Barriers to Healthcare Workers Reporting Adverse Events Following Immunization in Four Regions of Ghana

"Addressing the barriers to AEFI reporting that were identified in this study will strengthen the Ghana EPI [Expanded Programme on Immunization]."

Vaccine safety systems allow authorities to address concerns promptly and promote confidence in immunisation, especially as more vaccines are introduced into low- and middle-income countries (LMICs). Despite didactic training on adverse events following immunisation (AEFI) in Ghana, the reporting ratio of AEFI was 1.56 per 100,000 surviving infants in 2015, below the minimum reporting ratio of 10. With the goal of informing targeted interventions, this study aimed to estimate the proportion of health care workers (HCWs) reporting AEFI and to identify barriers to reporting.

The researchers conducted 2 cross-sectional surveys in December 2017, involving 306 HCWs and in-charges of 169 healthcare facilities in 4 regions in Ghana. One supervisor from each facility, responsible for overall reporting and management of AEFI, was also interviewed.

Of the HCWs interviewed, 176 (57.5%) reported they had ever encountered an AEFI. While many HCWs (over 80%) correctly defined an AEFI, HCWs had less knowledge about the reporting system in general (e.g., almost a quarter of HCWs did not know that all AEFI need to be reported). Of the 120 who had encountered an AEFI in the last year, 66 (55.0%) indicated they had reported the AEFI, and 38 (31.7%) completed a reporting form. The most common barriers to reporting of AEFI cited by HCWs were fear of personal consequences (44.1%), lack of knowledge or training (25.2%), and not believing an AEFI was serious enough to report (22.2%).

Discussing AEFI at the last supervisory monitoring visit was the only factor identified that was significantly associated with AEFI reporting in the past year (odds ratio (OR) 7.39; p < .001). Of 172 supervisors interviewed, 65 (37.8%) mentioned their facilities had ever encountered an AEFI; over 90% of facilities had reporting forms.

Reflecting on the findings, the researchers note that few HCW respondents indicated they received a supervisory visit where AEFI were discussed, which is problematic, as receiving an AEFI monitoring visit was the only factor that was found to be significantly associated with AEFI reporting in the previous year. "Discussing AEFI with HCWs during supervisory visits should promote reporting and serves as an opportunity to train on AEFI in a work environment."

In addition, strategies to address fear of personal consequences as a barrier to reporting of AEFI are needed. "While fear of personal consequences after reporting AEFI could be discussed during in-service training, it will need to be ameliorated through encouragement from supervisors, providing supportive supervision to address fear on an ongoing basis, implementing a supportive policy to protect HCWs who report, and changing organizational norms surrounding the importance of reporting without punishment."