Community-Based Assessment of Childhood Immunization Coverage and Associated Risk Factors in Pakistan

Abstract

Background: Pakistan has been making progress in its Expanded Programme on Immunization but still, incomplete immunization among children is a tremendous challenge especially in the underserved population. Knowing local coverage and barriers to completing routine immunization schedules is crucial to improving routine immunization completion. The present study evaluated the immunization status of children and the factors related to inadequate immunization status in a community based population.

Methods: It was a cross sectional study done at community level involving 400 children of 12-23 months age in selected urban and rural communities of Pakistan. Data were collected on the sociodemographic characteristics, maternal health care services used, immunisation status, knowledge of the caregivers, problems accessing health care, and reasons for failure to immunise using a structured questionnaire. Vaccination status was determined as full, partial or no vaccination for age. The analysis of the data was done with the IBM SPSS Statistics version 27 software. The influences of these factors on having an incomplete immunization were examined using univariable and multivariable binary logistic regression analyses.

Outcome: Of all the children, 67.0% were fully vaccinated, 27.5% were partially vaccinated, and 5.5% were unvaccinated. Coverage was found to be highest for the first doses of vaccines, and lower for the subsequent doses, with 9.4% drop off in coverage for pentavalent doses 1-3. At the multivariable level, the lack of understanding of the EPI schedule, vaccine hesitancy, missed vaccination opportunities, rural residence, low level of maternal education, inadequate antenatal care, and more distant healthcare facilities from vaccination services were independently associated with incomplete immunization status. The most common reasons for default were the lack of knowledge about the next immunization date, temporary childhood illness, difficulties with access, and fear of vaccine adverse effects.

The conclusion: Incomplete immunization was linked to a mix of informational, socioeconomic, access-related and behavioral factors. Better caregiver counselling, rural outreach, reminder tools and opportunistic vaccination can help to meet childhood vaccination timelines.