title: Socioeconomic inequalities are still a barrier to full child vaccine coverage in the Brazilian Amazon: a cross-sectional study in Assis Brasil, Acre, Brazil.
abstract: BACKGROUND
  Vaccines are very important to reduce morbidity and mortality by preventable infectious diseases, especially during childhood. Optimal coverage is not always achieved, for several reasons. Here we assessed vaccine coverage for the first 12 months of age in children between 12 and 59 months old, residing in the urban area of a small Amazonian city, and factors associated with incomplete vaccination.
  
  
  METHODS
  A census was performed in the urban area of Assis Brasil, in the Brazilian Amazon, in January 2010, with mothers of 282 children aged 12 to 59 months old, using structured interviews and data from vaccination cards. Mixed logistic regression was used to determine factors associated with incomplete vaccination schemes.
  
  
  RESULTS
  Only 82.6% of all children had a completed the basic vaccine scheme for the first year of life. Vaccine coverage ranged from 52.7% coverage (oral rotavirus vaccine) to 99.7% coverage (for Bacille Calmette-Guérin). The major deficiencies occurred in doses administered after the first six months of life. Incomplete vaccination was associated with not having enough income to buy a house (aOR = 2.12, 95% CI 1.06-4.21), low maternal schooling (aOR = 2.60, 95% CI 1.28 - 5.29) , and time of residence of the child in the urban area of the city (aOR = 0.73, 95% CI 0.55 - 0.95).
  
  
  CONCLUSIONS
  This study showed that vaccine coverage in the first twelve months of life in Assis Brasil is similar to other areas in the Amazon and it is below the coverage postulated by the Brazilian Ministry of Health. Low vaccine coverage was associated with socioeconomic inequities that still prevail in the Brazilian Amazon. Short and long-term strategies must be taken to update child vaccines and increase vaccine coverage in the Amazon.
authors.affiliation: Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil. flccbranco@uol.com.br.
authors.forename: Fernando Luiz Cunha Castelo
authors.initials: FL
authors.lastname: Branco
authors.affiliation: Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil. thascy_moraes@hotmail.com.
authors.forename: Thasciany Moraes
authors.initials: TM
authors.lastname: Pereira
authors.affiliation: Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil. brenomd_@hotmail.com.
authors.forename: Breno Matos
authors.initials: BM
authors.lastname: Delfino
authors.affiliation: Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil. athosbrana@hotmail.com.
authors.forename: Athos Muniz
authors.initials: AM
authors.lastname: Braña
authors.affiliation: Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil. hosoliart@hotmail.com.
authors.forename: Humberto
authors.initials: H
authors.lastname: Oliart-Guzmán
authors.affiliation: Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil. sauloaugustomantovani@hotmail.com.
authors.forename: Saulo Augusto Silva
authors.initials: SA
authors.lastname: Mantovani
authors.affiliation: Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil. antonio_camargo0@yahoo.com.br.
authors.forename: Antonio Camargo
authors.initials: AC
authors.lastname: Martins
authors.affiliation: Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil. crisufac@yahoo.com.br.
authors.forename: Cristieli Sérgio de Menezes
authors.initials: CS
authors.lastname: Oliveira
authors.affiliation: Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil. alandersonalves@hotmail.com.
authors.forename: Alanderson Alves
authors.initials: AA
authors.lastname: Ramalho
authors.affiliation: Scientific Computing Program, Oswaldo Cruz Foundation, Avenida Brasil, 4365, Rio de Janeiro, RJ, Brazil. claudia.codeco@gmail.com.
authors.forename: Claudia Torres
authors.initials: CT
authors.lastname: Codeço
authors.affiliation: Universidade Federal do Acre, BR 363 km 04, 69919-769, Rio Branco, Acre, Brazil. msnunes1@yahoo.com.br.
authors.forename: Mônica
authors.initials: M
authors.lastname: da Silva-Nunes
mesh_terms: D001938:Brazil; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007223:Infant; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000706:statistics & numerical data; D014611:Vaccination / Q000592:standards*