Differential coverage for vaccines in the expanded program on immunization (EPI) among children in rural Pakistan

Shahira Shahid · Sheraz Ahmed · Muhammad Farrukh Qazi · Rafey Ali · Asad Ali · Anita K. M. Zaidi +3 more

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Vaccine Coverage and Hesitancy Child Nutrition and Water Access Global Maternal and Child Health

Abstract

BACKGROUND: Pakistan has a well-established Expanded Program on Immunization (EPI) however vaccine-preventable diseases still account for high infant and child mortality rates. This study describes the differential vaccine coverage and determinants of vaccine uptake in rural Pakistan. METHODS: From October 2014 to September 2018, we enrolled children younger than 2 years of age from the Matiari Demographic Surveillance System in Sindh, Pakistan. Socio-demographic and vaccination history were collected from all participants. Vaccine coverage rates and timeliness were reported. Socio-demographic variables for missed and untimely vaccination were studied in multivariable logistic regression. RESULTS: Of the 3140 enrolled children, 48.4 % received all EPI recommended vaccines. Only 21.2 % of these were age appropriate. Around 45.4 % of the children were partially vaccinated, and 6.2 % were unvaccinated. Highest coverage was seen for the first dose of pentavalent (72.8 %), 10-valent Pneumococcal Conjugate Vaccine (PCV10) (70.4 %) and Oral Polio Vaccine (OPV) (69.2 %) and the lowest coverage was for measles (29.3 %) and rotavirus (1.8 %) vaccines. Primary caretakers and wage earners with a higher level of education were protective against missed and untimely vaccination. Enrollment in the 2nd, 3rd and 4th study year was negatively associated with being unvaccinated whereas distance from a major road was positively associated with non-adherence to schedule. CONCLUSION: Vaccine coverage was low among children in Matiari, Pakistan, and majority received delayed doses. Parents' education status and year of study enrollment was protective against vaccine dropout and delayed vaccination whereas geographical distance from a major road was a predictor. Vaccine promotion and outreach efforts may have had a beneficial impact on vaccine coverage and timeliness.

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References

2006The Use of Combination Vaccines Has Improved Timeliness of Vaccination in Children 2017The global effect of maternal education on complete childhood vaccination: a systematic review and meta-analysis 2014Factors associated with non-utilization of child immunization in Pakistan: evidence from the Demographic and Health Survey 2006-07 2018Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial 2018Reasons for non-vaccination and incomplete vaccinations among children in Pakistan 2013Pakistan's expanded programme on immunization: An overview in the context of polio eradication and strategies for improving coverage 2010A review of EPI progress in Pakistan towards achieving coverage targets: present situation and the way forward 2017Effect of combination vaccines on completion and compliance of childhood vaccinations in the United States

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