{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:06:08Z","timestamp":1790877968507,"version":"4.1.0"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u201324 months in Baghdad, Iraq.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 &gt;28 days of the scheduled date. Multivariate logistic regression was used to identify associated factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall vaccine coverage (timely\u2009+\u2009delayed) remained high (&gt;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\u201314.24) and perceived vaccine availability (aOR = 4.74; 95% CI: 1.09\u201320.51) were significantly associated with delay. No sociodemographic factors were significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0359962","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:29:42Z","timestamp":1790875782000},"page":"e0359962","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immunization timeliness and its determinants among young children in Baghdad, Iraq: A cross-sectional study using documented vaccination cards"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4231-0838","authenticated-orcid":true,"given":"Syed Shaukat Ali Muttaqi","family":"Shah","sequence":"first","affiliation":[{"name":"College of Pharmacy, Al-Farahidi University","place":["Baghdad, Iraq"],"department":["Department of Clinical Pharmacy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakeem Ahmed Mukhlif","family":"Al-ani","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Al-Farahidi University","place":["Baghdad, Iraq"],"department":["Department of Pharmacognosy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Abdul Wahab","family":"Alwardi","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Al-Farahidi University","place":["Baghdad, Iraq"],"department":["Department of Clinical Pharmacy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ale","family":"Zehra","sequence":"additional","affiliation":[{"name":"Dow College of Pharmacy, Dow University of Health Sciences","place":["Karachi, Sindh, Pakistan"],"department":["Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uroosa","family":"Kanwal","sequence":"additional","affiliation":[{"name":"Salim Habib University","place":["Karachi, Sindh, Pakistan"],"department":["Department of Pharmacy Practice, Faculty of Pharmacy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tehreem","family":"Ansari","sequence":"additional","affiliation":[{"name":"Dow University Hospital (Ojha Campus), Dow University of Health Sciences","place":["Karachi, Sindh, Pakistan"],"department":["Department of Infectious Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"issue":"5","key":"pone.0359962.ref001","doi-asserted-by":"crossref","first-page":"820","DOI":"10.3390\/vaccines10050820","article-title":"Iraqi Parents\u2019 Knowledge, Attitudes, and Practices towards Vaccinating Their Children: A Cross-Sectional Study","volume":"10","author":"W Al-Qerem","year":"2022","journal-title":"Vaccines (Basel)"},{"issue":"3","key":"pone.0359962.ref002","first-page":"404","article-title":"Iraq healthcare system: An update","volume":"4","author":"AJ Al-Mosawi","year":"2020","journal-title":"Lupine Online Journal of Medical Sciences"},{"issue":"8","key":"pone.0359962.ref003","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1080\/21645515.2019.1708669","article-title":"Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination","volume":"16","author":"A Nandi","year":"2020","journal-title":"Hum Vaccin Immunother"},{"issue":"10441","key":"pone.0359962.ref004","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1016\/S0140-6736(24)00850-X","article-title":"Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization","volume":"403","author":"AJ Shattock","year":"2024","journal-title":"Lancet"},{"issue":"6","key":"pone.0359962.ref005","doi-asserted-by":"crossref","first-page":"649","DOI":"10.3390\/vaccines13060649","article-title":"Expanded Programme on Immunization (EPI): A Legacy of 50 Years and the Road Ahead","volume":"13","author":"I Mirza","year":"2025","journal-title":"Vaccines (Basel)"},{"issue":"1","key":"pone.0359962.ref006","doi-asserted-by":"crossref","first-page":"37","DOI":"10.33762\/mjbu.2020.126642.1002","article-title":"Factors influencing compliance with immunization regimen among mothers in basrah, Iraq","volume":"38","author":"J Molan","year":"2020","journal-title":"MJBU"},{"key":"pone.0359962.ref007","unstructured":"Hussein RG. 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