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

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