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Published on 29.03.18 in Vol 4, No 1 (2018): EMPHNET Sixth Regional Conference

Preprints (earlier versions) of this paper are available at, first published Mar 29, 2018.

This paper is in the following e-collection/theme issue:


    Assessment of Immunization Session Practices in Primary Healthcare Centers - Wasit Province, Iraq, 2016-17

    Corresponding Author:

    Ali Amily


    Background: Annually, vaccines prevent more than 2.5 million child deaths globally. WHO and UNICEF estimates of immunization coverage in Iraq in 2016 revealed 63% for DTP3 and 66% for MCV1. Wasit is among governorates with a large number of under-immunized children, opening the door for many future outbreaks. Immunization session practices (ISPs), when maintained of high-quality, can ensure safer and more effective vaccination as well as higher coverage rates.

    Objective: The objective of this study was to assess ISPs in Primary Healthcare Centers (PHCs) in Wasit province.

    Methods: We conducted this cross-sectional study on 24(44%) PHCs in Wasit province, selected by simple random sampling. Based on WHO and the national guidelines, checklists were developed to assess 58 ISPs that were grouped into seven domains: vaccine and diluent management, cold chain management, session’s equipment, communication with clients and caregivers, vaccine preparation and administration, card review and registration and waste management. The score (out of 100%) was calculated for each domain in all selected PHCs, then the average for all domains was calculated in each PHC. The assessment was made by direct on-job observation of immunization sessions, through a single visit conducted to each PHC.

    Results: PHCs were ranging in their ISPs: 52-78%; with a mean of 67% (±8%). The highest scores were for the following domains: session’s equipment (88%), waste management (82%) and card review and registration (81%). The least achieving domains were: communication with clients and caregivers (36%) and cold chain management (38%). Vaccine preparation and administration was scoring 69%, whereas the score for vaccine and diluent management was only 50%.

    Conclusions: ISPs practiced in PHCs in Wasit province were far from the standard. National Expanded Program on Immunization should work on raising the capacity of vaccinators, particularly their communication skills with the clients and caregivers and the management of vaccines and cold chain.

    iproc 2018;4(1):e10622


    Edited by Y Khader; This is a non–peer-reviewed article. submitted 29.03.18; accepted 29.03.18; published 29.03.18

    ©Ali Amily, F Lami. Originally published in Iproceedings (, 29.03.2018.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in Iproceedings, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.