title: Risk factors for delay in age-appropriate vaccinations among Gambian children.
abstract: BACKGROUND
  Vaccination has been shown to reduce mortality and morbidity due to vaccine-preventable diseases. However, these diseases are still responsible for majority of childhood deaths worldwide especially in the developing countries. This may be due to low vaccine coverage or delay in receipt of age-appropriate vaccines. We studied the timeliness of routine vaccinations among children aged 12-59 months attending infant welfare clinics in semi-urban areas of The Gambia, a country with high vaccine coverage.
  
  
  METHODS
  A cross-sectional survey was conducted in four health centres in the Western Region of the Gambia. Vaccination dates were obtained from health cards and timeliness assessed based on the recommended age ranges for BCG (birth-8 weeks), Diphtheria-Pertussis-Tetanus (6 weeks-4 months; 10 weeks-5 months; 14 weeks-6 months) and measles vaccines (38 weeks-12 months). Risk factors for delay in age-appropriate vaccinations were determined using logistic regression. Analysis was limited to BCG, third dose of Diphtheria-Pertussis -Tetanus (DPT3) and measles vaccines.
  
  
  RESULTS
  Vaccination records of 1154 children were studied. Overall, 63.3% (95 % CI 60.6-66.1%) of the children had a delay in the recommended time to receiving at least one of the studied vaccines. The proportion of children with delayed vaccinations increased from BCG [5.8% (95 % CI 4.5-7.0%)] to DPT3 [60.4% (95 % CI 57.9%-63.0%)] but was comparatively low for the measles vaccine [10.8% (95 % CI 9.1%-12.5%)]. Mothers of affected children gave reasons for the delay, and their profile correlated with type of occupation, place of birth and mode of transportation to the health facilities.
  
  
  CONCLUSIONS
  Despite high vaccination coverage reported in The Gambia, a significant proportion of the children's vaccines were delayed for reasons related to health services as well as profile of mothers. These findings are likely to obtain in several countries and should be addressed by programme managers in order to improve and optimize the impact of the immunization coverage rates.
authors: Medical Research Council Unit, PO Box 273, Banjul, Fajara, The Gambia. aaodutola@mrc.gm.
authors: Aderonke
authors: A
authors: Odutola
authors: Medical Research Council Unit, PO Box 273, Banjul, Fajara, The Gambia. mafolabi@mrc.gm.
authors: Muhammed O
authors: MO
authors: Afolabi
authors: Medical Research Council Unit, PO Box 273, Banjul, Fajara, The Gambia. tundeyogundare@yahoo.com.
authors: Ezra O
authors: EO
authors: Ogundare
authors: Ministry of Health and Social Welfare, Banjul, The Gambia. ylowe_jallow@hotmail.com.
authors: Yamu Ndow
authors: YN
authors: Lowe-Jallow
authors: Medical Research Council Unit, PO Box 273, Banjul, Fajara, The Gambia. aworwui@mrc.gm.
authors: Archibald
authors: A
authors: Worwui
authors: Medical Research Council Unit, PO Box 273, Banjul, Fajara, The Gambia. jokebe@mrc.gm.
authors: Joseph
authors: J
authors: Okebe
authors: Medical Research Council Unit, PO Box 273, Banjul, Fajara, The Gambia. otama@who.int.|World Health Organization Regional Office for Africa, Brazzaville, Congo. otama@who.int.
authors: Martin O
authors: MO
authors: Ota
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage; D005260:Female; D005714:Gambia; D019983:Guideline Adherence; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D008458:Measles Vaccine / Q000008:administration & dosage; D008875:Middle Aged; D009035:Mothers; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D008458:Measles Vaccine