Home-based Record Ownership Prevalence

Last updated: 30 November 2017

Home-based records (e.g., vaccination cards, child health books) are an inexpensive yet effective instrument for systematically recording the vaccines received by an individual. Moreover, home-based records (HBRs) can enhance health professionals’ ability to make clinical decisions, empower parents/caregivers in the health care of their children, and support public health monitoring. Unfortunately, HBRs are too often underutilized or inappropriately used by parents and health care workers and therefore does not always fulfil their intended purpose.  


HBRs also support the collection of data for uses other than direct clinical care or delivery of vaccines, such as for quality management and public health monitoring. Periodic coverage surveys, through which information is collected directly from a sample of households, are one way in which immunization coverage of young children is monitored. Within these surveys, HBRs available in the household are used to collect documented information on vaccination services received by children. In the absence of an available or completed HBR, surveys often collect information based on maternal recall, though there is mixed evidence regarding the validity and reliability of recall relative to documented evidence in facility- and home-based records. Despite the importance of HBRs to monitoring, the reliance on these documents as a source of immunization data will almost certainly underestimate coverage until the proportion of  record holders is more nearly equal the proportion of children immunized [Fisher and Vaessen. Int Health News Abstract 1987; 8(6): 1, 4.], further reinforcing the need to improve issuance, maintenance and utilization of home-based records.

A repository of cards can be found at www.immunizationcards.org.

This purpose of this site is to maintain the prevalence of home-based vaccination cards based on Multiple Indicator Cluster Surveys (MICS) or Demographic and Health Surveys (DHS) for the period 2000-2016.  If the information posted here is incorrect or information is missing, please send an e-mail with corrective details and short note of explanation to info@brownconsultingroup.org.

Figure. Map of the most recent national estimated current home-based record ownership based on MICS or DHS survey results for the period 2000-2016

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever concerning the legal status of any country, territory, city or area or of its authorities, or concerning 
the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

As of 30 November 2017, 99 countries are represented on the above map with a MICS or DHS survey result for home-based record (HBR) ownership prevalence. A total of 23 of the 99 countries latest estimated national current HBR ownership was < 50%; 42 countries had a ownership prevalence between 50-79%; 17 countries had a ownership prevalence between 80-89%; and 17 countries had a ownership prevalence between 90-99% (median = 74%; 25%-tile = 53; 75%-tile = 84).  Of the 65 countries with an estimated national HBR prevalence <80%, 31 countries were located in the World Health Organization (WHO) African Region, 10 were in the Eastern Mediterranean Region, 8 were in the Region of the Americas and Western Pacific Region, 6 were in the South-East Asia Region and 2 were in the European Region.  

If an assumption is made that the most recent current HBR ownership prevalence levels observed in the table below are reflective of current status, then 62% of the estimated global birth 

cohort in 2016 (based on 2017 revision of World Population Prospects release from UNPD) resides in countries with a HBR prevalence < 80% based on the most recent MICS or DHS survey result for the 

period 2000-2016.

Table. Estimated home-based record ownership prevalence (ever, current) for children aged 12-23 months based on nationally representative DHS or MICS survey results for the period 2000-2016
(Last updated 30 November 2017)

DHS, USAID supported Demographic and Health Survey; MICS, UNICEF-supported Multiple Indicator Cluster Survey; PUF N/A, public use file not available; 95% confidence intervals reported in parentheses. Ownership prevalence values reflect values estimated for the 12-23 month old children unless otherwise specified in the last column. Reported sample size also reflects that for children 12-23 month unless notes indicate a different age group.

ever / current HBR ownership: In the standard DHS or MICS, caregivers are asked whether they maintain a home-based record on which the child's vaccination history is recorded. The caregiver is asked to produce the document for the field team to review. Children whose caregivers are able to produce the HBR for the field team to view are defined here as current HBR owners. If caregivers are not able to produce a home-based record on request, they are asked the follow-up question whether they have ever received a home-based record on which their child's vaccination history was documented. The combination of those children whose caregivers produce the HBR and those who respond affirmatively to the question on ever receipt define the population of ever HBR owners.

The findings and views expressed herein are those of the author(s) alone and do not necessarily reflect those of their respective institutions. All reasonable precautions have been taken to verify the information contained herein. However, the material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the site administrator(s) or their employer be liable for damages arising from its use.