Page 72 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
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11 National QA Convention, 4 – 6 October 2022
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Improving Mumps, Measles and Rubella (MMR) 2 Immunisation Rate in Klinik Kesihatan
Jalan Oya

Rose NMY, Cooghen DG
Klinik Kesihatan Jalan Oya, Sarawak

SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
The MMR 2 immunisation rate for KK Jalan Oya was always below the Ministry of Health standard of 95%.
The low immunisation rate poses public health danger as it leaves children and the community vulnerable to
vaccine-preventable diseases and deadly outbreaks.

KEY MEASURES OF IMPROVEMENT:
The indicator is the percentage of children aged 12-23 months registered in the clinic who received the second
dose of MMR vaccine at 12 months. The standard for this study is to achieve an MMR 2 immunisation rate of
more than 95%.

PROCESS OF GATHERING INFORMATION:
The process of gathering information in this project involves a retrospective study on 120 samples from KKK
101 Ledger 2017 to identify pitfalls in defaulter tracing, interview of defaulters, a KAP (Knowledge, Attitude
and Practice) study on parents/guardians, and an observational study for health promotion materials.

ANALYSIS AND INTERPRETATION:
Pre remedial MMR immunisation rate was 84.1% (2016) and 92.2% (2017). Parental factors, delay in defaulter
tracing and lack of health promotion are among the contributing factors identified. Out of 100 parents,
82% show good knowledge and 65% have good vaccination practice. Most defaulters face transportation
problems (60%), while 25% cited time constraints and 15% forgot appointments. Only 60% of defaulters were
successfully contacted and 40% of home visits were achieved within three days.

STRATEGIES FOR CHANGE:
Staff could trace defaulters efficiently by implementing a systematic defaulter tracing tool using Borang
Quality Assurance Project (QAP) that contains multiple patients’ particulars. A notification slip was left at the
patient’s home as a safety net for missed patients during the home visit.

EFFECT OF CHANGE:
In 2018, 84.8% of defaulters were successfully contacted and 80% of home visits were completed. The rate of
MMR 2 immunisation increased from 92.2% (2017) to 98.2% (2018).

THE NEXT STEP:
Defaulter tracing systems using Borang QAP are in the process of being adopted for infants registered in all
health clinics in Sibu division.

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