Determinants of vaccine coverage and timeliness in a northern Pakistani village

PLoS One. 2022 Feb 17;17(2):e0263712. doi: 10.1371/journal.pone.0263712. eCollection 2022.

Abstract

The incidence of vaccine preventable disease in Pakistan remains high despite a long-standing Expanded Program on Immunization (EPI). We describe vaccine completeness, timeliness and determinants of coverage from a remote rural cohort (2012-2014). Vaccination histories were taken from EPI records. Vaccination was complete if all doses were received according to the EPI schedule and timely if doses were not ≥3 days early or ≥ 28 days late. Three models are presented: a multivariable logistic regression of household demographic and socioeconomic factors associated with complete vaccination, a multivariable mixed effects logistic regression assessing whether or not the vaccine was administered late (versus on-time), and a mixed effects multivariable Poisson regression model analysing the interval (in days) between vaccine doses. Of 959 enrolled children with full vaccination histories, 88.2 and 65.1% were fully vaccinated following either the pentavalent or DPT/HBV schedules if measles was excluded; coverage dropped to 50.0 and 27.1% when both doses of measles were included. Sixty-four (6.7%) were unvaccinated. Coverage and timeliness declined with subsequent doses. Migrating into the village after 1995 (95%CI 1.88 to 5.17) was associated with late vaccination. Being male, having an older father, and having parents with at least some formal education reduced the likelihood of a late dose. The interval between doses was consistent at 5 weeks (compared with the 4 weeks recommended by EPI). None of the socio-demographic variables were related to the likelihood of receiving full coverage. Vaccine coverage in Oshikhandass was higher than national averages. Measles vaccine coverage and timeliness were low; special consideration should be paid to this vaccine. The local vaccination schedule differed from the EPI, but the consistency suggests good local administration.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Child, Preschool
  • Female
  • Humans
  • Immunization Programs / standards*
  • Immunization Schedule*
  • Infant
  • Infant, Newborn
  • Longitudinal Studies
  • Male
  • Measles / epidemiology
  • Measles / prevention & control*
  • Measles / virology
  • Measles Vaccine / administration & dosage*
  • Morbillivirus / drug effects
  • Morbillivirus / isolation & purification
  • Pakistan / epidemiology
  • Socioeconomic Factors*
  • Vaccination / statistics & numerical data*
  • Vaccination Coverage / statistics & numerical data*

Substances

  • Measles Vaccine

Grants and funding

Funding was provided by the Pakistan US S&T Cooperative Agreement between the Pakistan Higher Education Commission (HEC) (No.4-421/PAK-US/HEC/2010/955, grant to the Karakoram International University) and US National Academies of Science (Grant Number PGA-P211012 from NAS to the Fogarty International Center). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.