title: Achieving comprehensive childhood immunization: an analysis of obstacles and opportunities in The Gambia.
abstract: BACKGROUND
  Immunization is a vital component in the drive to decrease global childhood mortality, yet challenges remain in ensuring wide coverage of immunization and full immunization, particularly in low- and middle-income countries. This study assessed immunization coverage and the determinants of immunization in a semi-rural area in The Gambia.
  
  
  METHODS
  Data were drawn from the Farafenni Health and Demographic Surveillance System. Children born within the surveillance area between January 2000 and December 2010 were included. Main outcomes assessed included measles, BCG and DTP vaccination status and full immunization by 12 months of age as reported on child healthcards. Predictor variables were evaluated based on a literature review and included gender, ethnicity, area of residence, household wealth and mother's age.
  
  
  RESULTS
  Of the 7363 children included in the study, immunization coverage was 73% (CI 72-74) for measles, 86% (CI 86-87) for BCG, 79% (CI 78-80) for three doses of DTP and 52% (CI 51-53) for full immunization. Coverage was significantly associated with area of residence and ethnicity, with children in urban areas and of Mandinka ethnicity being least likely to be fully immunized.
  
  
  CONCLUSIONS
  Despite high levels of coverage of many individual vaccines, delivery of vaccinations later in the schedule and achieving high coverage of full immunization remain challenges, even in a country with a committed childhood immunization programme, such as The Gambia. Our data indicate areas for targeted interventions by the national Expanded Programme of Immunization.
authors: Department of Public Health, University of Oxford, Room 106, Rosemary Rue Building, Old Road Campus, Headington, Oxford OX3 7LG, UK. E-mail: sarah.payne@oxsph.org.
authors: Sarah
authors: S
authors: Payne
authors: John
authors: J
authors: Townend
authors: Momodou
authors: M
authors: Jasseh
authors: Yamundow
authors: Y
authors: Lowe Jallow
authors: Beate
authors: B
authors: Kampmann
mesh_terms: D005260:Female; D005714:Gambia; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D009035:Mothers / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data
keywords: The Gambia; child; determinants; immunization; socio-demographic