Delayed Vaccination and Associated Factors Among Children Less Than 2 Years in a Sample Attending Primary Health Care Centers in Baghdad City

Background: Vaccination is one of the most cost-effective preventive interventions, helping to prevent 2–3 million deaths per year; however, infectious diseases still affect Iraqi children, even though they receive vaccines free of charge. Objectives of study: To determine the rate and reasons for vaccination delay among a sample of children aged less than 2 years in Baghdad city. Method: An across-sectional study was carried out during the period from March to October 2020. A convenient sample of 30 Primary Health Care Centers (PHCCs) was distributed across the Al-Karkh and Al-Russafa Health Directorates in Baghdad. The information was obtained through direct interviews with the caregivers of a sample of 600 children under 2 years old who attended the health facility for immunization, using a structured questionnaire to assess each child's immunization schedule status. Results: Out of the 600 enrolled participants, 154 (25.7%) of their children had a vaccination delay. Of the delayed vaccinated children, 87% of the reasons were family-related, and only 13% were related to PHCCs. The main direct reasons for vaccination delays were a busy family schedule (41.7%), followed by social events such as death, sickness, or separation (22.4%), the perception that the child is too sick (14.9%), and changing the place of residence (17.8%). Indirect reasons include low mother's education, living in a rural area, and the accessibility to health care centers, including the difficulty and time needed to reach the health facility, especially during the month of emergency declaration in the country because of the COVID-19 pandemic. The study indicated that the highest percentage of vaccine delays was for the measles vaccine (22%). Conclusion: Major reasons for delay were related to family decisions, especially since the families were spending more effort and time trying to maintain an unusual balance of responsibilities after the COVID-19 pandemic. Families considered participation in the immunization process a lesser priority despite the health facility's continued provision of services, especially immunization.