Childhood immunization in rural Malawi: time of administration and predictors of non-compliance

A cohort of 760 newborns was followed prospectively for 2 years to ascertai n the time of administration of childhood vaccinations in rural Malawi and to study predictors of non-compliance with national vaccination recommendat ions. At 1 year of age, 99% of the infants were fully vaccinated against tu berculosis, 91% against polio, 90% against diphtheria, pertussis and tetanu s and 64% against measles. At 2 years, the corresponding vaccination covera ges were 99%, 93%, 93% and 84%. On average, all vaccinations were given 1-3 months later than recommended. Many of the delayed measles vaccinations we re given during a separate vertical campaign, during which 25% of previousl y unvaccinated 21-23-month-old children were identified and immunized. Non- compliance with vaccination recommendations was associated with living in v illages with no access to mobile vaccination teams, birth between April and June and birth at home. In this rural Malawian area, most vaccination serv ices were functioning well. To increase measles vaccination coverage, regul ar outreach activities should be encouraged.