title: Timeliness and completeness of vaccination and risk factors for low and late vaccine uptake in young children living in rural southern Tanzania.
abstract: BACKGROUND
  We studied coverage and timeliness of vaccination and risk factors for low and delayed vaccine uptake in children aged <2 years in rural Tanzania.
  
  
  METHODS
  We used data from a cluster survey conducted in 2004, which included 1403 children. Risk factors were analysed by log-binomial regression adjusted for the clustering. The analysis was restricted to BCG, first and third dose of Diphtheria-Tetanus-Pertussis vaccines (DTP-1 and DTP-3) and first dose of measles-containing vaccine (MCV-1).
  
  
  RESULTS
  Coverage for BCG, DTP-1, DTP-3 and MCV-1 was 94%, 96%, 90% and 86%, respectively. Delayed vaccination (>1 month after the recommended age) occurred in 398/1205 (33%) children for BCG, 404/1189 (34%) for DTP-1, 683/990 (69%) for DTP-3 and 296/643 (46%) for MCV-1. Coverage was lower for all vaccines except DTP-1 in children living ≥5 km from a healthcare facility. Delayed uptake was associated with poverty. Low and delayed MCV-1 vaccination was associated with low maternal education. Delayed BCG vaccination was associated with ethnicity and rainy season.
  
  
  CONCLUSIONS
  Despite reasonably high vaccination coverage, we observed substantial vaccination delays, particularly for DTP-3 and MCV-1. We found specific factors associated with low and/or delayed vaccine uptake. These findings can help to improve strategies to reach children who remain inadequately protected.
authors.affiliation: Department of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Olivier
authors.initials: O
authors.lastname: Le Polain de Waroux
authors.forename: Joanna R Armstrong
authors.initials: JR
authors.lastname: Schellenberg
authors.forename: Fatuma
authors.initials: F
authors.lastname: Manzi
authors.forename: Mwifadhi
authors.initials: M
authors.lastname: Mrisho
authors.forename: Kizito
authors.initials: K
authors.lastname: Shirima
authors.forename: Hassan
authors.initials: H
authors.lastname: Mshinda
authors.forename: Pedro
authors.initials: P
authors.lastname: Alonso
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
authors.forename: David M
authors.initials: DM
authors.lastname: Schellenberg
mesh_terms: D001500:BCG Vaccine / Q000008:administration & dosage*; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage*; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008297:Male; D008458:Measles Vaccine / Q000008:administration & dosage*; D009035:Mothers; D010342:Patient Acceptance of Health Care; D011203:Poverty; D011891:Rain; D012307:Risk Factors; D012424:Rural Population; D012621:Seasons; D013636:Tanzania; D014611:Vaccination
chemical_list: D001500:BCG Vaccine; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D008458:Measles Vaccine
keywords: Children; Coverage; Risk factors; Tanzania; Timeliness; Vaccination