Open Access Open Badges Analytic perspective

Performance of small cluster surveys and the clustered LQAS design to estimate local-level vaccination coverage in Mali

Andrea Minetti1*, Margarita Riera-Montes1, Fabienne Nackers1, Thomas Roederer1, Marie Hortense Koudika2, Johanne Sekkenes2, Aurore Taconet3, Florence Fermon3, Albouhary Touré4, Rebecca F Grais1 and Francesco Checchi1

Author Affiliations

1 Epicentre, Paris, France

2 Médecins Sans Frontières, Bamako, Mali

3 Médecins Sans Frontières, Paris, France

4 National Centre for Immunization, Ministry of Health, Bamako, Mali

For all author emails, please log on.

Emerging Themes in Epidemiology 2012, 9:6  doi:10.1186/1742-7622-9-6

Published: 12 October 2012



Estimation of vaccination coverage at the local level is essential to identify communities that may require additional support. Cluster surveys can be used in resource-poor settings, when population figures are inaccurate. To be feasible, cluster samples need to be small, without losing robustness of results. The clustered LQAS (CLQAS) approach has been proposed as an alternative, as smaller sample sizes are required.


We explored (i) the efficiency of cluster surveys of decreasing sample size through bootstrapping analysis and (ii) the performance of CLQAS under three alternative sampling plans to classify local VC, using data from a survey carried out in Mali after mass vaccination against meningococcal meningitis group A.


VC estimates provided by a 10 × 15 cluster survey design were reasonably robust. We used them to classify health areas in three categories and guide mop-up activities: i) health areas not requiring supplemental activities; ii) health areas requiring additional vaccination; iii) health areas requiring further evaluation. As sample size decreased (from 10 × 15 to 10 × 3), standard error of VC and ICC estimates were increasingly unstable. Results of CLQAS simulations were not accurate for most health areas, with an overall risk of misclassification greater than 0.25 in one health area out of three. It was greater than 0.50 in one health area out of two under two of the three sampling plans.


Small sample cluster surveys (10 × 15) are acceptably robust for classification of VC at local level. We do not recommend the CLQAS method as currently formulated for evaluating vaccination programmes.

Vaccination coverage; Mali; Meningitis; Lot quality assurance sampling; LQAS; Cluster sampling; Survey