Routine immunization in Pakistan: comparison of multiple data sources and identification of factors associated with vaccination.

Hafsa Imran,M Zubair Wadood,Dania Raja,Nicholas C Grassly,Rana M Safdar,Kathleen M O’Reilly

doi:10.1093/inthealth/ihx067

Abstract

BackgroundWithin Pakistan, estimates of vaccination coverage with the pentavalent vaccine, oral polio vaccine (OPV) and measles vaccine (MV) in 2011 were reported to be 74%, 75% and 53%, respectively. These national estimates may mask regional variation. The reasons for this variation have not been explored.MethodsData from the Multiple Indicator Cluster Surveys (MICS) for Balochistan and Punjab (2010–2011) are analysed to examine factors associated with receiving three or more doses of the pentavalent vaccine and one or more MVs using regression modelling. Pentavalent and OPV estimates from the MICS were compared to vaccine dose histories from surveillance for acute flaccid paralysis (AFP; poliomyelitis) to ascertain agreement.ResultsAdjusted coverage of children 12–23 months of age were estimated to be 16.0%, 75.5% and 34.2% in Balochistan and 58.0%, 87.7% and 72.6% in Punjab for the pentavalent vaccine, OPV and MV, respectively. Maternal education, healthcare utilization and wealth were associated with receiving the pentavalent vaccine and the MV. There was a strong correlation of district estimates of vaccination coverage between AFP and MICS data, but AFP estimates of pentavalent coverage in Punjab were biased toward higher values.ConclusionsNational estimates mask variation and estimates from individual surveys should be considered alongside other estimates. The development of strategies targeted towards poorly educated parents within low-wealth quintiles that may not typically access healthcare could improve vaccination rates.

Highlights

Vaccines are among the greatest success stories in public health
Pakistan consists of four provinces (Balochistan, Punjab, Sindh and Khyber Pakhtunkhwa), one federal capital territory (Islamabad), a Estimates of the adjusted percentage of children
We have explored household factors that were associated with vaccination coverage, but healthcare access and service provision will influence vaccination

Summary

Introduction

Since 2005 the average global child mortality rate has fallen by 3.6% per year[1] and Wang et al.[1] estimate that the impact of ‘secular trends’, which include technological developments such as vaccines, had the largest impact on reductions in child mortality rates. Within this comprehensive analysis, nine countries were highlighted as having child mortality rates that were decreasing at a lower-than-expected rate. Within Pakistan, estimates of vaccination coverage with the pentavalent vaccine, oral polio vaccine (OPV) and measles vaccine (MV) in 2011 were reported to be 74%, 75% and 53%, respectively These national estimates may mask regional variation.

Methods

Results

Discussion

Conclusion