title: Timing and delay in children vaccination; evaluation of expanded program of immunization in outskirt of Iranian cities.
abstract: BACKGROUND
  Most studies evaluated the vaccine coverage, but the time of vaccination is important as coverage. This study was conducted to evaluate the Expanded Program of Immunization (EPI) in outskirt of Iranian cities regarding to incidence of delay vaccination among children less than 4 years.
  
  
  METHODS
  This cross sectional descriptive study was conducted among children 24-47 months old, living in the suburbs of five metropolises of Iran. Totally, 3610 eligible children selected with proportioned cluster sampling method and data of vaccination card extracted after interview with child parents. Delayed incidence rate reported and predictive factors assessed by Chi square test and Multivariate logistic regression.
  
  
  RESULTS
  Overall, 56.6% to 93.2% vaccines were administered out of time. Delayed vaccination incidence with more than one-week delay varies from 5.5% to 74.9% for polio at birth and MMR2 at 18 month, respectively. Mother's educational level and birth order were the most important predictors of delayed vaccination. Incidence of delayed vaccination was enlarged by increasing birth order and decreased in lower educated mothers.
  
  
  CONCLUSIONS
  Incidence rate of delayed vaccination is more than expectation. Regarding to high coverage vaccines in Iran, heath officers and health policy makers should attempt for on-time vaccination beside of high immunization coverage especially in slum areas with more concentrated immigrants due to low literature and crowded families.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mehri
authors.initials: M
authors.lastname: Rejali
authors.affiliation: Department of Epidemiology and Biostatistics, Health Policy and Promotion Research Center, Qom University of Medical Sciences, Qom, Iran. beigi60@gmail.com.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Mohammadbeigi
authors.affiliation: Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Mokhtari
authors.affiliation: Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran.
authors.forename: Seyed Mohsen
authors.initials: SM
authors.lastname: Zahraei
authors.affiliation: Department of Public Health, School of Health, Arak University of Medical Sciences, Arak, Iran.
authors.forename: Babak
authors.initials: B
authors.lastname: Eshrati
mesh_terms: D001722:Birth Order; D002675:Child, Preschool; D002947:Cities; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D004334:Drug Administration Schedule; D004522:Educational Status; D006801:Humans; D007114:Immunization; D017589:Immunization Programs / Q000592:standards*; D015994:Incidence; D007223:Infant; D007492:Iran; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage*; D009035:Mothers; D023321:Poliovirus Vaccines / Q000008:administration & dosage*; D012424:Rural Population; D013383:Suburban Population; D014611:Vaccination
chemical_list: D022542:Measles-Mumps-Rubella Vaccine; D023321:Poliovirus Vaccines
keywords: Children; Delay; Immunization; Iran; Measles; Timelines vaccination