This article is part of the supplement: The fallacy of coverage: uncovering disparities to improve immunization rates through evidence. The Canadian International Immunization Initiative Phase 2 (CIII2) Operational Research Grants

Open Access Research

Evaluation of immunization coverage within the Expanded Program on Immunization in Kita Circle, Mali: a cross-sectional survey

Abdel Karim Koumaré12*, Drissa Traore1, Fatouma Haidara3, Filifing Sissoko1, Issa Traoré4, Sékou Dramé5, Karim Sangaré5, Karim Diakité5, Bréhima Coulibaly1, Birama Togola1 and Aguissa Maïga5

Author Affiliations

1 Faculté de Médecine de Pharmacie et d'Odonto Stomatologie, Université de Bamako, Bamako, Mali

2 Institut Africain de Formation en Pédagogie, Recherche et Evaluation en Sciences de la Santé (IAFPRESS) - Quartier du Fleuve - Bamako, BP 05 Koulouba, Mali

3 Centre de Santé de Référence de la commune V, Bamako, Mali

4 Centre de Santé de Réference de la commune V du cercle de Kita, Mali

5 Direction Régionale de la Santé de Kayes, Mali

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BMC International Health and Human Rights 2009, 9(Suppl 1):S13  doi:10.1186/1472-698X-9-S1-S13

Published: 14 October 2009



In 1986, the Government of Mali launched its Expanded Program on Immunization (EPI) with the goal of vaccinating, within five years, 80% of all children under the age of five against six target diseases: diphtheria, tetanus, pertussis, poliomyelitis, tuberculosis, and measles. The Demographic and Health Survey carried out in 2001 revealed that, in Kita Circle, in the Kayes region, only 13% of children aged 12 to 23 months had received all the EPI vaccinations. A priority program was implemented in 2003 by the Regional Health Department in Kayes to improve EPI immunization coverage in this area.


A cross-sectional survey using Henderson's method (following the method used by the Demographic and Health Surveys) was carried out in July 2006 to determine the level of vaccination coverage among children aged 12 to 23 months in Kita Circle, after implementation of the priority program. Both vaccination cards and mothers' declarations (in cases where the mother cannot make the declaration, it is made by the person responsible for the child) were used to determine coverage.


According to the vaccination cards, 59.9% [CI 95% (54.7-64.8)] of the children were fully vaccinated, while according to the mothers' declarations the rate was 74.1% [CI 95% (69.3-78.4)]. The drop-out rate between DTCP1 and DTCP3 was 5.5%, according to the vaccination cards. The rate of immunization coverage was higher among children whose mothers had received the anti-tetanus vaccine [OR = 2.1, CI 95% (1.44-3.28)]. However, our study found no difference associated with parents' knowledge about EPI diseases, distance from the health centre, or socio-economic status. Lack of information was one reason given for children not being vaccinated against the six EPI diseases.


Three years after the implementation of the priority program (which included decentralization, the active search for missing children, and deployment of health personnel, material and financial resources), our evaluation of the vaccination coverage rates shows that there is improvement in the EPI immunization coverage rate in Kita Circle. The design of our study did not, however, enable us to determine the extent to which different aspects of the program contributed to this increase in coverage. Efforts should nevertheless be continued, in order to reach the goal of 80% immunization coverage.

Abstract in French

See the full article online for a translation of this abstract in French.