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• MOSVs were common, with three out of five children experiencing at least one missed opportunity. • Once MOSVs occurred, children in rural areas had their missed opportunities corrected more frequently compared to their urban counterparts. • All eighteen vaccine doses for which the study cohort was eligible, could have achieved higher coverage if MOSVs had been avoided with possible gains ranging from less than one to about eleven percentage points with full basic vaccination gaining up to thirteen percentage points. • The unequal distribution of MOSV correction between urban and rural areas did not contribute significantly to the overall urban–rural coverage inequity, but it did contribute 95% to coverage inequity among children who experienced MOSVs before the survey. Identifying actionable targets is crucial to improve overall and equity in vaccination coverage, and in line with the global Immunization Agenda 2030. Therefore, this study seeks to assess the prevalence of missed opportunities for simultaneous vaccination (MOSVs) and their impact on vaccination coverage and urban–rural inequity in The Gambia. We used data of children aged 12–23 months from The Gambia 2019/2020 demographic and health survey (weighted n = 1355) with seen vaccination cards. We analyzed: the frequency of MOSVs; percentage point coverage reduction attributable to MOSVs for 18 vaccine doses and full basic vaccination; and MOSVs' contribution to urban–rural coverage inequity through Blinder-Oaxaca decomposition. Sixty percent of children experienced MOSVs, in both urban and rural areas, but urban MOSVs were more seldom corrected (35.9 % vs 45.3 %). All eighteen vaccine doses assessed could have achieved between one to eleven percentage points higher coverage if MOSVs had been avoided, with full basic vaccination gaining even more. While MOSV correction did not impact overall urban–rural coverage inequity, it did exacerbate (explained coefficient = -0.1007; P = 0.002) inequities among children who experienced MOSVs, explaining 95 % of the observed difference. Our study highlights the prevalence and negative impact of MOSVs on overall vaccination coverage. Although MOSVs did not contribute significantly to the total urban–rural inequity in coverage, they have detrimental effects on vaccination coverage and urban–rural inequity among children who had experienced MOSVs. Addressing MOSVs, can enhance coverage and reduce the risk of under-vaccination, aligning with global initiatives. [ABSTRACT FROM AUTHOR]

Introduction: The Hepatitis B virus that can cause liver cancer is highly prevalent in the Gambia, with one in ten babies at risk of infection from their mothers. Timely hepatitis B birth dose administration to protect babies is very low in The Gambia. Our study assessed whether 1) a timeliness monitoring intervention resulted in hepatitis B birth dose timeliness improvements overall, and 2) the intervention impacted differentially among health facilities with different pre-intervention performances. Methods: We used a controlled interrupted time series design including 16 intervention health facilities and 13 matched controls monitored from February 2019 to December 2020. The intervention comprised a monthly hepatitis B timeliness performance indicator sent to health workers via SMS and subsequent performance plotting on a chart. Analysis was done on the total sample and stratified by pre-intervention performance trend. Results: Overall, birth dose timeliness improved in the intervention compared to control health facilities. This intervention impact was, however, dependent on pre-intervention health facility performance, with large impact among poorly performing facilities, and with uncertain moderate and weak impacts among moderately and strongly performing facilities, respectively. Conclusion: The implementation of a novel hepatitis B vaccination timeliness monitoring system in health facilities led to overall improvements in both immediate timeliness rate and trend, and was especially helpful in poorly performing health facilities. These findings highlight the overall effectiveness of the intervention in a low-income setting, and also its usefulness to aid facilities in greatest need of improvement. [ABSTRACT FROM AUTHOR]