Missed opportunities for vaccination (MOV) in children up to 5 years old in 19 Médecins Sans Frontières-supported health facilities: a cross-sectional survey in six low-resource countries

OBJECTIVE: To describe missed opportunities for vaccination (MOV) among children visiting Médecins Sans Frontières (MSF)-supported facilities, their related factors, and to identify reasons for non-vaccination. DESIGN: Cross-sectional surveys conducted between 2011 and 2015. SETTING AND PARTICIPANTS: Children up to 59 months of age visiting 19 MSF-supported facilities (15 primary healthcare centres and four hospitals) in Afghanistan, Democratic Republic of the Congo, Mauritania, Niger, Pakistan and South Sudan. Only children whose caregivers presented their vaccination card were included. OUTCOME MEASURES: We describe MOV prevalence and reasons for no vaccination. We also assess the association of MOV with age, type of facility and reason for visit. RESULTS: Among 5055 children’s caregivers interviewed, 2738 presented a vaccination card of whom 62.8% were eligible for vaccination, and of those, 64.6% had an MOV. Presence of MOV was more likely in children visiting a hospital or a health facility for a reason other than vaccination. MOV occurrence was significantly higher among children aged 12–23 months (84.4%) and 24–59 months (88.3%) compared with children below 12 months (56.2%, p≤0.001). Main reasons reported by caregivers for MOV were lack of vaccines (40.3%), reason unknown (31.2%) and not being informed (17.6%). CONCLUSIONS: Avoiding MOV should remain a priority in low-resource settings, in line with the new ‘Immunization Agenda 2030’. Children beyond their second year of life are particularly vulnerable for MOV. We strongly recommend assessment of eligibility for vaccination as routine healthcare practice regardless of the reason for the visit by screening vaccination card. Strengthening implementation of ‘Second year of life’ visits and catch-up activities are proposed strategies to reduce MOV.