Obstacles to achieving immunization for all 2000: missed immunization opportunities and inappropriately timed immunization.

Missed opportunities and inappropriately timed immunization substantially reduced the coverage achieved in Mozambique and Guinea Conakry. During coverage surveys in Mozambique the authors noted dates of attendance at a health facility for growth monitoring or vaccination and in Conakry they also abstracted dates of curative care visits from home-based documents. In Mozambique an average of 84% of children ages 12-23 months had documents and an average of 53% of children were fully and correctly vaccinated. Among children with cards 11% had received all vaccines but at least 1 dose was applied before the recommended age or with too short an interval between doses (inappropriately timed vaccinations). A further 8% of children had sufficient documented contacts with preventive services to be fully vaccinated but immunization opportunities had been missed. In Conakry 54% of 12-23 month olds had immunization cards and only 19% were fully and correctly vaccinated. Among children with cards 9% had received all vaccines but some were inappropriately timed and 19% had enough contacts with curative or preventive services to be fully vaccinated; however opportunities had been missed. The authors recommend that home-based records document all health center visits including those for curative care and that missed opportunities and vaccination timing be routinely evaluated during vaccine coverage surveys. (authors modified)