Rural-Urban Differences in Reasons for Incomplete Vaccination in Children Under Six Years, Southeast Iran 2013

Abstract

Background: Geographical differences in vaccination programs are a major public health problem, which is often linked to the availability of healthcare services and socioeconomic factors. Objectives: The current study aimed to identify the differences in the patterns and the reasons for incomplete vaccination of children in urban and rural areas. Patients and Methods: In the current cross-sectional study, a total of 1039 children under six years (612 rural and 427 urban subjects) were recruited from a databank of partially vaccinated children from March to December 2013. A group of trained Community Health Volunteers completed the study questionnaires by interviewing the parents of the identified children during their routine home visits. The Chi square test and Fisher’s Exact test were used to compare the distribution of categorical variable between urban and rural areas. Results: The patterns of the number of missed doses of vaccine were similar for urban and rural subjects, but urban children 1 - 6 years were significantly more likely to miss subsequent doses of Oral Polio Vaccine (OPV) and Diphtheria-Tetanus-Pertussis (DTP). A statistically significant association was found between mother’s age, place of birth and the number of missed vaccine doses. Rural healthcare providers more frequently disseminated vaccination information than urban vaccinators (P < 0.001). A greater proportion of rural parents reported the lack of vaccines and healthcare staff misconduct as a reason for postponing vaccination, while over-crowdedness of health center, mother illness and forgetfulness, child illness and following physician recommendations were mentioned by a greater fraction of urban mothers. Conclusions: Efforts to improve vaccination coverage should be taken into account regarding the differences in the factors that contribute to the incomplete vaccination status of children in the rural and urban areas. The current study findings indicate that vaccination services especially in the urban areas need to be reassessed to ensure that all children are covered. To develop and promote childhood vaccination strategies, special attention should be paid to address maternal barriers for children under-vaccination.