{"id":"https://openalex.org/W7214799505","doi":"https://doi.org/10.20944/preprints202609.2501.v1","title":"Determinants of Routine Immunisation Data Quality in Malawi: A PRISM-Framed Mixed-Methods Assessment","display_name":"Determinants of Routine Immunisation Data Quality in Malawi: A PRISM-Framed Mixed-Methods Assessment","publication_year":2026,"publication_date":"2026-09-29","ids":{"openalex":"https://openalex.org/W7214799505","doi":"https://doi.org/10.20944/preprints202609.2501.v1"},"language":"en","primary_location":{"id":"doi:10.20944/preprints202609.2501.v1","doi":"https://doi.org/10.20944/preprints202609.2501.v1","is_oa":true,"landing_page_url":"https://doi.org/10.20944/preprints202609.2501.v1","pdf_url":null,"source":{"id":"https://openalex.org/S6309402219","display_name":"Preprints.org","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://doi.org/10.20944/preprints202609.2501.v1","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5151224095","display_name":"Esther Malata","orcid":"https://orcid.org/0009-0001-2103-9663","observed_orcids":["https://orcid.org/0009-0001-2103-9663"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Esther Malata","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5024920559","display_name":"Beverly Shaila Laher","orcid":"https://orcid.org/0000-0002-6120-2701","observed_orcids":["https://orcid.org/0000-0002-6120-2701"]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Beverly Shailla Laher","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5065435121","display_name":"Jacqueline Rose Chinkonde","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Jacqueline R. Chinkonde","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5020192649","display_name":"Blessings H. Likoswe","orcid":"https://orcid.org/0000-0003-4583-7683","observed_orcids":["https://orcid.org/0000-0003-4583-7683"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Blessings H. Likoswe","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5151156754","display_name":"Beatrice Mkomadzinja","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Beatrice Mkomadzinja","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5022637365","display_name":"Susanne Barnaba","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Susan Barnaba","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5151165655","display_name":"Jimmy Banda","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Jimmy Banda","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5093849786","display_name":"Hannah Kachule","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Hannah Kachule","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5116295700","display_name":"Lonjezo Dzekedzeke","orcid":"https://orcid.org/0009-0000-9163-4479","observed_orcids":["https://orcid.org/0009-0000-9163-4479"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Lonjezo Dzekedzeke","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5062757516","display_name":"Andrew Matchado","orcid":"https://orcid.org/0000-0002-0302-5591","observed_orcids":["https://orcid.org/0000-0002-0302-5591"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Andrew Matchado","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5040059018","display_name":"Humphrey Chatenga","orcid":"https://orcid.org/0000-0002-8794-8392","observed_orcids":["https://orcid.org/0000-0002-8794-8392"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Humphrey Chatenga","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5002249741","display_name":"Ajib Phiri","orcid":"https://orcid.org/0000-0002-1615-0164","observed_orcids":["https://orcid.org/0000-0002-1615-0164"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Ajib Phiri","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5040343040","display_name":"Temwa Mzengeza","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Temwa Mzengeza","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5153427680","display_name":"Patrick N. Omar","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Patrick N. Omar","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5072957609","display_name":"Abiba L.P Longwe-Ngwira","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Abiba L. P. Longwe-Ngwira","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5018212973","display_name":"Chiara Pierotti","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Chiara Pierotti","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5059866523","display_name":"Charles Nwosisi","orcid":"https://orcid.org/0000-0002-9771-6659","observed_orcids":["https://orcid.org/0000-0002-9771-6659"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Charles Nwosisi","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5054141149","display_name":"Jennifer Barak","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Jennifer Barak","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5063533227","display_name":"Mike Chisema","orcid":"https://orcid.org/0000-0002-9705-3699","observed_orcids":["https://orcid.org/0000-0002-9705-3699"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Mike Chisema","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5092678969","display_name":"Brenda Mhone","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Brenda Mhone","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5061875179","display_name":"Hastings Chiumia","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Hastings Chiumia","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5040235344","display_name":"John C. Phuka","orcid":"https://orcid.org/0000-0003-4951-8145","observed_orcids":["https://orcid.org/0000-0003-4951-8145"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"John Phuka","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5012194562","display_name":"Asm Shahabuddin","orcid":"https://orcid.org/0000-0001-8543-0517","observed_orcids":["https://orcid.org/0000-0001-8543-0517"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"A. S. M. Shahabuddin","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":["https://openalex.org/A5024920559","https://openalex.org/A5065435121"],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T14400","display_name":"Medical Coding and Health Information","score":0.48750001192092896,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T14400","display_name":"Medical Coding and Health Information","score":0.48750001192092896,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10350","display_name":"Electronic Health Records Systems","score":0.15610000491142273,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10833","display_name":"Vaccine Coverage and Hesitancy","score":0.11349999904632568,"subfield":{"id":"https://openalex.org/subfields/3306","display_name":"Health"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/routine-immunization","display_name":"routine immunization","score":0.8090000152587891},{"id":"https://openalex.org/keywords/immunization-data-quality","display_name":"immunization data quality","score":0.9160000085830688},{"id":"https://openalex.org/keywords/prism-framework","display_name":"PRISM framework","score":0.6150000095367432},{"id":"https://openalex.org/keywords/data-accuracy","display_name":"data accuracy","score":0.6200000047683716},{"id":"https://openalex.org/keywords/pentavalent-vaccine","display_name":"pentavalent vaccine","score":0.652999997138977},{"id":"https://openalex.org/keywords/health-information-systems","display_name":"health information systems","score":0.5799999833106995},{"id":"https://openalex.org/keywords/data-governance","display_name":"data governance","score":0.7139999866485596},{"id":"https://openalex.org/keywords/data-verification","display_name":"data verification","score":0.6499999761581421},{"id":"https://openalex.org/keywords/malawi","display_name":"Malawi","score":0.6069999933242798}],"concepts":[{"id":"https://openalex.org/C24756922","wikidata":"https://www.wikidata.org/wiki/Q1757694","display_name":"Data quality","level":3,"score":0.6007999777793884},{"id":"https://openalex.org/C196879817","wikidata":"https://www.wikidata.org/wiki/Q872685","display_name":"Data governance","level":4,"score":0.531499981880188},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.4862000048160553},{"id":"https://openalex.org/C133462117","wikidata":"https://www.wikidata.org/wiki/Q4929239","display_name":"Data collection","level":2,"score":0.45809999108314514},{"id":"https://openalex.org/C198477413","wikidata":"https://www.wikidata.org/wiki/Q7647069","display_name":"Survey data collection","level":2,"score":0.45019999146461487},{"id":"https://openalex.org/C39389867","wikidata":"https://www.wikidata.org/wiki/Q380767","display_name":"Corporate governance","level":2,"score":0.4474000036716461},{"id":"https://openalex.org/C39896193","wikidata":"https://www.wikidata.org/wiki/Q380344","display_name":"Descriptive statistics","level":2,"score":0.4422999918460846},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.41040000319480896},{"id":"https://openalex.org/C138816342","wikidata":"https://www.wikidata.org/wiki/Q189603","display_name":"Public health","level":2,"score":0.3785000145435333},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.35510000586509705},{"id":"https://openalex.org/C169087156","wikidata":"https://www.wikidata.org/wiki/Q2131593","display_name":"Framing (construction)","level":2,"score":0.3447999954223633},{"id":"https://openalex.org/C1668388","wikidata":"https://www.wikidata.org/wiki/Q1149776","display_name":"Data management","level":2,"score":0.34150001406669617},{"id":"https://openalex.org/C2779530757","wikidata":"https://www.wikidata.org/wiki/Q1207505","display_name":"Quality (philosophy)","level":2,"score":0.3319999873638153},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.31380000710487366},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.3122999966144562},{"id":"https://openalex.org/C71405471","wikidata":"https://www.wikidata.org/wiki/Q757012","display_name":"Quality management","level":3,"score":0.295199990272522},{"id":"https://openalex.org/C75630572","wikidata":"https://www.wikidata.org/wiki/Q538904","display_name":"Applied psychology","level":1,"score":0.2928999960422516},{"id":"https://openalex.org/C142546437","wikidata":"https://www.wikidata.org/wiki/Q2661195","display_name":"Descriptive research","level":2,"score":0.29170000553131104},{"id":"https://openalex.org/C180198813","wikidata":"https://www.wikidata.org/wiki/Q121182","display_name":"Information system","level":2,"score":0.2831000089645386},{"id":"https://openalex.org/C203481301","wikidata":"https://www.wikidata.org/wiki/Q76221","display_name":"Data system","level":2,"score":0.2736999988555908},{"id":"https://openalex.org/C3019952477","wikidata":"https://www.wikidata.org/wiki/Q1324077","display_name":"Health records","level":3,"score":0.2635999917984009},{"id":"https://openalex.org/C145642194","wikidata":"https://www.wikidata.org/wiki/Q870895","display_name":"Health informatics","level":3,"score":0.2581999897956848},{"id":"https://openalex.org/C87156501","wikidata":"https://www.wikidata.org/wiki/Q7268708","display_name":"Qualitative property","level":2,"score":0.25459998846054077},{"id":"https://openalex.org/C182566","wikidata":"https://www.wikidata.org/wiki/Q759524","display_name":"Organizational structure","level":2,"score":0.25369998812675476},{"id":"https://openalex.org/C182306322","wikidata":"https://www.wikidata.org/wiki/Q1779371","display_name":"Order (exchange)","level":2,"score":0.25200000405311584},{"id":"https://openalex.org/C545542383","wikidata":"https://www.wikidata.org/wiki/Q2751242","display_name":"Medical emergency","level":1,"score":0.25110000371932983}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.20944/preprints202609.2501.v1","doi":"https://doi.org/10.20944/preprints202609.2501.v1","is_oa":true,"landing_page_url":"https://doi.org/10.20944/preprints202609.2501.v1","pdf_url":null,"source":{"id":"https://openalex.org/S6309402219","display_name":"Preprints.org","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.20944/preprints202609.2501.v1","doi":"https://doi.org/10.20944/preprints202609.2501.v1","is_oa":true,"landing_page_url":"https://doi.org/10.20944/preprints202609.2501.v1","pdf_url":null,"source":{"id":"https://openalex.org/S6309402219","display_name":"Preprints.org","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"posted-content"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.9391000270843506,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W4309659856","https://openalex.org/W1846898798","https://openalex.org/W4382117499","https://openalex.org/W4382117380","https://openalex.org/W2740778870","https://openalex.org/W3217083298","https://openalex.org/W4409284555","https://openalex.org/W4361001416","https://openalex.org/W2294818551","https://openalex.org/W6959746671"],"abstract_inverted_index":{"Background/Objectives:":[0],"Efforts":[1],"to":[2,54,65,268,309,350],"improve":[3],"routine":[4,55,318,342],"health":[5],"data":[6,14,24,57,72,84,127,263,319,344,352],"often":[7],"focus":[8],"on":[9,19,247],"tools":[10],"and":[11,25,46,77,110,115,129,132,143,152,167,180,208,243,250,270,301,327,355,361],"forms,":[12,166],"yet":[13,190],"quality":[15,345],"depends":[16],"as":[17,245,251],"much":[18],"the":[20,23,26,29,71,88,104,136,141,168,206,254,262,296,306,317],"organization":[21],"around":[22],"behavior":[27],"of":[28,36,61,91,100,126,176,192,205,257,290,316],"people":[30],"who":[31],"produce":[32],"it.":[33],"The":[34,138,156,178,281,313],"Performance":[35],"Routine":[37],"Information":[38],"System":[39],"Management":[40],"framework":[41],"separates":[42],"these":[43,334],"technical,":[44],"organizational,":[45],"behavioral":[47,181,209,328],"determinants.":[48],"This":[49],"study":[50],"applied":[51],"that":[52,106,225,236,258],"framing":[53],"immunization":[56,343],"in":[58,63,97,161,173,261,323],"five":[59],"districts":[60],"Malawi,":[62],"order":[64],"ask":[66],"not":[67,331],"only":[68,288],"how":[69,351],"good":[70],"were":[73,118,133,159,171,183,187,230,321],"but":[74,287,325],"why.":[75],"Materials":[76],"Methods:":[78],"A":[79,202],"mixed-methods":[80],"facility":[81,338],"assessment":[82],"measured":[83],"accuracy":[85,144,215,278,283],"by":[86],"recounting":[87],"third":[89],"dose":[90],"pentavalent":[92],"vaccine":[93],"against":[94],"monthly":[95],"reports":[96],"50":[98],"facilities,":[99],"which":[101],"44":[102,291],"being":[103],"subset":[105],"had":[107],"both":[108],"reported":[109],"verified":[111],"values.":[112],"Technical,":[113],"organisational,":[114],"behavioural":[116],"determinants":[117,142,158,182,210],"assessed":[119],"through":[120,135],"a":[121,124,148],"structured":[122],"checklist,":[123],"survey":[125],"staff,":[128],"key-informant":[130],"interviews,":[131],"interpreted":[134],"framework.":[137],"relationship":[139],"between":[140],"was":[145,198,264,274,279,285],"examined":[146],"using":[147],"composite":[149,203],"readiness":[150],"score":[151,204],"descriptive":[153],"comparison.":[154],"Results:":[155],"technical":[157,314],"largely":[160,322],"place,":[162,324],"because":[163],"registers,":[164],"reporting":[165],"electronic":[169],"system":[170],"available":[172],"about":[174],"98%":[175],"facilities.":[177],"organizational":[179,207,326],"weaker.":[184],"Governance":[185],"structures":[186],"widely":[188],"present,":[189],"none":[191],"ten":[193],"governance":[194],"or":[195],"data-use":[196],"functions":[197],"associated":[199],"with":[200,214],"accuracy.":[201],"showed":[211],"no":[212,231],"association":[213],"(Spearman":[216],"\u03c1":[217],"=":[218,221],"0.22,":[219],"p":[220],"0.153),":[222],"so":[223],"facilities":[224,292],"met":[226,237],"almost":[227],"every":[228],"condition":[229],"more":[232],"accurate":[233,308,337],"than":[234],"those":[235],"few.":[238],"Staff":[239],"described":[240],"audits,":[241],"supervision,":[242],"training":[244],"dependent":[246],"external":[248],"funding,":[249],"lapsing":[252],"under":[253],"2025":[255],"withdrawal":[256],"funding.":[259],"Confidence":[260],"high":[265],"at":[266],"91":[267],"100%,":[269,286],"review":[271],"before":[272],"submission":[273],"near":[275],"universal,":[276],"although":[277],"uneven.":[280],"median":[282],"ratio":[284],"34":[289],"(77%)":[293],"fell":[294],"within":[295,310],"acceptable":[297],"range,":[298],"while":[299],"over-reporting":[300],"under-reporting":[302],"nearly":[303],"cancelled,":[304],"leaving":[305],"aggregate":[307],"1%.":[311],"Conclusions:":[312],"foundations":[315,335],"systems":[320],"mechanisms":[329],"did":[330],"consistently":[332],"translate":[333],"into":[336],"level":[339],"data.":[340],"Strengthening":[341],"will":[346],"require":[347],"greater":[348],"attention":[349],"verification,":[353],"feedback":[354],"corrective":[356],"actions":[357],"are":[358],"routinely":[359],"implemented":[360],"sustained.":[362]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-09-30T00:00:00"}
