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Effect of Electronic Immunization Registries on Immunization Record Completeness in Nigerian Primary Healthcare Centres

Abstract

Complete and accurate immunization records are essential for effective childhood immunization programmes because they support monitoring of vaccination status, identification of children who have missed scheduled doses, appropriate follow-up, continuity of vaccination, reporting, programme planning, and resource allocation. In Nigerian primary healthcare centres, dependence on paper-based immunization records may contribute to incomplete documentation, missing vaccination dates, duplication of records, difficulty retrieving previous vaccination histories, and delays in updating immunization information. Electronic immunization registries provide a digital platform for recording, storing, updating, and retrieving vaccination information and may improve the completeness and accessibility of immunization records. However, challenges including inadequate digital infrastructure, unreliable electricity and internet connectivity, limited healthcare-worker training, system downtime, data-entry errors, and inadequate technical support may affect their effectiveness. Against this background, this study investigates the effect of electronic immunization registries on immunization record completeness in Nigerian primary healthcare centres. The study will be anchored on the Health Systems Framework, the Technology Acceptance Model, and the Donabedian Model of Healthcare Quality. The Health Systems Framework emphasizes health information systems, service delivery, health workforce, medical technologies, and infrastructure as essential components of effective healthcare delivery and immunization services. The Technology Acceptance Model explains how perceived usefulness and perceived ease of use may influence healthcare workers' acceptance and utilization of electronic immunization registries. The Donabedian Model explains how healthcare structures and processes influence the quality of healthcare services, with electronic information systems representing an important structural component and immunization record completeness serving as a measurable quality indicator. Collectively, these theoretical perspectives provide a suitable framework for explaining how electronic immunization registries may influence immunization record completeness in Nigerian primary healthcare centres. The study will adopt a quantitative quasi-experimental or analytical comparative research design. The study population will comprise selected primary healthcare centres and healthcare workers responsible for immunization services and record management. Immunization records of eligible children attending the selected facilities will also be reviewed. A multistage sampling technique will be used to select states, local government areas, primary healthcare centres, immunization clinics, healthcare workers, and relevant child immunization records. Electronic immunization registries will be measured using indicators such as availability of an electronic registry, duration of implementation, frequency of use, proportion of immunization encounters entered electronically, system functionality, accessibility of records, staff training, technical support, data-entry procedures, and system uptime. Immunization record completeness will be assessed using indicators such as completeness of child demographic information, documentation of vaccines received, vaccination dates, vaccine doses, missed doses, scheduled appointments, complete vaccination history, unique patient identification, and completion of required record fields. Data will be collected using structured questionnaires, electronic registry records, paper immunization registers, child health cards, facility immunization registers, data-quality assessment tools, and relevant health information system reports. Descriptive statistics will be used to summarize facility characteristics, electronic registry utilization, and immunization record completeness. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of electronic immunization registries on immunization record completeness. Where a quasi-experimental design is adopted, record completeness before and after implementation of electronic immunization registries or between facilities using electronic and paper-based systems may be compared. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that electronic immunization registries have a significant positive effect on immunization record completeness in Nigerian primary healthcare centres. Facilities using electronic immunization registries are expected to demonstrate more complete documentation of children's vaccination histories than facilities relying primarily on paper-based records. Electronic registries may reduce missing information, improve documentation of vaccination dates and doses, facilitate retrieval of previous vaccination records, and support identification and follow-up of children who have missed scheduled vaccinations. Improved record completeness may also strengthen immunization monitoring, reporting, programme evaluation, service planning, and continuity of vaccination. However, inadequate electricity, poor internet connectivity, limited digital literacy, system downtime, insufficient training, inaccurate data entry, and weak technical support may reduce the effectiveness of electronic immunization registries. The study therefore expects functional, user-friendly, adequately supported, and properly implemented electronic immunization registries to contribute significantly to improved completeness of immunization records in Nigerian primary healthcare centres. The study is expected to contribute to the literature on electronic immunization registries, immunization record completeness, digital health, health information systems, childhood immunization, primary healthcare, vaccination monitoring, data quality, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, National Primary Health Care Development Agency immunization programmes, state ministries of health, primary healthcare centre managers, immunization programme coordinators, health information officers, development partners, and policymakers regarding strategies for strengthening digital immunization information systems. The study will also provide evidence-based recommendations for expanding electronic immunization registry coverage, improving electricity and digital infrastructure, strengthening healthcare-worker training, providing reliable technical support, improving data-quality monitoring, integrating electronic immunization registries with existing health information systems, and developing sustainable digital systems for complete and accurate immunization records across Nigerian primary healthcare centres.

Keywords: Electronic immunization registries, immunization record completeness, childhood immunization, primary healthcare centres, digital health, health information systems, vaccination records, immunization services, data quality, Nigeria, public health.