title: Acceptance of multiple injectable vaccines in a single immunization visit in The Gambia pre and post introduction of inactivated polio vaccine.
abstract: As the World Health Organization (WHO) currently recommends that children be protected against 11 different pathogens, it is becoming increasingly necessary to administer multiple injectable vaccines during a single immunization visit. In this study we assess Gambian healthcare providers' and infant caregivers' attitudes and practices related to the administration of multiple injectable vaccines to a child at a single immunization visit before and after the 2015 introduction of inactivated polio vaccine (IPV). IPV introduction increased the number of injectable vaccines recommended for the 4-month immunization visit from two to three in The Gambia.
  
  
  
  We conducted a cross-sectional questionnaire-based survey before and after the introduction of IPV at 4months of age in a representative sample of all health facilities providing immunizations in The Gambia. Healthcare providers who administer vaccines at the selected health facilities and caregivers who brought infants for their 4month immunization visit were surveyed.
  
  
  
  Prior to IPV introduction, 9.9% of healthcare providers and 35.7% of infant caregivers expressed concern about a child receiving more than 2 injections in a single visit. Nevertheless, 98.8% and 90.9% of infants received all required vaccinations for the visit before and after IPV introduction, respectively. The only reason why vaccines were not received was vaccine stock-outs. Infant caregivers generally agreed that vaccinators could be trusted to provide accurate information regarding the number of vaccines that a child needed.
  
  
  
  Healthcare providers and infant caregivers in this resource limited setting accepted an increase in the number of injectable vaccines administered at a single visit even though some expressed concerns about the increase.
authors: Vaccines and Immunity Theme, Medical Research Council Unit, Gambia. Electronic address: bukkyidoko@gmail.com.
authors: Olubukola T
authors: OT
authors: Idoko
authors: Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA.
authors: Lee M
authors: LM
authors: Hampton
authors: Vaccines and Immunity Theme, Medical Research Council Unit, Gambia.
authors: Robert B
authors: RB
authors: Mboizi
authors: Vaccines and Immunity Theme, Medical Research Council Unit, Gambia.
authors: Schadrac C
authors: SC
authors: Agbla
authors: Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA.
authors: Aaron S
authors: AS
authors: Wallace
authors: Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA.
authors: Jennifer B
authors: JB
authors: Harris
authors: Ministry of Health and Social Welfare, Banjul, Gambia.
authors: Dawda
authors: D
authors: Sowe
authors: Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA.
authors: Daniel C
authors: DC
authors: Ehlman
authors: Vaccines and Immunity Theme, Medical Research Council Unit, Gambia; Academic Department of Paediatrics, Imperial College London, UK.
authors: Beate
authors: B
authors: Kampmann
authors: WHO Regional Office for Africa, Brazaville, Congo.
authors: Martin O
authors: MO
authors: Ota
authors: Global Immunization Division, Centres for Disease Control and Prevention, Atlanta, USA.
authors: Terri B
authors: TB
authors: Hyde
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology*; D003430:Cross-Sectional Studies; D005714:Gambia; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011054:Poliovirus Vaccine, Inactivated / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D011054:Poliovirus Vaccine, Inactivated
keywords: Acceptance; Caregivers; Healthcare providers; Multiple injectable vaccines; Single visit; The Gambia