Differential coverage for vaccines in the expanded program on immunization (EPI) among children in rural Pakistan

Hepatitis B vaccination coverage and associated factors among children living in northwest Ethiopia city administrations: A community-based study

Objective

A study was being conducted to assess the current vaccination coverage, dropout rates, and associated risk factors in children under 15 years old in northwest Ethiopia.

Study design

A community-based cross-sectional survey.

Methods

A community-based survey was conducted in northwest Ethiopia from January to March 2024. A two-stage cluster-sampling technique was used to select a representative sample. Sociodemographic information, vaccination history, and epidemiological risk factors were collected using a pre-tested, structured questionnaire. Data analysis was performed using SPSS version 23, employing descriptive statistics, chi-square test, and logistic regression model. Associations of vaccination determinants were investigated, with a p-value <0.05 considered statistically significant.

Results

In the study, 808 children were surveyed, with 53.0 % being female and 53.0 % were born at hospitals. Most (52.5 %) were under 5 years old, with a mean age of 5.4 ± 3.5 years. Seven hundred thirty four (90.8 %) had received at least one dose of the hepatitis B vaccine, and 82.7 % had received three doses, with a 9.0 % dropout rate. Among children completely vaccinated against hepatitis B, 366 (54.8 %) were in the age group of 1-4 years. The vaccination coverage was 85.4 %, 82.9 %, and 76.5 % in Bahir Dar, Gondar, and Debre Markos, respectively. Several factors have been identified as predictors of complete hepatitis B vaccination in children, including mothers who attended primary school (AOR = 2.9; 95 % CI: 1.4-5.8) and those with secondary education or higher (AOR = 2.2; 95 % CI: 1.3-4.0), married mothers (AOR = 2.5; 95 % CI: 1.5-4.3), and mothers aged 21-30 years (AOR = 2.7; 95 % CI: 1.3-5.6) and those aged 31-40 years (AOR = 2.8; 95 % CI: 1.4-5.5) were more likely to have their children fully vaccinated. Additionally, children born in hospitals (AOR = 2.4; 95 % CI: 1.3-4.3) or health centers (AOR = 4.0; 95 % CI: 2.2-7.4), increased access to vaccination services (AOR = 2.5; 95 % CI: 1.5-4.3), children aged 1-4 years (AOR = 3.1; 95 % CI: 1.7-5.5) and 5-9 years (AOR = 3.8; 95 % CI: 2.1-7.1) had higher HB vaccination coverage.

Conclusion

The complete hepatitis B vaccination coverage in this study was lower than the WHO recommendation for developing countries. Therefore, enhancing the promotion of facility delivery and ensuring easy access to vaccines are crucial for improving children's vaccination coverage.

Bridging the Vaccination Equity Gap: A Community-Driven Approach to Reduce Vaccine Inequities in Polio High-Risk Areas of Pakistan

Background: Immunization saves millions of lives, and globally, vaccines have significantly contributed to reducing mortality and morbidity due to more than 20 life-threatening illnesses. However, there are considerable disparities in vaccination coverage among countries and within populations. This study evaluates the reduction in disparities in vaccination coverage across various socio-economic groups by adopting an integrated community-engagement approach combined with maternal and child health services through mobile health camps. Methods: This secondary analysis is based on a community-based demonstration project conducted between 2014 and 2016 across 146 union councils in polio high-risk districts of Sindh, Khyber Pakhtunkhwa (KP) and Baluchistan in Pakistan. The intervention involved structured community engagement and mobile health camps providing routine immunization alongside maternal and child health services. Data were collected through cross-sectional independent surveys using the WHO two-stage cluster technique at the baseline and the endline, covering over 120,000 children under 5 years old. Four key outcome indicators were analyzed: fully vaccinated children, under-immunized children, unvaccinated children, and polio zero-dose children for equity in vaccine uptake. Results: The proportion of fully vaccinated children increased in the lowest wealth quintile from 28.5% (26.7%, 30.3%) at the baseline to 51.6% (49.5%, 53.8%) at the endline. In comparison, the increase in the richest quantities was 16.2% (14.0%, 18.4%) from the baseline 56.4% (54.6%, 58.2%) to the endline 72.7% (71.1%, 74.2%). Under-vaccination dropped by 10.2% (95% CI: -11.4%, -9.1%), with the poorest quintile showing an 11.8% reduction. The gap between the highest and lowest wealth quintiles in full immunization narrowed by 6.9%, from 27.9% to 21.0% at the baseline and the endline, respectively. The prevalence of zero-dose children significantly decreased across all quintiles, with the highest reduction observed in the lowest quintile of -11.3% (-13.6%, -9.1%). The difference between the highest and lowest wealth quintiles reduced from 6.2% to 3.8%. A significant reduction in polio zero-dose children was achieved, as 13.5% (95% CI: -14.8%, -12.2%), from 29.2% (95% CI: 28.0%, 30.3%) to 15.6% (14.8%, 16.5%). Conclusions: This study shows that integrating community engagement with maternal and child health services through health camps can significantly enhance immunization coverage and reduce wealth-based disparities in high-risk, hard-to-reach areas. The approach improved coverage for zero-dose and fully vaccinated children, suggesting a potential for scaling in regions with access issues, conflict, and vaccine hesitancy.

Leveraging Data from a Provincial Electronic Immunization Registry to Analyze Immunization Coverage, Timeliness, and Defaulters Among 8.8 Million Children from the 2018 to 2023 Birth Cohorts in Sindh Province, Pakistan

BACKGROUND/OBJECTIVES

Full immunization coverage in Pakistan remains suboptimal at 66%. An in-depth assessment is needed to understand the long-term trends in immunization and identify the extent of defaulters and associated risk factors of them being left uncovered by the immunization system.

METHODS

We conducted a 5-year analysis using the Government's Provincial Electronic Immunization Registry data for the 2018-2023 birth cohorts in Sindh province. We analyzed 8,792,392 child-level immunization records from 1 January 2018 to 31 May 2024 to examine trends in immunization coverage, timeliness, defaulter rates, and associated risk factors; Results: Our findings indicate gradual improvements in immunization coverage, with full immunization rates increasing by 23.2% (from 47.5% to 70.7%) from 2018 to 2022. While timeliness declined from 2018 to 2021, it recovered in 2022 and 2023. Over the 5-year study period, >90% of children defaulted on vaccinations, with 34.8% fully covered and 9.1% uncovered. Children from urban areas (OR = 1.54; 95% CI = 1.52, 1.56; p-value < 0.001) and those enrolled through fixed immunization sites (OR = 2.11; 95% CI = 2.08, 2.15; p-value < 0.001) and mobile immunization vans (OR = 1.13; 95% CI = 1.13, 1.77; p-value = 0.003) were at higher risk of being uncovered defaulters.

CONCLUSIONS

This study demonstrates improvements in immunization coverage in Sindh while highlighting the challenge of low timeliness and high default rates. Our findings provide insights to strengthen immunization access and timeliness, particularly in high-default areas, and can guide policies in similar low-income settings for more equitable and comprehensive immunization coverage.