Immunization status of children in Nepal and associated factors, 2016

Pooja N Patel; Manila Hada; Bradley F Carlson; Matthew L Boulton

doi:10.1016/j.vaccine.2021.08.059

Immunization status of children in Nepal and associated factors, 2016

Vaccine. 2021 Sep 24;39(40):5831-5838. doi: 10.1016/j.vaccine.2021.08.059. Epub 2021 Aug 26.

Authors

Pooja N Patel¹, Manila Hada², Bradley F Carlson¹, Matthew L Boulton³

Affiliations

¹ Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
² Division of Epidemiology I, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20993, USA.
³ Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA. Electronic address: mboulton@umich.edu.

PMID: 34456076
DOI: 10.1016/j.vaccine.2021.08.059

Abstract

Background: Nepal has made substantial improvements in childhood immunization uptake. However, vaccination levels are still below the country-specific Sustainable Development Goal target of 94.8% coverage by 2025 for children aged 12-23 months who received all immunizations recommended in the national immunization schedule by their first birthday. A better understanding of the predictors of full immunization can inform successful programmatic interventions to improve coverage while also guiding resource allocation to ensure all children are fully vaccinated. This study estimates childhood immunization coverage in Nepal and characterizes the association between immunization status and various sociodemographic predictors.

Methods: Data from the 2016 Nepal Demographic and Health Survey were used to examine the immunization status of children aged 12-23 months. Immunization status was categorized as fully immunized (receiving all recommended doses), under-immunized (receiving at least one, but not all, recommended doses), and un-immunized (not receiving any doses of any vaccine). Associations between full and under-immunization and potential sociodemographic predictors were assessed using logistic regression.

Results: Among 976 children, 78.2% were fully immunized, 21% were under-immunized, and 0.8% were un-immunized. Retention of an immunization card was significantly associated with full immunization status. Mothers who had completed a formal education above secondary school and mothers who were working at time of interview had increased odds of full immunization. Birthing in an institutional setting was also associated with higher odds of full immunization.

Conclusions: Overall, immunization coverage in Nepal is relatively high, although it varies by dose and sociodemographic factors. Almost 25% of Nepalese children were not fully immunized, leaving them at increased risk for vaccine-preventable disease related morbidity and mortality. Nepal must continue focused efforts to reach every child and minimize the equity gap; programs may focus on advocating for the use of immunization cards, education and empowerment for girls, and delivery in institutional settings.

Keywords: Child health; Expanded Program on Immunization; Immunization coverage; Nepal.

MeSH terms

Child
Cross-Sectional Studies
Female
Humans
Immunization*
Nepal
Socioeconomic Factors
Vaccination Coverage*