title: Coverage and timing of children's vaccination: an evaluation of the expanded programme on immunisation in The Gambia.
abstract: OBJECTIVE
  To evaluate the coverage and timeliness of the Expanded Programme on Immunisation (EPI) in The Gambia.
  
  
  METHODS
  Vaccination data were obtained between January 2005 and December 2012 from the Farafenni Health and Demographic Surveillance System (FHDSS), the Basse Health and Demographic Surveillance System (BHDSS), the Kiang West Demographic surveillance system (KWDSS), a cluster survey in the more urban Western Health Region (WR) and a cross sectional study in four clinics in the semi-urban Greater Banjul area of WR. Kaplan-Meier survival function was used to estimate the proportion vaccinated by age and to assess timeliness to vaccination.
  
  
  RESULTS
  BCG vaccine uptake was over 95% in all regions. Coverage of DPT1 ranged from 93.2% in BHDSS to 99.8% in the WR. Coverage decreased with increasing number of DPT doses; DPT3 coverage ranged from 81.7% in BHDSS to 99.0% in WR. Measles vaccination coverage ranged from 83.3% in BHDSS to 97.0% in WR. DPT4 booster coverage was low and ranged from 43.9% in the WR to 82.8% in KWDSS. Across all regions, delaying on previous vaccinations increased the likelihood of being delayed for the subsequent vaccination.
  
  
  CONCLUSIONS
  The Gambia health system achieves high vaccine coverage in the first year of life. However, there continues to be a delay to vaccination which may impact on the introduction of new vaccines. Examples of effectively functioning EPI programmes such as The Gambia one may well be important models for other low income countries struggling to achieve high routine vaccination coverage.
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia; London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Susana
authors.initials: S
authors.lastname: Scott
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: Aderonke
authors.initials: A
authors.lastname: Odutola
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: Grant
authors.initials: G
authors.lastname: Mackenzie
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia; London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Tony
authors.initials: T
authors.lastname: Fulford
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: Muhammed O
authors.initials: MO
authors.lastname: Afolabi
authors.affiliation: Ministry of Health and Social Welfare Government of The Gambia, The Quadrangle, Banjul, The Gambia.
authors.forename: Yamundow
authors.initials: Y
authors.lastname: Lowe Jallow
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: Momodou
authors.initials: M
authors.lastname: Jasseh
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: David
authors.initials: D
authors.lastname: Jeffries
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: Bai Lamin
authors.initials: BL
authors.lastname: Dondeh
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: Stephen R C
authors.initials: SR
authors.lastname: Howie
authors.affiliation: Medical Research Council Unit, Fajara, The Gambia.
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
mesh_terms: D017677:Age Distribution; D001500:BCG Vaccine / Q000008:administration & dosage / Q000627:therapeutic use; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005714:Gambia; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D032541:Mass Vaccination / Q000706:statistics & numerical data*; D008458:Measles Vaccine / Q000008:administration & dosage / Q000627:therapeutic use; D055118:Medication Adherence; D009313:National Health Programs / Q000706:statistics & numerical data*
chemical_list: D001500:BCG Vaccine; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D008458:Measles Vaccine