Determinants of vaccine coverage and timeliness in a northern Pakistani village

Alexandra F. Jamison, Benjamin J. J. McCormick, Ejaz Hussain, Elizabeth D. Thomas, Syed Iqbal Azam, Chelsea L. Hansen, Zeba A. Rasmussen* (Corresponding Author)

*Corresponding author for this work

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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.
Original languageEnglish
Article numbere0263712
Number of pages12
JournalPloS ONE
Issue number2
Publication statusPublished - 17 Feb 2022

Bibliographical note

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.
We are deeply indebted to the mothers and families who participated in these projects and the dedicated project staff. Study staff: Gulab Jan, Zohra Bano, Mobina Bano, Gul Nasreen, Mehtab Bano, Kaniz Fatima, Iqbal Bano, Dil Roz, Nazara, Ghazala, Nasima Begum, Alia Rani, Mehwish Hakeem, Rubina, Sameena, Zevar Jan, Sunaira, Resham Jan. FIC: Assis Jahan, Wasiat Shah. Karakoram International University: Khalil Ahmed, Arif Hussain, Mirza Jibran, Asif Hussain. Editorial assistance was kindly provided by Stacey Knobler, Jessica Seidman, Stephanie Richard and David Spiro. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. National Institutes of Health or Department of Health and Human Services.

Data Availability Statement

Data used in these analyses are published on Zenodo, DOI: 10.5281/zenodo.5804908.


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