Routine Immunization Coverage and Immunization Card Retention in Pakistan: Results From a Cross-sectional National Survey.

Immunization is one of the most successful public health interventions available, saving millions of lives from death and disability each year. Therefore, improving immunization coverage is a high priority for the Government of Pakistan and essential to progress toward universal health coverage. This survey reports the national and provincial/regional coverage and determinants of fully, partially, and not-vaccinated children 12-23 months of age, antigen-wise coverage, percentage of home-based vaccination records (HBR) retention, and reasons for nonretention; dropout, timeliness, and prevalence of missed opportunities for simultaneous vaccination (MOSV). The survey was a descriptive cross-sectional national household survey carried out across Pakistan. The survey included 110,790 children 12-23 months old and their caregivers. A World Health Organization (WHO)-Expanded Program on Immunization (EPI) Survey questionnaire was adapted to collect information. Data were analyzed using the WHO Vaccination Coverage Quality Indicators (VCQI) software and Stata version 17. Nationally excluding Azad Jammu and Kashmir (AJK) and Gilgit Baltistan (GB), the coverage of fully vaccinated children was 76.5%. The likelihood of being fully vaccinated was higher among children of educated parents who belonged to higher wealth quintiles and resided in any province/region other than Balochistan. The main reasons for unimmunization were no faith in immunization, rumors about vaccines, and distance to the facility. About two-thirds (66.2%) of the children had their HBR available, and the main reasons for not having a card were never visiting a health facility and having no awareness about the importance of a card. Dropout was discernible for later doses of vaccines compared with earlier ones. Higher proportions of children received the last doses late by more than two months. Of the 218,002 vaccination visits documented on HBR in the provinces, MOSVs occurred in 17.6% of the visits. The immunization coverage rates provide a direction to strategize the progress to improve the vaccination rates in Pakistan. The country needs to outline the immediate and long-term actions to combat vaccine-preventable diseases, such as escalating integrated immunization campaigns and outreach activities, provision of mobility support, and deploying behavioral interventions as a cross-cutting strategy to improve awareness and reduce misconceptions.

Hussain I ，Khan A ，Rhoda DA ，Ahmed I ，Umer M ，Ansari U ，Shah MA ，Yunus S ，Brustrom J ，Oelrichs R ，Soofi SB ，Bhutta ZA ... -  《-》

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

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. 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. 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. 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.

Shahid S ，Ahmed S ，Qazi MF ，Ali R ，Ali SA ，Zaidi AKM ，Iqbal NT ，Jehan F ，Imran Nisar M ... -  《-》

EPI immunization coverage, timeliness and dropout rate among children in a West Cameroon health district: a cross sectional study.

Ateudjieu J ，Yakum MN ，Goura AP ，Tembei AM ，Ingrid DK ，Bita'a Landry B ，Kenfack B ，Amada L ，Tadzong I ，Bissek AC ... -  《BMC PUBLIC HEALTH》

Vaccination coverage in Lebanon following the Syrian crisis: results from the district-based immunization coverage evaluation survey 2016.

Mansour Z ，Hamadeh R ，Rady A ，Danovaro-Holliday MC ，Fahmy K ，Said R ，Brandt L ，Warrak R ，Ammar W ... -  《BMC PUBLIC HEALTH》

Contextual factors influencing incomplete immunization and investigation of its geospatial heterogeneity in Pakistan: a cross-sectional study based on PDHS (2017-18).

Immunization is one of the most effective public health initiatives, saving millions of lives and lowering the risk of diseases such as diphtheria, tetanus, influenza, and measles. Immunization saves an estimated 2-3 million lives per year. A study of the regional variations in incomplete immunization will be useful in identifying gaps in the performance of immunization programs that are not noticed by standard vaccination programs monitoring. The primary goal of this study was to identify factors influencing child immunization status and to examine regional variations in incomplete immunization among children aged 12 to 23 months in Pakistan. For the current study, the data were taken from the Demographic and Health Survey for Pakistan (PDHS 2017-2018). Ever-married women who had children aged 12-23 months were included in this study. The immunization status of children was used as an outcome variable. In order to determine the effects of different factors on incomplete immunization, multilevel logistic model was used. To study the geographical variation of incomplete immunization, hotspot analysis was done using ArcGIS 10.7 and SaTScan software and to identify significant predictors of incomplete immunization, GWR 4 software was used. Place of delivery, gender of child, mother's educational level and region were identified as significant determinants of incomplete immunization of children in Pakistan. Chances of incomplete immunization of children were found significantly lower for educated mothers (AOR = 0.52, 95% CI 0.34-0.79) and mothers who had delivered children in the health facilities (AOR = 0.51, 95% CI 0.32-0.83). Female children were more likely (AOR = 1.44, 1.95% CI 1.04-1.99) to be incompletely immunized as compared to male children. FATA (AOR = 11.19, 95% CI 4.89-25.6), and Balochistan (AOR = 10.94, 95% CI 5.08-23.58) were found at the highest risk of incomplete immunization of children as compared to Punjab. The significant spatial heterogeneity of incomplete immunization was found across Pakistan. The spatial distribution of incomplete immunization was clustered all over Pakistan. The high prevalence of incomplete immunization was observed in Balochistan, South Sindh, North Sindh, South KPK, South FATA, Gilgit Baltistan, Azad Jammu Kashmir, South and East Punjab. Drang and Harcho were identified as hotspot areas of incomplete immunization in Gilgit Baltistan. Secondary clusters with a high risk of incomplete immunization were found in regions Balochistan, Sindh and FATA. Gender biasedness towards female children, regarding complete immunization of children prevailed in Pakistan. Spatial heterogeneity was also found for incomplete immunization of children. To overcome the problem access to health facilities is the foremost step. Government should target hotspot areas of incomplete immunization of children to provide primary health care facilities by opening health care units in these areas. The government in collaboration with the media should launch awareness campaigns in those areas to convince people that complete immunization is the right of every child regardless of gender.

Kamal A ，Waseem A ，Siddiqa M ，Ijaz M ，Shakeel A ，Iftikhar S ... -  《BMC PUBLIC HEALTH》