Health Policy and Planning
Volume 29 Issue 2 March 2014
http://heapol.oxfordjournals.org/content/current

Achieving comprehensive childhood immunization: an analysis of obstacles and opportunities in The Gambia
Sarah Payne1, John Townend3, Momodou Jasseh3, Yamundow Lowe Jallow4 and Beate Kampmann2,3
Author Affiliations
1School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK, 2Department of Paediatrics, St Mary’s Campus, Imperial College of Science, Technology & Medicine, Norfolk Place, London W2 1PG, UK, 3MRC-Unit, Atlantic Road, Fajara, The Gambia, West Africa and 4Ministry of Health and Social Welfare Government of The Gambia, The Quadrangle Banjul, The Gambia
Accepted January 11, 2013.
http://heapol.oxfordjournals.org/content/29/2/193.abstract

Abstract
Introduction
Immunization is a vital component in the drive to decrease global childhood mortality, yet challenges remain in ensuring wide coverage of immunization and full immunization, particularly in low- and middle-income countries. This study assessed immunization coverage and the determinants of immunization in a semi-rural area in The Gambia.

Methods
Data were drawn from the Farafenni Health and Demographic Surveillance System. Children born within the surveillance area between January 2000 and December 2010 were included. Main outcomes assessed included measles, BCG and DTP vaccination status and full immunization by 12 months of age as reported on child healthcards. Predictor variables were evaluated based on a literature review and included gender, ethnicity, area of residence, household wealth and mother’s age.

Results
Of the 7363 children included in the study, immunization coverage was 73% (CI 72–74) for measles, 86% (CI 86–87) for BCG, 79% (CI 78–80) for three doses of DTP and 52% (CI 51–53) for full immunization. Coverage was significantly associated with area of residence and ethnicity, with children in urban areas and of Mandinka ethnicity being least likely to be fully immunized.

Conclusions
Despite high levels of coverage of many individual vaccines, delivery of vaccinations later in the schedule and achieving high coverage of full immunization remain challenges, even in a country with a committed childhood immunization programme, such as The Gambia. Our data indicate areas for targeted interventions by the national Expanded Programme of Immunization.