Determinants of vaccination in an urban population in Conakry, Guinea.

A community survey was conducted in 1989 in Conakry, Guinea to determine reasons for low vaccination coverage. Some 377 children aged 12-23 months and their guardians were studied, of whom 204 (54%) had vaccination records. According to their records 19% of children were fully and correctly vaccinated. Thirty-nine incompletely vaccinated children (19% of those with records) had sufficient documented contacts with health services to be fully vaccinated, but at least one immunization opportunity was missed. Multivariate analyses were conducted to identify factors associated with receipt of first dose diphtheria/pertussis/tetanus/oral polio vaccine (DPT/OPV) and with completion of the DPT/OPV series. Factors determining initiation of the series included maternal education (assessed by ability to speak French), household possession of a television, maternal age less than 35 years, child's birth in hospital, and, for non-French speakers, the mother considering vaccination to be affordable. Factors determining completion of the DPT/OPV series, among children who began vaccination, included maternal education, employment, and past positive experience with vaccination services (short waiting times, not having been turned away from vaccination, and not knowing a child with a post-vaccine 'abscess'). Vaccination coverage can be substantially increased in Conakry by improving health services to avoid missed opportunities, following the vaccination schedule correctly, reducing waiting times and avoiding abscesses.