Monitoring health interventions – who's afraid of LQAS?

Lot quality assurance sampling (LQAS) is used to evaluate health services. Subunits of a population (lots) are accepted or rejected according to the number of failures in a random sample (N) of a given lot. If failures are greater than decision value (d), we reject the lot and recommend corrective actions in the lot (i.e. intervention area); if they are equal to or less than d, we accept it. We used LQAS to monitor coverage during the last 3 days of a meningitis vaccination campaign in Niger. We selected one health area (lot) per day reporting the lowest administrative coverage in the previous 2 days. In the sampling plan we considered: N to be small enough to allow us to evaluate one lot per day, deciding to sample 16 individuals from the selected villages of each health area, using probability proportionate to population size; thresholds and d to vary according to administrative coverage reported; α ≤5% (meaning that, if we would have conducted the survey 100 times, we would have accepted the lot up to five times when real coverage was at an unacceptable level) and β ≤20% (meaning that we would have rejected the lot up to 20 times, when real coverage was equal or above the satisfactory level). We classified all three lots as with the acceptable coverage. LQAS appeared to be a rapid, simple, and statistically sound method for in-process coverage assessment. We encourage colleagues in the field to consider using LQAS in complement with other monitoring techniques such as house-to-house monitoring.