName":"Colbourn","suffix":""}],"badges":[],"createdAt":"2025-07-01 21:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7023550/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7023550/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86408305,"identity":"e9d9a754-94cb-471c-ab2e-7027565da7d6","added_by":"auto","created_at":"2025-07-10 10:16:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26728,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePercentage over-reporting and under-reporting for caregivers who reported vaccine card inaccuracy\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7023550/v1/e2ff45f596a78d27bef85759.png"},{"id":86408306,"identity":"6dc96ed5-d93d-4e3a-9146-0394976930aa","added_by":"auto","created_at":"2025-07-10 10:16:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":61907,"visible":true,"origin":"","legend":"\u003cp\u003eCaregiver-Reported Reasons for Inaccuracies in Child Vaccination Cards (Multiple Responses Allowed; N=441).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7023550/v1/debc027097f8b0d01f24504c.png"},{"id":86409696,"identity":"2c22643b-4e47-4b91-8eb7-df149c90bd47","added_by":"auto","created_at":"2025-07-10 10:32:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2258062,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7023550/v1/3932ae9d-78f6-4fb3-ac9d-21a758c54dcb.pdf"},{"id":86409359,"identity":"4ba11cbe-e58b-4a3e-939b-0f149a9821f4","added_by":"auto","created_at":"2025-07-10 10:24:57","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":126247,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialVaccinecardinaccuracy.docx","url":"https://assets-eu.researchsquare.com/files/rs-7023550/v1/9f36f0e6590b90972b67798e.docx"}],"financialInterests":"Competing interest reported. The authors declare the following potential competing interests:\nTim Colbourn received research funding from the Save the Children-GSK partnership and has served as a consultant for The Global Fund to Fight AIDS, Tuberculosis and Malaria and the United Nations Economic Commission for Africa.\nWithin the INSPIRING Consortium, SA, CC, and PV are employees of Save the Children UK, which is part of the research funding partnership.\nTFO and MM are employees of GSK, a pharmaceutical company that manufactures vaccines.\nAAB, HRG and AGF are principal officers of Oxygen for Life Initiative, a Nigerian non-profit organization focused on medical oxygen systems.\nAll other authors declare no competing financial interests or personal relationships that could influence this work.","formattedTitle":"Uncovering And Investigating Reasons for Inaccuracies in Vaccine Card Records in Kiyawa LGA Jigawa, Nigeria: A Mixed Method Study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eGlobally, immunization programs have made significant strides in reducing the burden of infectious diseases such as tuberculosis, polio, pneumonia, diphtheria, pertussis, tetanus, hepatitis B, and measles. However, persistent disparities in vaccine access and delivery, particularly in low- and middle-income countries (LMICs), continue to hinder progress. In 2023 an estimated 14.5\u0026nbsp;million infants failed to receive the first dose of the diphtheria-tetanus-pertussis (DTP) vaccine, with an additional 6.5\u0026nbsp;million children remaining only partially vaccinated. This gap in immunization coverage contributes to the 4.9\u0026nbsp;million under-five child deaths due to preventable causes each year (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). These gaps in coverage are most pronounced in sub-Saharan Africa, where weak health systems, socioeconomic inequities, cultural and logistical barriers exacerbate low vaccination coverage rates (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccurate and reliable vaccination coverage data is essential for addressing immunization gaps. Coverage estimates are generally derived from three primary sources: household surveys, routine administrative data, and immunization cards, each presenting unique strengths and limitations. Household surveys, such as the Demographic and Health Surveys (DHS), provide robust population-level estimates and are considered a gold standard, but their resource intensity and infrequent implementation limit their real-time utility. Routine administrative data offer timely updates, but are prone to inaccuracies due to reporting inconsistencies, population estimation errors, and potential data manipulation, impacting their reliability for program management (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Immunization cards serve as vital tools for tracking individual vaccination histories, enabling informed clinical decision-making, preventing unnecessary vaccinations, and promoting caregiver adherence. Although immunization card data are essential for public health surveillance, pinpointing areas with low coverage, and directing targeted interventions, caregiver recall can serve as a necessary alternative for estimating childhood vaccination status when vaccination cards are unavailable or deemed unreliable. Studies suggest that caregiver recall can be a dependable method, although its accuracy varies depending on the context and type of vaccine (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNigeria is estimated to have the highest number of \u0026lsquo;zero dose\u0026rsquo; children, and the highest number of absolute child deaths each year, linked to systemic weaknesses in Nigeria\u0026rsquo;s health infrastructure, shortages in the healthcare workforce, and logistical barriers in vaccine distribution (\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). As a result, vaccination coverage remains critically low. The 2024 Nigeria Demographic and Health Survey (NDHS) reported that only 39% of under-5 children nationwide, and 56.9% in Jigawa State, received at least one dose of BCG vaccine for tuberculosis protection, three doses of polio vaccine, three doses of DPT-containing vaccine against diphtheria, pertussis, and tetanus, and one dose of measles-containing vaccine. The survey assessed vaccination coverage for these basic antigens by calculating the percentage of children who received specific vaccines at any time prior to the survey, as documented by either vaccination cards or maternal report. These figures indicate Nigeria is off track for achieving Sustainable Development Goal (SDG) 3.8 target of achieving universal health coverage for vaccination by 2030 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eJigawa State, in Northern Nigeria, faces distinct contextual challenges that severely compromise the reliability of immunization card data. The increased drive to improve vaccine coverage has led to reports of some unintended consequences. Financial incentives leading to increased demand has overburdened healthcare workers, leading to inadequate record-keeping and inaccurate card completion (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Moreover, these incentives foster an environment where caregivers may coerce healthcare workers into falsifying vaccination records, resulting in distorted coverage estimates and a critical loss of data integrity (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Given the absence of electronic registries, immunization cards are the exclusive tool for vaccination coverage estimation in Jigawa. Therefore, a thorough understanding of the underlying causes of card inaccuracies is essential for effective public health interventions.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eStudy aim\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWe aimed to quantify the prevalence of these inaccuracies and to explore the systemic and contextual factors that contribute to them. By identifying these factors, this research will generate evidence-based recommendations to strengthen immunization data quality, and support accurate monitoring of vaccination uptake and global health targets.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study employed an explanatory sequential mixed-methods design. Initially, quantitative cross-sectional data was gathered from women aged 16\u0026ndash;49 with children under five in the Kiyawa Local Government Area (LGA) of Jigawa State, Nigeria, between September 12, 2022, and January 25, 2023. This data was collected as part of the endline survey for the INSPIRING Jigawa cluster randomized controlled trial (ISRCTN39213655) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). We then collected qualitative data to explore factors contributing to vaccine card inaccuracies through Focus Group discussions (FGDs) with male and female caregiver groups in selected Kiyawa LGA communities, and in-depth interviews (IDIs) with healthcare workers. These qualitative data collection activities occurred between May 6 and June 20, 2023, with follow-up validation and analysis completed in June and July 2023.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e\u003c/p\u003e\u003cp\u003eKiyawa LGA, located in Jigawa State within Nigeria's northwest geopolitical zone. The socio-cultural landscape of Kiyawa LGA is notably homogeneous, with the Hausa-Fulani ethnic group representing 99% of residents. Agriculture serves as the primary livelihood for the majority of the population. Kiyawa LGA comprises three districts\u0026mdash;Kiyawa, Shuwarin, and Abalago\u0026mdash;divided into eleven electoral wards. Its population has grown from 172,952 in the 2006 census to an estimated 230,000 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Jigawa State has one of the lowest populations in the region, with a population of 4.3\u0026nbsp;million in 2006 and a projected 7.5\u0026nbsp;million in 2022 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The 2024 Nigeria DHS reported that only 32.9% of children aged 12\u0026ndash;23 months in Jigawa State were fully immunized according to the national schedule.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003ePopulation, Sampling and Recruitment\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eQuantitative\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003ePopulation\u003c/em\u003e\u003c/p\u003e\u003cp\u003eEligible participants were women aged 16\u0026ndash;49 years who are permanent residents of Kiyawa LGA and have at least one child aged 0\u0026ndash;59 months and were able to present the child's vaccination card during a household visit. We excluded women who were unavailable at the time of visit and those who refused to give consent. Children of deceased or separated mothers were included if they remained in the same household and a caregiver was able to provide informed consent.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eSampling\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe sampling methods have been described in detail previously published papers (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). We employed a multi-stage cluster sampling design, beginning with a community mapping exercise to enumerate all villages and their compounds. This process generated a complete sampling frame by recording the number of residential compounds in each village, ensuring a systematic approach to selecting potential sampling units.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFor compound enumeration, we adapted the Expanded Programme on Immunization (EPI) approach (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). First, a central point in each village was identified with the help of local gatekeepers. A random starting direction was then determined by spinning a pen, followed by sequentially numbering all residential compounds in a clockwise manner. Non-residential buildings were excluded from the count. Villages served as primary sampling units (clusters), selected through probability proportionate to size (PPS) sampling based on compound counts to ensure larger villages had a higher inclusion probability, improving representativeness. A minimum cluster size of 50 compounds was enforced to maintain statistical power. Finally, compounds were randomly selected using Stata version 16 for baseline surveys.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eSample size\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe household survey sample size was based on the INSPIRING trial's primary outcome, which was originally powered to detect the primary outcome through sampling of 4,480 compounds (\u0026sim;127 compounds/cluster) and 9,726 children. No additional power calculations were performed as this secondary analysis relied on the trial's established sample size (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eQualitative\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTo explore the factors influencing vaccine card inaccuracies, four FGDs and four IDIs were conducted. FGDs, comprising two groups of fathers and two groups of mothers of children under five, were held in two wards (Ward 1 and Ward 2) selected based on their proximity and high reported frequency of vaccination record inaccuracies, irrespective of the percentage of inaccuracy. Community gatekeepers facilitated participant recruitment, ensuring diverse socioeconomic and demographic representation. Each FGD included 8 to 9 participants. The inclusion of fathers aimed to provide insight into household decision-making and gender-related barriers to immunization. Four FGDs were deemed sufficient for thematic saturation, given the study population's homogeneity and focused research questions, aligning with qualitative research practices in similar settings and logistical feasibility. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFour IDIs were conducted with male Healthcare workers (HCWs), reflecting the gender composition of facility leadership in Kiyawa LGA. HCWs were selected from both FDG wards and other LGA wards using convenience sampling. These interviews aimed to capture HCW perspectives on vaccination record-keeping challenges and practices, including systemic and operational barriers contributing to inaccuracies.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eData Collection Procedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eQuantitative\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eCompound survey\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe trial endline surveys consisted of questionnaires for three respondent types in each compound: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) compound head, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) household heads, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) eligible women. The compound head provided information on compound membership, structure, assets, income, and community cohesion. Women were asked about their socio-demographics, and then for each of their surviving children aged 0\u0026ndash;59 months were requested to present their vaccination card. They were then asked to verify the accuracy of the documented information. In cases where discrepancies were noted, mothers were asked to provide the correct vaccination history based on their recall, and a picture of the vaccine card was taken.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eData collection was conducted by 20 locally recruited female clinical data collectors, overseen by two field supervisors. Data collectors underwent a comprehensive one-month training which included practical sessions, home assignments, online webinars and a field pilot in a neighbouring LGA. The training included sessions on how to interpret vaccination cards, ask questions about maternal recall, and record discrepancies. Data were collected using a custom CommCare application on Android tablets, featuring integrated skip patterns and data cleaning rules to minimize errors.\u003c/p\u003e\u003cp\u003eWhen vaccine cards were presented, data collectors extracted key details, including vaccination dates and vaccine types (BCG, DPT-HepB-Hib, oral polio, measles), into a data collection form. Mothers were asked to validate the card's accuracy. In cases where mothers reported discrepancies between the information on the vaccination card and their recollection (e.g. a vaccine documented on the card that the child did not receive), the data collector recorded the mother\u0026rsquo;s recollection of the vaccination details in the data collection form. To facilitate verification, the data collector then photographed the vaccine page of all presented cards, regardless of whether discrepancies were reported.\u003c/p\u003e\u003cp\u003eSupervisors conducted periodic spot checks and reviewed photographed card images to verify the accuracy of data entry, ensuring consistency and reliability in the data collection process. Mothers were informed that their participation was voluntary and that their responses would be kept confidential.\u003c/p\u003e\u003cp\u003e\u003cem\u003eQualitative\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTwo clinical data collectors underwent a two-day training session. One collector facilitated the FGDs, while the other documented notes and posed supplementary questions. An FGD guide, informed by quantitative data findings and structured around vignettes addressing over- and under-reporting of vaccination coverage (Supplementary File S1: Vignette Scenarios used for FGDs and IDIs), was developed. These vignettes were based on real-life scenarios reported by caregivers during surveys, highlighting vaccine card inaccuracies. The HCW interview guide was subsequently developed using emerging FGD findings. Both FGDs and HCW interviews were conducted face-to-face, lasting 60\u0026ndash;120 minutes. All discussions were audio-recorded, transcribed, translated from Hausa to English, and anonymized.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eAnalysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eQuantitative\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eDescriptive statistics were used to present the sociodemographic characteristics of women and children, as well as vaccination coverage. Vaccine card documentation of \u0026ldquo;ever vaccinated\u0026rdquo; was used. Vaccine card accuracy was assessed against caregiver reports and discrepancies were flagged as inaccurate. To determine specific antigen discrepancies and their frequency, data were extracted from photographs of vaccine card records and cross-referenced with caregiver-reported vaccination status. Indecipherable information from the photographs was recorded as missing data.\u003c/p\u003e\u003cp\u003eWe defined inaccuracies as discrepancies between vaccine cards and caregiver reports, classifying them into two types: over-reporting (vaccines recorded on the card but not received by the child) and under-reporting (vaccines received by the child but missing from the card). The extent of inaccuracies was quantified by calculating the proportion of children with at least one inaccuracy and the average number of inaccuracies per child. This provided a measure of the magnitude and distribution of reporting errors. Next, we stratified inaccuracies by specific antigens (BCG, DPT-HepB-Hib, oral polio, measles) and by number of doses in order to identify patterns in reporting errors. This stratification revealed whether inaccuracies were more common for certain vaccines or doses, potentially pointing to systemic issues such as stockouts, recording errors, or challenges in vaccine administration. Findings were presented in bar charts to show the proportion of inaccuracies by antigen and dose.\u003c/p\u003e\u003cp\u003eTo determine factors associated with vaccine card inaccuracies, we conducted univariate and multivariate logistic regression analyses. The outcome variable, vaccine card inaccuracy, was binary (inaccurate\u0026thinsp;=\u0026thinsp;1), and defined as any discrepancy, under-reporting or over-reporting in any recorded antigen. Explanatory variables included sociodemographic, healthcare access, educational, and financial incentive variables. The unit of analysis was the child (i.e., each child\u0026rsquo;s vaccine card) and to account for maternal-level clustering (multiple children per woman), we used mixed-effects models with random effects per woman. Variance inflation factor (VIF) tests were employed to ensure model stability by validating the absence of collinearity among predictors.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eQualitative\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe analysis team (DB, JS, AAB and TC) conducted a conventional content analysis (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) of the interviews and FGDs using QDA Miner Lite software. DB and JS reviewed transcripts for completeness and accuracy and then independently read and coded the transcribed interviews. DB and JS then worked together to identify codes that support or contradict the reasons found in the quantitative data (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). AAB and TC reviewed the codes and after multiple iterations of team discussion and refinement, the team agreed on the final codes which described reasons for inaccuracies in vaccine card records. Quantitative findings were integrated with qualitative results to provide context for observed inaccuracies in vaccination records.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eReflexivity\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eDB, JS and AAB are Nigerians. DB and JS hold master\u0026rsquo;s degrees in public health and were residents in Jigawa for the duration of the research project, while AAB is a community health physician and PhD candidate studying mixed methods research. TC is a professor of global health systems, epidemiology, and evaluation from the United Kingdom. We analysed viewpoints from the perspectives of a Nigerian caregiver and a healthcare professional.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eParticipant characteristics\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA total of 3,232 women were included in the quantitative analysis (Supplementary Fig.\u0026nbsp;1: Participant inclusion flow diagram). Among them, 37.0% were between the ages of 16 and 24, 62.8% of the women were married before reaching the age of 16, 64.0% had at least two children under the age of 5, and only 10.4% had received formal education. Most respondents (52.4%) identified as farmers or labourers, and although 84.5% earn something, only 0.6% earned a monthly income exceeding 30,000 naira (approx. 30 US dollars) - Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Overall, 4,258 children\u0026rsquo;s vaccination cards were presented, out of the 9,726 children surveyed, from 3,232 mothers/caregivers. Of these the 4,258 eligible children, 51.8% were male and 48.1% were 25 months and above. 441 (10.4%) of the child vaccination cards were reported to be inaccurate by the caregiver (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFor the qualitative data, we had 33 participants across the 4 FGDs, 17 female and 16 males. The men\u0026rsquo;s ages ranged from 33\u0026ndash;55 years, and women from 16\u0026ndash;49 years (Supplemental Table\u0026nbsp;1: Characteristics of FGD and IDI participants).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic Characteristics of children and caregivers in Kiyawa LGA, Jigawa State\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMaternal characteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;3,232)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge group*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 25 years\u003c/p\u003e\u003cp\u003e25\u0026ndash;34 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,197\u003c/p\u003e\u003cp\u003e1,346\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(37.0)\u003c/p\u003e\u003cp\u003e(41.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u0026ndash;49 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e688\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(21.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge at first marriage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 16 years\u003c/p\u003e\u003cp\u003e16 years and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,031\u003c/p\u003e\u003cp\u003e1,201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(62.8)\u003c/p\u003e\u003cp\u003e(37.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHighest Level of Education**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003cp\u003eInformal/religious/formal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e861\u003c/p\u003e\u003cp\u003e2,368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(26.7)\u003c/p\u003e\u003cp\u003e(73.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,219\u003c/p\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(99.6)\u003c/p\u003e\u003cp\u003e(0.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIslam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(99.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of surviving children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 3\u003c/p\u003e\u003cp\u003e3\u0026ndash;4 children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e943\u003c/p\u003e\u003cp\u003e1,078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(29.2)\u003c/p\u003e\u003cp\u003e(33.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 children and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(37.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of under-5 children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(36.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(64.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot working/Housewife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e567\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(17.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFarming/Manual Labour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,693\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(52.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBusiness/Professional/TBA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e972\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(30.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNothing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e497\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(15.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActual Income***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;30,000 naira\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,700\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(83.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;30,000 naira\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarriage type****\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnly wife\u003c/p\u003e\u003cp\u003eMore than one\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,579\u003c/p\u003e\u003cp\u003e1,639\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(49.1)\u003c/p\u003e\u003cp\u003e(50.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCharacteristics of care-seeking facilities according to women\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e(N\u0026thinsp;=\u0026thinsp;3,232)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMain Careseeking facility\u0026curren;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePHC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,722\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(87.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e325\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(10.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(2.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNumber of facility\u0026rsquo;s visit last 3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e381\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(11.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 or 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,622\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(81.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(7.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCharacteristics of children who presented card\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e(N\u0026thinsp;=\u0026thinsp;4,258)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChild\u0026rsquo;s sex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,206\u003c/p\u003e\u003cp\u003e2,052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(51.8)\u003c/p\u003e\u003cp\u003e(48.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChild\u0026rsquo;s age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026ndash;11 months\u003c/p\u003e\u003cp\u003e12\u0026ndash;24 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,181\u003c/p\u003e\u003cp\u003e1,030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(27.7)\u003c/p\u003e\u003cp\u003e(24.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 months and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2,047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(48.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple birth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingleton\u003c/p\u003e\u003cp\u003eMultiple\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4,138\u003c/p\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(97.2)\u003c/p\u003e\u003cp\u003e(2.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChild sick in the last two weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e884\u003c/p\u003e\u003cp\u003e3,370\u003c/p\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003cp\u003e79.1\u003c/p\u003e\u003cp\u003e0.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHas the caregiver confirmed that the vaccine card is accurate?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot accurate\u003c/p\u003e\u003cp\u003eAccurate\u003c/p\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e441\u003c/p\u003e\u003cp\u003e3,609\u003c/p\u003e\u003cp\u003e208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(10.4)\u003c/p\u003e\u003cp\u003e(84.7)\u003c/p\u003e\u003cp\u003e(4.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Missing age (n\u0026thinsp;=\u0026thinsp;1); **Missing education (n\u0026thinsp;=\u0026thinsp;3); ***Missing monthly income (n\u0026thinsp;=\u0026thinsp;16); ****Missing marital status (n\u0026thinsp;=\u0026thinsp;14), \u0026curren;Missing care facility (n\u0026thinsp;=\u0026thinsp;109); all other variables had no missing data; TBA\u0026thinsp;=\u0026thinsp;Traditional Birth Attendant\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eVaccines coverage among under 5 children, based on information provided by the caregiver.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAnalysis of immunization records (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) revealed high reported coverage for most basic vaccines among the 4,258 children with available vaccination cards. Nearly all mother\u0026rsquo;s recall and card information indicated receipt of BCG (mother\u0026rsquo;s recall\u0026thinsp;=\u0026thinsp;98.3%; card information\u0026thinsp;=\u0026thinsp;98.3%), polio-0 (mother\u0026rsquo;s recall\u0026thinsp;=\u0026thinsp;99.1%; card information\u0026thinsp;=\u0026thinsp;98.2%), and Penta-1 (mother\u0026rsquo;s recall\u0026thinsp;=\u0026thinsp;93.1%; card information\u0026thinsp;=\u0026thinsp;93.2%), while measles 2 vaccination rates were notably lower (mother\u0026rsquo;s recall\u0026thinsp;=\u0026thinsp;17.7%; card information\u0026thinsp;=\u0026thinsp;17.6%). Maternal recall data showed similar coverage patterns to card records, with minimal discrepancies between the two sources. The agreement between maternal recall and card information was high, exceeding 99% concordance for all vaccines assessed.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Vaccine Coverage Estimates from Vaccination Cards and Maternal Recall among Children Under 5 in Kiyawa LGA (N\u0026thinsp;=\u0026thinsp;4258)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaccine type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMother\u0026rsquo;s recall\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e% recall coverage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCard information\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e% card coverage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDiscrepancy between mother\u0026rsquo;s recall and card coverage %\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBCG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e98.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOLIO 0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e98.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOLIO 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3930\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3945\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e92.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOLIO 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3661\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3668\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e86.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOLIO 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e75.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCV 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3939\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3953\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e92.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCV 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3681\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3682\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e86.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCV 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3374\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e79.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePENTA 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3963\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e93.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3968\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e93.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePENTA 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3697\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3695\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e86.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePENTA 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3379\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e79.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMEASLES 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2600\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2590\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e60.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMEASLES 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e754\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e748\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e17.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDiscrepancies by wards\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the prevalence of inaccuracies in vaccine cards across different wards, revealing that while the majority of cards were accurate (84.8% overall), there was notable variation by ward: Kiyawa (97.3%) and Kwanda (97.7%) exhibited the highest proportions of accurate cards, while Garko (15.5%), Katanga (13.1%), Katuka (14.6%), and Shuwarin (15.1%) showed the highest percentages of inaccurate cards. The proportion of respondents who were \"not sure\" about the accuracy of their cards also varied, with Balago (11.5%) and Tsirma (14.8%) having the highest percentages in this category.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of inaccuracies in vaccine cards by wards\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWards\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot accurate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e% Not accurate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAccurate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e% Accurate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNot sure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e% Not sure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e% Total (row)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAndaza\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e353\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e85.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e414\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBalago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e333\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e86.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFake\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e603\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e712\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGarko*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e322\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKatanga\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e377\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e82.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e459\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKatuka*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e448\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e556\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKiyawa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e97.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKwanda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e97.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaje\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShuwarin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e534\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e636\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTsirma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e441\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,609.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4,258.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e*Selected for the formation of the FGD groups.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eDiscrepancies by vaccine\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnalysis of vaccination recording accuracy revealed distinct patterns across vaccine types (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). BCG demonstrated the highest data consistency between cards and maternal recall, with minimal under-reporting (1.5%) and over-reporting (1.5%). For the Polio series, recording discrepancies showed more for two doses - OPV0 and OPV3 showed greater discrepancies of under-reporting (OPV0\u0026thinsp;=\u0026thinsp;11.3%; OPV3\u0026thinsp;=\u0026thinsp;12.8) and OPV3 showed substantial over-reporting (16.3%). The PCV and PENTA series exhibited moderate discrepancies, with slightly higher under-reporting for later doses. Most notably, Measles-2 vaccination showed the poorest agreement between sources, with a striking under-reporting (55.0%) and substantial over-reporting (25.0%) on cards, suggesting this vaccine was both frequently missed in practice and inconsistently documented when administered.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDifferences in mother\u0026rsquo;s recall and card details of children whose mothers reported inaccuracy by vaccine, using the mother\u0026rsquo;s recall as reference (N\u0026thinsp;=\u0026thinsp;439)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMother\u0026rsquo;s recall\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCard details\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUnder reporting on card (Recall not Card)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOver reporting on card (Card not Recall)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCard extra\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e% under reporting on card\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e% over reporting on card\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBCG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e409\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e409\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolio 0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e423\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e383\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e11.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolio 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e334\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e349\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e7.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolio 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e9.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolio 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e12.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e16.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCV 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e337\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e351\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCV 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e5.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e5.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCV 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePENTA 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e350\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e4.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePENTA 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e257\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e5.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e4.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePENTA 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e10.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e7.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMEASLES 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e4.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMEASLES 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e55.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e25.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e213/439\u0026thinsp;=\u0026thinsp;0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e193/439\u0026thinsp;=\u0026thinsp;0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e*2 cards have no record\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eFactors associated with inaccuracy reports by caregivers\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe adjusted analysis found caregiver's age and age at first marriage, the number of children alive and number of under-five children, caregiver\u0026rsquo;s occupation, caregiver\u0026rsquo;s income, child birth order were not significantly associated with reporting card inaccuracies. However, a woman\u0026rsquo;s educational status, having a co-wife and child age were all significantly associated with reporting card inaccuracies. Women with any form of education had higher odds of reporting inaccuracies (OR\u0026thinsp;=\u0026thinsp;1.33, p\u0026thinsp;=\u0026thinsp;0.032); having a co-wife was associated with a decreased odds of recording inaccuracies (OR\u0026thinsp;=\u0026thinsp;0.78, p\u0026thinsp;=\u0026thinsp;0.038); while there was also higher odds of reporting inaccuracies for older children (12\u0026ndash;24 months-OR\u0026thinsp;=\u0026thinsp;2.70 and 25 months and above-OR\u0026thinsp;=\u0026thinsp;2.30, both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to children under 1 year. Only health status of child in the last 2 weeks (OR\u0026thinsp;=\u0026thinsp;1.39, p\u0026thinsp;=\u0026thinsp;0.005) and facility where care was sought (OR\u0026thinsp;=\u0026thinsp;1.92, p\u0026thinsp;=\u0026thinsp;0.017) was significant in the unadjusted analysis but not significant in the adjusted analysis (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariable Logistic Regression Analysis of Inaccuracies in Child Vaccination Cards, adjusted for Maternal-Level Clustering\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u003cp\u003eOutcome: child vaccine card inaccurate (under- or over-reporting of any antigen)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eUnadjusted (each variable considered separately)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eAdjusted (all variables included in one multivariable model)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOdds ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e95% confidence interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOdds ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e95% confidence interval\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCaregiver\u0026rsquo;s age\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLess than 25 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;34 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.449\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.724\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35 years and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.511\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.816\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge at first marriage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLess than 16 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16 years and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.263\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAny education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.032\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of children alive\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLess than 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.417\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.705\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.888\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of under-5 children\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOne\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.259\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot working/Housewife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFarming/Manual labour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.373\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBusiness/ professional/TBA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.503\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.122\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEarn Income\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarn nothing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarn something\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave co-wife\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone/Only wife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than one\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e0.038\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChild birth-order\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingleton\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiple\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.795\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.802\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChild\u0026rsquo;s age\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLess than 1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u0026ndash;24 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(2.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(1.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25 months and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(1.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMorbidity (sick in the last 2 weeks)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCare seeking facility type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePHC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.219\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(1.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e(0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.170\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eReasons for inaccuracy of child vaccination card according to caregivers\u0026rsquo; response\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eLack of knowledge of vaccination schedule or forgetfulness about the vaccination schedule\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Among 441 caregivers reporting inaccuracies in their child\u0026rsquo;s vaccination cards, the most common reason cited was maternal lack of knowledge of vaccination schedule or forgetfulness about the vaccination schedule (19.5%; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). While forgetfulness alone does not inherently cause card inaccuracies, it frequently led to missed vaccinations giving room for healthcare workers to completely fill the child\u0026rsquo;s vaccination card during follow-up visits or mop-up activities, even if the missed dose had not been administered, thus leading to over-reporting.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe in-charge told me to go with him to do our quality survey before the supervisor comes. So, we used 2 days and visited all the communities under the ward to check their cards and we corrected any card we see error. We fill in any cards that is not fully immunized by age or by antigen according to the cards... The supervisor came the 3rd day and did the quality survey, and we passed greatly. \u003cb\u003e(HCW 01)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCaregiver refused vaccination\u003c/b\u003e\u003c/p\u003e\u003cp\u003eVaccine refusal by caregivers (11.2%) emerged as another significant contributor to vaccination card inaccuracies in our quantitative findings (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Qualitative data corroborated this observation, identifying vaccine hesitancy as a key underlying factor. In some cases, hesitant mothers permitted healthcare workers to complete their child's vaccination card despite non-administration of vaccines, primarily to avoid subsequent clinic visits, leading to over-reporting of vaccine received. This practice reflected both caregivers' desire to limit health system engagement and healthcare workers' reluctance to make repeat visits to remote villages with challenging accessibility due to poor road conditions. These findings may also account for the 2.6% of mothers who reported their children vaccine card was filled all at once during a single visit (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe government is not confronting this issue, because how can LGA team tell me to fill cards for defaulters knowing that they rejected the vaccine but I don't have choice than to just do as I was told. Because if I don't obey them, they will threaten me \u003cb\u003e(HCW 04)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThere are households that don't accept immunization in this community the healthcare worker knows them, so the healthcare worker use to fill immunization card for their children and not immunize the children \u003cb\u003e(Participant 8, Male, Ward 01)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eHealthcare workers refuse to vaccinate the children\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSimilarly to caregiver\u0026rsquo;s vaccine hesitancy, our qualitative findings further elucidate the relationship between vaccination card inaccuracies and hesitancy among healthcare workers themselves who refuse to vaccinate the children (1.2%), leading to over-reporting. This phenomenon can directly compromise vaccination program integrity, as hesitant HCWs may complete vaccination cards without administering the actual vaccines. Such practices not only create inaccurate immunization records that may leave individuals unprotected but also erode community trust in vaccination programs. These concerning findings were corroborated by reports from both healthcare workers and community members.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Some of us healthcare workers we don't believe in this vaccines things oooo, there is one of my close friend I would not mentioned his name. But he is a community health extension worker and he is\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eproviding Immunization services but he doesn't give his children the immunization. He only fill card for them. He has two children now but all of them has never been immunized\u003c/em\u003e \u003cb\u003e(HCW 01)\u003c/b\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSome healthcare workers were the ones discouraging people...So if healthcare worker who is supposed to encourage people are discouraging them, what do you expect from a common man who only act on instruction of healthcare workers \u003cb\u003e(Participant 4, Male, Ward 02)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eVaccine and vaccine card stockouts\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOur findings also identified systemic challenges contributing to vaccination card inaccuracies. Among caregivers, 10.4% reported vaccine stockouts during immunization sessions, while 5.7% attributed discrepancies to lost or forgotten cards, and 5.5% indicated their child received vaccines that were never documented (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These logistical barriers frequently lead to inaccurate record-keeping. Qualitative data also revealed that healthcare workers often improvise with temporary paper records when facing card stockouts or when mothers present without their vaccination cards. Although well-intentioned, these stopgap measures meant to preserve immunization histories often fail when temporary records aren't transferred to official cards, leading to under-reporting. Both healthcare workers and community members acknowledged this persistent documentation gap, underscoring the vulnerabilities in maintaining reliable vaccination records in resource constraints settings.\u003c/p\u003e\u003cp\u003e\u003cem\u003e \" If a caregiver forgot the child's immunization card at home and if it is within community where the healthcare center is located she or he would be asked to go back home and bring the card before the\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003echild would be immunized, but if they are far from the healthcare centre, the healthcare worker would immunized the children and record the vaccine given to the child on a sheet of paper, which can easily be misplaced\u003c/em\u003e \u003cb\u003e(Participant 4, Male, Ward 02)\u003c/b\u003e\u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe healthcare worker told me there was no vaccines card available, but he used white sheet of paper and enter my baby's information and he also entered it into the immunization register \u003cb\u003e(Participant 1, Female, Ward 02)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWhat we normally do whenever we don't have vaccine cards is, I used to buy exercise book and then cut pieces of paper from it then use it for new visit and for those that lost their vaccine card \u003cb\u003e(HCW 03)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn some instances, as reported by a caregiver, even temporary paper documentation may be omitted entirely.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFor me I thought that, may be that was how the immunization of that day should be. To vaccinate the children without documenting \u003cb\u003e(Participant 7, Female, Ward 02)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFilled in vaccine card before administering vaccines\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAdditionally, some vaccinators pre-emptively complete vaccination cards for all children that came to the facility for immunization before administering vaccines. Such practice that leads to inaccuracies when vaccine stockouts occur (10.4%) or caregivers leave before their child\u0026rsquo;s turn to receive the vaccine, leading to over-reporting. Inaccuracies are further compounded when documentation and vaccine administration are handled by separate healthcare workers, creating mismatches between records and actual vaccinations, and undermining the reliability of immunization data.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe scenario I witness was that the immunization card was filled but the vaccines got finished so the caregiver was asked to come back the following week to receive the vaccines, which they don\u0026rsquo;t usually do \u003cb\u003e(Participant 7, Female, Ward 01)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eScenarios like this use to happen where the health care workers would fill the immunization card and register before administering the vaccines so in some cases the vaccines might finish and some children will not be immunized \u003cb\u003e(Participant 2, Female, Ward 01)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFinancial incentives for receiving vaccines\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFinancial incentives for receiving vaccines, just like in the quantitative study (2.4%), also emerged as a potential concern in the qualitative study. In this setting where immunization is incentivized, mothers may prioritize obtaining these incentives over accurate record-keeping, potentially leading to misuse of vaccine cards such as duplicate cards or borrowing another child\u0026rsquo;s documentation. Healthcare workers and caregivers alike reported these practices, underscoring how well-intentioned incentive programs can inadvertently compromise data integrity.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI had one child that died who is older than the one alive and his immunization card was up-to-date so we concluded to give the supervisor the deceased child card for the one alive and that was what we did. He was so happy to see the card all up to date and he gave us 2,000 naira that day \u003cb\u003e(Participant 2, Male, Ward 02)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNow as it is we don't even know those whose card has actually been lost... Some women would take their children for the same immunization in different hospitals especially measle because they would receive 2,000 naira as incentives. You would hear a woman narrating beautiful lies just to receive 2,000 naira for 5th visit especially Measles vaccine \u003cb\u003e(HCW 02)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis statement by HCW 02 further explains why discrepancies is much higher for measles 2 vaccine compared to other vaccines, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eIn addition, the absence of a centralized digital immunization registry further exacerbates documentation discrepancies. In the current fragmented system, healthcare workers cannot verify a child\u0026rsquo;s complete vaccination history when families relocate, particularly if the physical vaccine card is missing. For instance, when new residents present without documentation, providers must issue a new card that only captures vaccinations administered at their facility\u0026mdash;resulting in incomplete records that compromise accurate immunization tracking and follow-up.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHe told me that I have to go back to Bauchi for them to fill the first and second dose. Because he doesn't know the exact date and I don\u0026rsquo;t know myself. That was how I completed the remaining immunization without filling the first two. The card is still like that half-filled till now because I have not gone back to Bauchi \u003cb\u003e(Participant 7, Female, Ward 01)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOther reasons we identified in the qualitative data include:\u003c/p\u003e\u003cp\u003e\u003cb\u003ePoor road infrastructure\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMore also, Healthcare workers also highlighted significant logistical challenges in reaching remote settlements for outreach programs, primarily due to poor road infrastructure caused by poorly planned facility locations. The lack of motor vehicle access to these areas complicates outreach sessions and delays the delivery of essential vaccines. This not only impedes immunization efforts but also exposes healthcare workers to travel-related accidents. Additionally, such accidents risk the loss of vital antigens and vaccine cards, further jeopardizing public health initiatives.\u003c/p\u003e\u003cp\u003eWhen such accidents occur and antigens or vaccine cards are lost or damaged, healthcare workers may resort to either administering vaccines without documenting them or recording doses without actual administration, compromising both accountability and immunization coverage.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;There are communities that if not because of this work I wouldn't go there till I die. There was a day I was going to Barka community for outreach, I fell from the bike and the vaccination box also fell and\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003esome of the antigens broke. Similar thing happened to my friend last year during raining season when he was going to one of the communities in Kwanda ward. he fell inside the river with the vaccination box\u003c/em\u003e \u003cb\u003e(HCW 01)\u0026rdquo;\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMissed opportunity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnother key concern was the perceived \"missed opportunity\" when a child could not be vaccinated due to a lost vaccination card. In such cases, driven by the public health imperative to vaccinate, HCWs sometimes administered the vaccine even without the card, a practice corroborated by caregiver testimonies during focus group discussions.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIt is better to immunize a child without recording it than to record without giving the immunization because the most important thing is immunizing the child. In fact, that is exactly what our health care worker are doing in this area \u003cb\u003e(Participant 1, Female, Ward 01)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur study assessed inaccuracies in vaccine cards and explored underlying causes for discrepancies in vaccine card documentation. Our quantitative analysis showed that there are correlations between a woman's education, having a co-wife, child\u0026rsquo;s age, and reporting of inaccuracy in their child\u0026rsquo;s vaccination card, while the qualitative context provided by the FGDs and interviews sheds more light on the factors contributing to discrepancies between caregiver reports and vaccine card records. We observed that the reasons for inaccuracies in child\u0026rsquo;s vaccination card could be attributable to caregivers, HCWs, and the influence of health system factors on immunization service delivery (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur analysis reveals that maternal education level significantly influences the detection of discrepancies in vaccination records. Literate mothers, equipped with skills to critically evaluate immunization cards, demonstrated greater capacity to identify inconsistencies between documented and administered vaccines (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This increased awareness stems not only from an ability to interpret card information but also from a stronger understanding of the card\u0026rsquo;s role in tracking immunization history. Such mothers were more likely to engage proactively with healthcare workers regarding irregularities, thereby serving as a corrective mechanism for record-keeping errors (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). However, while education enhances discrepancy detection, it represents just one factor among many contributing to vaccination record inaccuracies in Jigawa\u0026rsquo;s complex immunization ecosystem.\u003c/p\u003e\u003cp\u003eThe perceived or actual inaccuracies of vaccine cards from older children may be because older children may have experienced changes in caregivers or may have accessed immunization from different facilities, leading to fragmented records (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). However, this finding may be multi factoral, also stemming from time related card retention to caregiver recall challenges (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These challenges underscore the need for improved electronic health records system and caregiver education on the importance of long term card retention.\u003c/p\u003e\u003cp\u003eOur analysis also found that women with co-wives are more likely to report vaccine card accuracy compared to women who are sole wives of their husband. Women in polygamous homes may have greater support networks, more shared experiences, and increased social pressure to demonstrate good mothering, all of which encourages retention and use of vaccine cards (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, our study identifies vaccine card stockouts as a critical driver of reporting inaccuracies in Jigawa\u0026rsquo;s immunization system. During shortages, healthcare workers (HCWs) often resort to paper substitutes, which are prone to loss or damage before subsequent visits. Compounding this issue, mothers whose children complete their vaccination schedule during stockouts rarely return to transfer paper records to official cards once supplies are replenished. This gap systematically undermines data reliability, as demonstrated by Seror et al. 2023, found significantly higher coverage estimates among children with available vaccination cards (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Wagner et al 2019 further highlights how cards serve as vital clinical decision-making tools by documenting vaccination histories (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). While electronic systems (common in high-income countries) and low-cost alternatives like vaccine bracelets (\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) show promise, paper-based records remain essential in low-resource settings, particularly for mobile populations who may transition between different health systems. These findings underscore the urgent need to stabilize vaccine card supply chains to preserve data integrity in immunization program.\u003c/p\u003e\u003cp\u003eThis study also underscores the critical barriers to accurate vaccine card documentation in geographically remote areas of Jigawa, where logistical constraints exacerbate systemic data inaccuracies. Limited healthcare access, compounded by poor road infrastructure and long distances, forces healthcare workers to rely on motorcycles, the only feasible mode of transport for vaccine delivery. These conditions not only increase the risk of accidents but also jeopardize the integrity of vaccine carriers and immunization cards, leading to antigen spoilage, lost records, and incomplete vaccinations. Our findings align with evidence from Tefera (2018) (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) and Kwedi Nolna et al. (2018) (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), who identified distance and poor road networks as key determinants of low immunization coverage, with Nolna et al. (2018) further linking outreach service quality to incomplete vaccination rates (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). To mitigate these challenges, targeted policy interventions such as strategically relocating healthcare facilities to improve accessibility and investing in cold-chain resilience are urgently needed to enhance both service delivery and data reliability in underserved communities.\u003c/p\u003e\u003cp\u003eMeanwhile, our study also reveals how vaccine misinformation fuels caregiver hesitancy, directly contributing to inaccuracies in immunization records (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Despite refusing vaccines due to distrust, some caregivers still request completed vaccination cards, a contradiction that underscores the erosion of trust in vaccines, healthcare workers, and the broader health system. Compounding this issue, HCWs face immense pressure to meet coverage targets, which may incentivize overreporting of administered vaccines. This practice not only distorts data integrity but also risks further alienating caregivers, creating a vicious cycle of distrust and unreliable record-keeping, which undermines data integrity. This necessitates robust monitoring and evaluation (M\u0026amp;E) systems capable of detecting both data discrepancies and emerging trust issues among caregivers and health workers (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCritical staffing shortages exacerbate these documentation challenges, with health workers reporting unsustainable patient loads during immunization sessions, sometimes exceeding 200 clients per provider. These overwhelming conditions directly contribute to record-keeping lapses, including missed card entries and omitted health education components. Existing research corroborates that such staffing constraints limit service quality and completeness (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), particularly in documentation practices. Addressing these personnel gaps must become an immediate priority, as accurate record-keeping fundamentally depends on having adequate, well-supported health workers to maintain proper procedures during vaccination sessions.\u003c/p\u003e\u003cp\u003eFinancial incentives designed to boost vaccination rates (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) may inadvertently compromise documentation accuracy and child safety. Our interviews revealed that caregivers facing economic hardship sometimes seek unnecessary vaccinations to obtain incentives, particularly for higher-value vaccines like measles-2, where incentive-linked discrepancies were most pronounced. This aligns with findings by Bakare et al. (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) and Moro et al. (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) on financial incentives driving excess vaccination. Additionally, campaign-based delivery of certain vaccines (e.g., measles (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e)) further complicates accurate record-keeping. These findings underscore how incentive structures can distort both vaccination practices and documentation. Implementing biometric-linked electronic systems could address these issues by maintaining reliable vaccination histories, preventing unnecessary doses (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), and eliminating card-related access barriers that currently compromise data integrity.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations of the study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOur study has two key limitations. First, including all children under five years of age may introduce recall bias, particularly for vaccinations administered more than one year before the study (Supplemental Table\u0026nbsp;2: Caregiver\u0026rsquo;s recall by child\u0026rsquo;s age). When caregivers perceived vaccination card information as inaccurate, their judgment was prioritized, but their recall and understanding of vaccine types and schedules may have been limited, potentially affecting accuracy.\u003c/p\u003e\u003cp\u003eSecond, the quantitative component relied exclusively on maternal reports, which may reduce comparability with the qualitative findings. While maternal recall served as a pragmatic comparator for assessing vaccination card inaccuracies, its inherent limitations, such as potential memory errors or incomplete knowledge of immunization schedules, are acknowledged. Nevertheless, this approach aligns with the study\u0026rsquo;s objective of evaluating card accuracy in a setting without electronic immunization registries.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis mixed-methods study reveals that inaccuracies in Jigawa\u0026rsquo;s immunization records stem from interconnected health system weaknesses (particularly fragmented documentation practices) and caregiver-level factors (including vaccine hesitancy and limited health literacy). While financial incentives can improve vaccination rates, our findings caution against implementation strategies that prioritize documentation compliance over actual vaccine administration. Immediate solutions should combine innovations like vaccine bracelets to supplement paper records, SMS-based appointment reminders to reduce missed opportunities, and mandatory healthcare worker verification of immunization history during each visit, even as cloud-based digital systems remain the optimal long-term solution for comprehensive record-keeping. Future studies should employ multi-source data triangulation (e.g., facility registers, community health records and surveys) to enhance the validity of coverage assessments and better evaluate documentation accuracy in low-resource settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLow- and middle-income countries \u0026ndash; LMICs\u003c/p\u003e\n\u003cp\u003eDiphtheria-tetanus-pertussis \u0026ndash; DTP\u003c/p\u003e\n\u003cp\u003eDemographic and Health Surveys \u0026ndash; DHS\u003c/p\u003e\n\u003cp\u003eNigeria Demographic and Health Survey \u0026ndash; NDHS\u003c/p\u003e\n\u003cp\u003eSustainable Development Goal \u0026ndash; SDG\u003c/p\u003e\n\u003cp\u003eLocal Government Area \u0026ndash; LGA\u003c/p\u003e\n\u003cp\u003eFocus Group discussions \u0026ndash; FGDs\u003c/p\u003e\n\u003cp\u003eIn-depth interviews \u0026ndash; IDIs\u003c/p\u003e\n\u003cp\u003eExpanded Programme on Immunization \u0026ndash; EPI\u003c/p\u003e\n\u003cp\u003eProbability proportionate to size \u0026ndash; PPS\u003c/p\u003e\n\u003cp\u003eVariance inflation factor \u0026ndash; VIF\u003c/p\u003e\n\u003cp\u003eHealthcare workers \u0026ndash; HCWs\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe received ethical approval from the Jigawa State Government (ref: JPHCDA/ADM/GEN/073/V.I) and the University College London Research Ethics Committee (ref: 3433/004) in accordance with the Declaration of Helsinki. Additionally, we obtained approval from the Kiyawa Local Government Authority, District, Ward, and Village leaders in all communities before commencing data collection. Verbal consent was sought from all participants for both qualitative and quantitative aspect of the survey. Our study data collectors verbally explained the project, allowed participants to review the consent form, and encouraged them to ask questions. Moreover, the data collectors emphasized that participation was voluntary and assured that the collected data would be used solely for research purposes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be made available on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare the following potential competing interests:\u003c/p\u003e\n\u003cp\u003eTim Colbourn received research funding from the Save the Children-GSK partnership and has served as a consultant for The Global Fund to Fight AIDS, Tuberculosis and Malaria and the United Nations Economic Commission for Africa.\u003c/p\u003e\n\u003cp\u003eWithin the INSPIRING Consortium, SA, CC, and PV are employees of Save the Children UK, which is part of the research funding partnership.\u003c/p\u003e\n\u003cp\u003eTFO and MM are employees of GSK, a pharmaceutical company that manufactures vaccines.\u003c/p\u003e\n\u003cp\u003eAAB, HRG and AGF are principal officers of Oxygen for Life Initiative, a Nigerian non-profit organization focused on medical oxygen systems.\u003c/p\u003e\n\u003cp\u003eAll other authors declare no competing financial interests or personal relationships that could influence this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded through the GlaxoSmithKline (GSK)–Save the Children partnership (grant reference: 82603743).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDB and JS led the study design, data analysis, and manuscript preparation, with equal contributions to conceptualization, investigation, methodology, visualization, and writing (original draft and revisions). FS, AAB, OU, AI, and RAB contributed to study conceptualization, data validation, and investigation, with additional input on manuscript revisions. HG, EDM, and AGF provided supervisory support, funding acquisition, and conceptual guidance, while also contributing to methodology development and manuscript review. JB and CK contributed to study design, data curation, and project administration, with critical input on methodology and manuscript revisions. TC supervised the overall project, secured funding, and contributed substantially to study conceptualization, methodology, data analysis, and manuscript preparation (original draft and revisions). All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would also like to acknowledge all respondents and data collectors.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eImmunization coverage [Internet]. [cited 2025 Mar 14]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/immunization-coverage\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/immunization-coverage\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLevels and trends in child mortality - UNICEF DATA [Internet]. [cited 2025 Mar 14]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://data.unicef.org/resources/levels-and-trends-in-child-mortality-2024/\u003c/span\u003e\u003cspan address=\"https://data.unicef.org/resources/levels-and-trends-in-child-mortality-2024/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMutua MK, Mohamed SF, Porth JM, Faye CM. Inequities in On-Time Childhood Vaccination: Evidence From Sub-Saharan Africa. Am J Prev Med [Internet]. 2021 Jan 1 [cited 2025 Mar 14];60(1):S11\u0026ndash;23. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ajpmonline.org/article/S0749-3797(20)30425-6/fulltext\u003c/span\u003e\u003cspan address=\"https://www.ajpmonline.org/article/S0749-3797(20)30425-6/fulltext\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: A systematic review. BMC Public Health [Internet]. 2020 Jul 14 [cited 2025 Mar 14];20(1):1108. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-020-09169-4\u003c/span\u003e\u003cspan address=\"10.1186/s12889-020-09169-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBakibinga P, Kabaria C, Kyobutungi C, Manyara A, Mbaya N, Mohammed S et al. A protocol for a multi-site, spatially-referenced household survey in slum settings: methods for access, sampling frame construction, sampling, and field data collection. BMC Med Res Methodol [Internet]. 2019 May 30 [cited 2025 Mar 14];19(1):109. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12874-019-0732-x\u003c/span\u003e\u003cspan address=\"10.1186/s12874-019-0732-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePeabody JW, Luck J, Jain S, Bertenthal D, Glassman P. Assessing the Accuracy of Administrative Data in Health Information Systems. Med Care [Internet]. 2004 Nov [cited 2025 Mar 14];42(11):1066. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.lww.com/lww-medicalcare/abstract/2004/11000/assessing_the_accuracy_of_administrative_data_in.5.aspx\u003c/span\u003e\u003cspan address=\"https://journals.lww.com/lww-medicalcare/abstract/2004/11000/assessing_the_accuracy_of_administrative_data_in.5.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePorth JM, Wagner AL, Tefera YA, Boulton ML. Childhood Immunization in Ethiopia: Accuracy of Maternal Recall Compared to Vaccination Cards. Vaccines [Internet]. 2019 Jun 7 [cited 2025 Mar 14];7(2):48. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/2076-393X/7/2/48\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/2076-393X/7/2/48\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBinyaruka P, Borghi J. Validity of parental recalls to estimate vaccination coverage: evidence from Tanzania. BMC Health Serv Res [Internet]. 2018 Jun 13 [cited 2025 Mar 14];18(1):440. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12913-018-3270-z\u003c/span\u003e\u003cspan address=\"10.1186/s12913-018-3270-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBreaking. barriers, building bridges: the collaborative effort to reach every child in Nigeria [Internet]. [cited 2025 Jun 22]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/feature-stories/detail/breaking-barriers-building-bridges-collaborative-effort-nigeria\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/feature-stories/detail/breaking-barriers-building-bridges-collaborative-effort-nigeria\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMohammed Y, Reynolds HW, Waziri H, Attahiru A, Olowo-okere A, Kamateeka M et al. Exploring the landscape of routine immunization in Nigeria: A scoping review of barriers and facilitators. Vaccine X [Internet]. 2024 Oct 1 [cited 2025 Jun 22];20:100563. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S2590136224001360\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S2590136224001360\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBakare AA, King C, Salako J, Bakare D, Uchendu OC, Burgess RA et al. Pneumonia knowledge and care seeking behavior for children under-five years in Jigawa, Northwest Nigeria: a cross-sectional study. Front Public Health [Internet]. 2023 Jul 18 [cited 2025 Jun 22];11:1198225. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.frontiersin.org/articles/\u003c/span\u003e\u003cspan address=\"https://www.frontiersin.org/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpubh.2023.1198225/full\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2023.1198225/full\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFederal Ministry of Health and Social Welfare of Nigeria (FMoHSW). National Population Commission (NPC), [Nigeria], and ICF. Nigeria Demographic and Health Survey 2023-24 - Key Indicators Report (English) [Internet]. 2024 [cited 2025 Mar 14]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dhsprogram.com/publications/publication-PR157-Preliminary-Reports-Key-Indicators-Reports.cfm\u003c/span\u003e\u003cspan address=\"https://dhsprogram.com/publications/publication-PR157-Preliminary-Reports-Key-Indicators-Reports.cfm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTargets of Sustainable Development. Goal 3 [Internet]. [cited 2025 Mar 15]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/europe/about-us/our-work/sustainable-development-goals/targets-of-sustainable-development-goal-3\u003c/span\u003e\u003cspan address=\"https://www.who.int/europe/about-us/our-work/sustainable-development-goals/targets-of-sustainable-development-goal-3\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCash Incentives for Vaccination New [Internet]. [cited 2025 Jun 22]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.newincentives.org/cash-incentives-for-vaccination\u003c/span\u003e\u003cspan address=\"https://www.newincentives.org/cash-incentives-for-vaccination\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCampos-Mercade P, Meier AN, Pope D, Schneider FH. Motivating vaccination with financial incentives. Trends Cogn Sci [Internet]. 2023 Dec [cited 2025 Jun 22];27(12):1099\u0026ndash;101. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://linkinghub.elsevier.com/retrieve/pii/S1364661323001717\u003c/span\u003e\u003cspan address=\"https://linkinghub.elsevier.com/retrieve/pii/S1364661323001717\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKing C, Burgess RA, Bakare AA, Shittu F, Salako J, Bakare D et al. Integrated Sustainable childhood Pneumonia and Infectious disease Reduction in Nigeria (INSPIRING) through whole system strengthening in Jigawa, Nigeria: study protocol for a cluster randomised controlled trial. Trials [Internet]. 2022 Jan 31 [cited 2025 Mar 15];23(1):95. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13063-021-05859-5\u003c/span\u003e\u003cspan address=\"10.1186/s13063-021-05859-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBakare AA, Akinsola KO, King C, Sogbesan AA, Bakare OR, Fadahunsi OY et al. Provider and community perceptions of integrated COVID-19 and routine childhood immunisation programmes in Nigeria: a qualitative exploratory study. BMC Health Serv Res [Internet]. 2024 Oct 21 [cited 2025 Mar 15];24(1):1262. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12913-024-11623-7\u003c/span\u003e\u003cspan address=\"10.1186/s12913-024-11623-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKing C, Colbourn T. The INSPIRING Project \u0026ndash; building capacity to reduce child deaths in Jigawa State, Nigeria [Internet]. [cited 2025 Mar 15]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.isrctn.com/ISRCTN39213655\u003c/span\u003e\u003cspan address=\"http://www.isrctn.com/ISRCTN39213655\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJigawa State Government. | A New World [Internet]. [cited 2025 Mar 15]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.jigawastate.gov.ng/thestate5.html\u003c/span\u003e\u003cspan address=\"https://www.jigawastate.gov.ng/thestate5.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJigawa. (State, Nigeria) - Population Statistics, Charts, Map and Location [Internet]. [cited 2023 Jul 12]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.citypopulation.de/en/nigeria/admin/NGA018__jigawa/\u003c/span\u003e\u003cspan address=\"https://www.citypopulation.de/en/nigeria/admin/NGA018__jigawa/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSalako J, Bakare D, Sogbesan A, Colbourn T, Shittu F, Bakare AA et al. COVID-19 knowledge and practices in Jigawa State, Nigeria: A cross-sectional survey conducted during the second wave. Menon GI, editor. PLOS Glob Public Health [Internet]. 2024 Jul 1 [cited 2025 Jun 22];4(7):e0003386. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dx.plos.org/10.1371/journal.pgph.0003386\u003c/span\u003e\u003cspan address=\"https://dx.plos.10.1371/journal.pgph.0003386\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBennett S, Woods T, Liyanage WM, Smith DL. A simplified general method for cluster-sample surveys of health in developing countries. World Health Stat Q Rapp Trimest Stat Sanit Mond. 1991;44(3):98\u0026ndash;106.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHennink M, Kaiser BN. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc Sci Med 1982. 2022;292:114523.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHsieh HF, Shannon SE. Three Approaches to Qualitative Content Analysis. Qual Health Res [Internet]. 2005 Nov [cited 2025 Feb 4];15(9):1277\u0026ndash;88. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.sagepub.com/doi/\u003c/span\u003e\u003cspan address=\"https://journals.sagepub.com/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1049732305276687\u003c/span\u003e\u003cspan address=\"10.1177/1049732305276687\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFern\u0026aacute;ndez-Basanta S, Lagoa-Millarengo M, Movilla-Fern\u0026aacute;ndez MJ. Encountering Parents Who Are Hesitant or Reluctant to Vaccinate Their Children: A Meta-Ethnography. Int J Environ Res Public Health [Internet]. 2021 Jul 16 [cited 2025 Apr 23];18(14):7584. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/1660-4601/18/14/7584\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/1660-4601/18/14/7584\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKibreab F, Lewycka S, Tewelde A. Impact of mother\u0026rsquo;s education on full immunization of children aged 12\u0026ndash;23 months in Eritrea: population and health survey 2010 data analysis. BMC Public Health [Internet]. 2020 Dec [cited 2024 Apr 24];20(1):267. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmcpublichealth.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmcpublichealth.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-020-8281-0\u003c/span\u003e\u003cspan address=\"10.1186/s12889-020-8281-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOdusanya OO, Alufohai EF, Meurice FP, Ahonkhai VI. Determinants vaccination coverage rural Nigeria. 2008;8:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaina LC, Karanja S, Kombich J. Immunization coverage and its determinants among children aged 12\u0026ndash;23 months in a peri-urban area of Kenya. Pan Afr Med J [Internet]. 2013 Feb 1 [cited 2025 Jun 15];14(3). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.panafrican-med-journal.com//content/article/14/3/full\u003c/span\u003e\u003cspan address=\"https://www.panafrican-med-journal.com//content/article/14/3/full\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBove R, Valeggia C. Polygyny and women\u0026rsquo;s health in sub-Saharan Africa. Soc Sci Med 1982. 2009;68(1):21\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStrassmann BI. Polygyny as a Risk Factor for Child Mortality among the Dogon. Curr Anthropol. 1997;38(4):688\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeror V, Cortaredona S, Ly EY, Ndiaye S, Gaye I, Fall M et al. Vaccination card availability and childhood immunization in Senegal. BMC Public Health [Internet]. 2020 Dec [cited 2023 Jul 11];20(1):658. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmcpublichealth.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmcpublichealth.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-020-08792-5\u003c/span\u003e\u003cspan address=\"10.1186/s12889-020-08792-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWagner AL. The use and significance of vaccination cards. Hum Vaccines Immunother [Internet]. 2019;15(12):2844\u0026ndash;6. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/21645515.2019.1625647\u003c/span\u003e\u003cspan address=\"10.1080/21645515.2019.1625647\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSiddiqi DA, Ali RF, Munir M, Shah MT, Khan AJ, Chandir S. Effect of vaccine reminder and tracker bracelets on routine childhood immunization coverage and timeliness in urban Pakistan (2017-18): a randomized controlled trial. BMC Public Health [Internet]. 2020 Dec [cited 2024 Apr 18];20(1):1086. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmcpublichealth.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmcpublichealth.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12889-020-09088-4\u003c/span\u003e\u003cspan address=\"10.1186/s12889-020-09088-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYau IB, Zubair Mustapha M, Nwaze E, Nobila O, Maigoro A, Abdullah A et al. Improving the timeliness and completeness of childhood vaccination through color-coded bracelets: a pilot study among Fulani tribe populations in Nigeria. J Public Health Afr [Internet]. 2023 May 3 [cited 2024 Apr 18];14(5):2079. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334432/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334432/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSampson S, Adenipekun A, Atobatele S, Ayodeji O, Omeje O, Oni F. An assessment of the effectiveness of an electronic wristband in improving routine immunization timeliness and reducing drop-out. J Public Health [Internet]. 2023 Dec 1 [cited 2024 Apr 18];45(4):947\u0026ndash;56. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/pubmed/fdad134\u003c/span\u003e\u003cspan address=\"10.1093/pubmed/fdad134\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTefera YA, Wagner AL, Mekonen EB, Carlson BF, Boulton ML. Predictors and Barriers to Full Vaccination among Children in Ethiopia. Vaccines. 2018;6(2):22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKwedi Nolna S, Bonono CR, Nsangou Moncher M, Bind\u0026eacute; T, Nolna D, Ongolo Zogo P. Factors influencing the performance of routine immunization in urban areas: A comparative case study of two cities in Cameroon: Douala and Yaound\u0026eacute;. Vaccine [Internet]. 2018 Nov [cited 2024 Mar 20];36(49):7549\u0026ndash;55. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://linkinghub.elsevier.com/retrieve/pii/S0264410X18314142\u003c/span\u003e\u003cspan address=\"https://linkinghub.elsevier.com/retrieve/pii/S0264410X18314142\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNovilla MLB, Goates MC, Redelfs AH, Quenzer M, Novilla LKB, Leffler T et al. Why Parents Say No to Having Their Children Vaccinated against Measles: A Systematic Review of the Social Determinants of Parental Perceptions on MMR Vaccine Hesitancy. Vaccines [Internet]. 2023 May 2 [cited 2024 Mar 17];11(5):926. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/2076-393X/11/5/926\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/2076-393X/11/5/926\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarzouk M, Omar M, Sirison K, Ananthakrishnan A, Durrance-Bagale A, Pheerapanyawaranun C et al. Monitoring and Evaluation of National Vaccination Implementation: A Scoping Review of How Frameworks and Indicators Are Used in the Public Health Literature. Vaccines [Internet]. 2022 Apr 6 [cited 2024 Mar 17];10(4):567. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e/2076-393X/10/4/567.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlaniyan A, Isiguzo C, Agbomeji S, Akinlade-Omeni O, Ifie B, Hawk M. Barriers, facilitators, and recommendations for childhood immunisation in Nigeria: perspectives from caregivers, community leaders, and healthcare workers. Pan Afr Med J [Internet]. 2022 [cited 2024 Mar 20];43. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.panafrican-med-journal.com/content/article/43/97/full\u003c/span\u003e\u003cspan address=\"https://www.panafrican-med-journal.com/content/article/43/97/full\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eErdem O, Erdem S, Monson K. Children, vaccines, and financial incentives. Int J Health Econ Manag [Internet]. 2023 Dec [cited 2024 Mar 20];23(4):537\u0026ndash;52. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10754-023-09343-2\u003c/span\u003e\u003cspan address=\"10.1007/s10754-023-09343-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBakare AA, Akinsola KO, King C, Sogbesan AA, Bakare OR, Fadahunsi OY et al. Provider and community perspectives of integrated COVID-19 and routine childhood immunisation programmes in Nigeria: a qualitative exploratory study [Internet]. In Review; 2024 Feb [cited 2024 Mar 19]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchsquare.com/article/rs-3952946/v1\u003c/span\u003e\u003cspan address=\"https://www.researchsquare.com/article/rs-3952946/v1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoro PL, Arana J, Marquez PL, Ng C, Barash F, Hibbs BF et al. Is there any harm in administering extra-doses of vaccine to a person? Excess doses of vaccine reported to the Vaccine Adverse Event Reporting System (VAERS), 2007\u0026ndash;2017. Vaccine [Internet]. 2019 Jun [cited 2024 Mar 17];37(28):3730\u0026ndash;4. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://linkinghub.elsevier.com/retrieve/pii/S0264410X19305766\u003c/span\u003e\u003cspan address=\"https://linkinghub.elsevier.com/retrieve/pii/S0264410X19305766\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO | Regional Office for Africa [Internet]. 2024 [cited 2024 Apr 24]. As Nigerian government Flags-off 2017/2018 Measles Vaccination Campaign, Kaduna state Governor\u0026rsquo;s children get vaccinated against measles disease. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.afro.who.int/news/nigerian-government-flags-20172018-measles-vaccination-campaign-kaduna-state-governors\u003c/span\u003e\u003cspan address=\"https://www.afro.who.int/news/nigerian-government-flags-20172018-measles-vaccination-campaign-kaduna-state-governors\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJean Baptiste AE, Van Der Schans J, Bawa S, Masresha B, Wagai J, Oteri J et al. The cost of implementing measles campaign in Nigeria: comparing the stand-alone and the integrated strategy. Health Econ Rev [Internet]. 2023 Jun 13 [cited 2024 Apr 24];13(1):36. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://healtheconomicsreview.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://healtheconomicsreview.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13561-023-00441-y\u003c/span\u003e\u003cspan address=\"10.1186/s13561-023-00441-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eACIP Timing and Spacing Guidelines for Immunization | CDC [Internet]. 2023 [cited 2023 Aug 21]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vaccination card accuracy, Healthcare worker, Immunization records, Mother’s recall, Low- and middle-income countries","lastPublishedDoi":"10.21203/rs.3.rs-7023550/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7023550/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAccurately measuring vaccination coverage is crucial for programmatic and policy decision making, however accurate measurement of coverage can be challenging. We aimed to understand the extent of, and reasons for, inaccurate vaccination card records in a rural, low-income setting in Jigawa state, Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted an explanatory sequential mixed-methods study in Kiyawa Local Government Area, Jigawa State, from September 2022 to July 2023, using data from the INSPIRING Jigawa trial (ISRCTN39213655). Quantitative data was gathered from surveyed women aged 16\u0026ndash;49 in sampled compounds, who presented their child\u0026rsquo;s vaccine card. Vaccine documentation was defined as inaccurate when the vaccine card is discordant with caregiver report. Adjusted logistic regression identified factors associated with inaccuracies. We conducted in-depth interviews with healthcare workers and focus groups with community members, analyzing transcripts using conventional content analysis, and triangulated findings with quantitative results.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eRecords for 4258 children under five-years, from 3232 women, were examined. Of these children, 441 (10.4%) had vaccine cards that were deemed inaccurate by their caregivers. Inaccuracies were primarily attributed to cards being filled despite the child not receiving the vaccine, misplacement or loss of vaccine cards, vaccine stock-out when cards had already been filled, and vaccine card stock-out when the vaccine had been administered. We observed associations between education level, profession, and having co-wives, with the reporting of inaccurate vaccine cards. Women with business/professional/TBA occupations had higher odds of reporting vaccine card inaccuracies, along with more educated women. Our qualitative findings highlighted maternal lack of knowledge of vaccination schedule and forgetfulness about the vaccination schedule as common reasons for vaccine card inaccuracy.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eWe identified health system failures and caregiver barriers leading to inaccurate reports in vaccine cards. It is essential to sensitize caregivers and healthcare providers on the importance of accurately documenting vaccines and validating immunization recording systems.\u003c/p\u003e","manuscriptTitle":"Uncovering And Investigating Reasons for Inaccuracies in Vaccine Card Records in Kiyawa LGA Jigawa, Nigeria: A Mixed Method Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-10 10:16:52","doi":"10.21203/rs.3.rs-7023550/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4e965f18-49dd-4865-bb7a-46cc5efa17f9","owner":[],"postedDate":"July 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-10T10:16:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-10 10:16:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7023550","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7023550","identity":"rs-7023550","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}