Studies of missed opportunities for immunization in developing and industrialized countries

Missed opportunities for immunization are an obstacle to raising immunization coverage among children

and women of childbearing age. To determine their global magnitude and reasons, studies reported up

to July 1991 were reviewed. A standard measure for the prevalence of missed opportunities was calculated for each study. Seventy-nine studies were identified from 45 countries; 18 were population-based,

52 were health-service-based, and 9 were intervention trials. A median of 32% (range, 0-99%) of the

children and women of childbearing age who were surveyed had missed opportunities during visits to

the health services for immunization or other reasons. Missed opportunities were mainly due to failure

to administer simultaneously all vaccines for which a child was eligible; false contraindications; health

workers' practices, including not opening a multidose vaccine vial for a small number of persons to

avoid vaccine wastage; and logistical problems. To eliminate missed opportunities for immunization,

programmes should emphasize routine supervision and periodic in-service training of health workers

which would ensure simultaneous immunizations, reinforce information about true contraindications, and

improve health workers' practices.