title: Is vaccination coverage a good indicator of age-appropriate vaccination? A prospective study from Uganda.
abstract: BACKGROUND
  Timely vaccination is important to protect children from common infectious diseases. We assessed vaccination timeliness and vaccination coverage as well as coverage of vitamin A supplementation in a Ugandan setting.
  
  
  RESULTS
  This study used vaccination information gathered during a cluster-randomized trial promoting exclusive breastfeeding in Eastern Uganda between 2006 and 2008 (ClinicalTrials.gov no. NCT00397150). Five visits were carried out from birth up to 2 years of age (median follow-up time 1.5 years), and 765 children were included in the analysis. We used Kaplan-Meier time-to-event analysis to describe vaccination coverage and timeliness. Vaccination coverage at the end of follow-up was above 90% for all vaccines assessed individually that were part of the Expanded Program on Immunization (EPI), except for the measles vaccine which had 80% coverage (95%CI 76-83). In total, 75% (95%CI 71-79) had received all the recommended vaccines at the end of follow-up. Timely vaccination according to the recommendations of the Ugandan EPI was less common, ranging from 56% for the measles vaccine (95%CI 54-57) to 89% for the Bacillus Calmette-Guérin (BCG) vaccine (95%CI 86-91). Only 18% of the children received all vaccines within the recommended time ranges (95%CI 15-22). The children of mothers with higher education had more timely vaccination. The coverage for vitamin A supplementation at end of follow-up was 84% (95%CI 81-87).
  
  
  CONCLUSIONS
  Vaccination coverage was reasonably high, but often not timely. Many children were unprotected for several months despite being vaccinated at the end of follow-up. There is a need for continued efforts to optimise vaccination timeliness.
authors.affiliation: Centre for International Health, University of Bergen, 5018 Bergen, Norway. lars.fadnes@cih.uib.no
authors.forename: Lars T
authors.initials: LT
authors.lastname: Fadnes
authors.forename: Victoria
authors.initials: V
authors.lastname: Nankabirwa
authors.forename: Halvor
authors.initials: H
authors.lastname: Sommerfelt
authors.forename: Thorkild
authors.initials: T
authors.lastname: Tylleskär
authors.forename: James K
authors.initials: JK
authors.lastname: Tumwine
authors.forename: Ingunn M S
authors.initials: IM
authors.lastname: Engebretsen
mesh_terms: D002648:Child; D002986:Clinical Trials as Topic; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007115:Immunization Schedule; D053208:Kaplan-Meier Estimate; D008297:Male; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D014454:Uganda; D014611:Vaccination / Q000706:statistics & numerical data*; D014612:Vaccines / Q000008:administration & dosage; D014801:Vitamin A / Q000008:administration & dosage
chemical_list: D014612:Vaccines; D014801:Vitamin A