AI Insight
This cross-sectional study of 168 children aged 18-24 months in Baghdad, Iraq found that while overall vaccine coverage remained high (over 96% for the first nine months), only 8.3% of children received all vaccinations on time. Immunization delay affected 91.7% of children, with timeliness dropping from 98.6% at birth to 37.5% at 18 months, and missed doses highest at 18 months (36.3%). Lack of knowledge about vaccination schedules and perceived vaccine availability were the primary factors significantly associated with delays.
Why it matters
The findings reveal a critical gap between vaccine coverage and timeliness in post-conflict Iraq, indicating that while vaccines reach most children, they often arrive late. This suggests interventions should focus on improving caregiver education about vaccination schedules and ensuring consistent vaccine supply, particularly for children in their second year of life, to maximize protection during vulnerable periods.
Understand the Science
by Syed Shaukat Ali Muttaqi Shah, Hakeem Ahmed Mukhlif Al-ani, Mohammed Abdul Wahab Alwardi, Ale Zehra, Uroosa Kanwal, Tehreem Ansari
Background
Childhood immunization is a critical public health intervention, yet timeliness remains a challenge in post conflict affected settings like Iraq. This study assessed timeliness of immunization, missed doses, and associated factors with delay among children aged 18–24 months in Baghdad, Iraq.
Methods
A cross-sectional study was conducted in 11 primary healthcare centers in Baghdad between May and July 2025. Data were collected from 168 children using documented immunization cards. Immunization delay was defined as vaccination administered beyond >28 days of the scheduled date. Multivariate logistic regression was used to identify associated factors.
Results
Overall vaccine coverage (timely + delayed) remained high (>96%) for first nine months, at 12 and 18 months, coverage declined to 85.1% and 63.7%, respectively. Only 14 children (8.3%) received all vaccinations on time. Immunization delay was observed in 154 (91.7%) children, with 28 (16.7%) of children with delay at a single visit and 126 (75.0%) at multiple visits. Missed doses were highest at 18 months (36.3%), followed by 12 months (14.9%). Timely vaccination dropped sharply from 98.6% at birth to 52.4% at 9 months, and 37.5% at 18months. The most common reason for delay was lack of knowledge about the vaccination schedule (54.8%). In adjusted analysis, lack of knowledge of schedule (aOR = 3.85; 95% CI: 1.04–14.24) and perceived vaccine availability (aOR = 4.74; 95% CI: 1.09–20.51) were significantly associated with delay. No sociodemographic factors were significant.
Conclusion
Immunization delay is highly prevalent among children in Baghdad. Interventions focusing on caregiver knowledge and ensuring consistent vaccine supply are urgently needed, particularly for children in the second year of life. However, due to purposive sampling, these findings may not be generalizable to all of Baghdad or Iraq.