Barriers to universal child immunization in rural Senegal 5 years after the accelerated Expanded Programme on Immunization.

Although the Expanded Programme on Immunization (EPI) has been a worldwide success, weak points remain, particularly in Africa. In Senegal, for example, immunization coverage was low in 1990 (60%), in part because of poor results in rural areas. In order to identify obstacles to EPI in such areas, we carried out an immunization survey in Bandafassi, a rural area of Senegal, where 6078 inhabitants lived in 23 small villages. Only 41% of children aged 1-10 years were completely vaccinated in February 1992, with considerable variations in coverage from one village to another, according to their geographical location: 71% of children were completely vaccinated in villages less than 10 km from the health centre, whereas in remote villages only 10% of children had been completely vaccinated. There was no variation according to ethnic group. From 1987 to 1992, the gap in immunization coverage between the remote villages and those located close to the health centre has steadily increased. There is a need to improve the performance of the mobile teams in the remote villages and to increase awareness about the importance of immunization.