title: Household experience and costs of seeking measles vaccination in rural Guinea-Bissau.
abstract: Children younger than 12 months of age are eligible for childhood vaccines through the public health system in Guinea-Bissau. To limit open vial wastage, a restrictive vial opening policy has been implemented; 10-dose measles vaccine vials are only opened if six or more children aged 9-11 months are present at the vaccination post. Consequently, mothers who bring their child for measles vaccination can be told to return another day. We aimed to describe the household experience and estimate household costs of seeking measles vaccination in rural Guinea-Bissau.
  
  
  
  Within a national sample of village clusters under demographic surveillance, we interviewed mothers of children aged 9-21 months about their experience with seeking measles vaccination. From information about time and money spent, we calculated household costs of seeking measles vaccination.
  
  
  
  We interviewed mothers of 1308 children of whom 1043 (80%) had sought measles vaccination at least once. Measles vaccination coverage was 70% (910/1308). Coverage decreased with increasing distance to the health centre. On average, mothers who had taken their child for vaccination took their child 1.4 times. Mean costs of achieving 70% coverage were 2.04 USD (SD 3.86) per child taken for vaccination. Half of the mothers spent more than 2 h seeking vaccination and 11% spent money on transportation.
  
  
  
  We found several indications of missed opportunities for measles vaccination resulting in suboptimal coverage. The household costs comprised 3.3% of the average monthly income and should be taken into account when assessing the costs of delivering vaccinations.
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.|Bandim Health Project, Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen S, Denmark.|Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Byberg
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.|Bandim Health Project, Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen S, Denmark.|Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark.
authors.forename: A B
authors.initials: AB
authors.lastname: Fisker
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
authors.forename: A
authors.initials: A
authors.lastname: Rodrigues
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
authors.forename: I
authors.initials: I
authors.lastname: Balde
authors.affiliation: Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: U
authors.initials: U
authors.lastname: Enemark
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.|Bandim Health Project, Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen S, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Aaby
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.|Bandim Health Project, Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen S, Denmark.|Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark.
authors.forename: C S
authors.initials: CS
authors.lastname: Benn
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: U K
authors.initials: UK
authors.lastname: Griffiths
mesh_terms: D003906:Developing Countries; D005382:Financing, Personal; D006169:Guinea-Bissau / Q000453:epidemiology; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000706:statistics & numerical data*; D007223:Infant; D007407:Interviews as Topic; D008458:Measles Vaccine / Q000008:administration & dosage*; D009035:Mothers; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D013997:Time Factors; D014186:Transportation
chemical_list: D008458:Measles Vaccine
keywords: Guinea-Bissau; Guinée-Bissau; costes para el hogar; coûts pour les ménages; household costs; measles vaccine; missed opportunities; occasions manquées; oportunidades perdidas; vaccin antirougeoleux; vacuna de sarampión