Determinants of immunization in polio super high-risk union councils of Pakistan

• Published in: Vaccine Vol. 42; no. 3; pp. 583 - 590
• Main Authors: Khan, Ahmad, Hussain, Imtiaz, Rhoda, Dale A., Umer, Muhammad, Ansari, Uzair, Ahmed, Imran, Clary, Caitlin, Muhammad Safdar, Rana, Bashir Soofi, Sajid
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 25.01.2024; Elsevier Limited; Elsevier Science
• Subjects: Caregivers; Child; Children; Children & youth; Community involvement; Community participation; Councils; Cross-Sectional Studies; Data collection; Epidemiology; Estimates; Female; Fully vaccinated; Households; Humans; Immunization; Immunization coverage; Immunization Programs; Infant; Measles; Pakistan; Pakistan - epidemiology; Polio super high-risk union councils; Poliomyelitis; Poliomyelitis - epidemiology; Poliomyelitis - prevention & control; Poliovirus; Poliovirus Vaccine, Inactivated; Poliovirus Vaccine, Oral; Population; Questionnaires; Sample size; Sampling techniques; Vaccination - methods; Vaccines; Pakistan; Polio super high-risk union councils; Pakistan; Immunization coverage; Fully vaccinated
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2023.12.056

•48.3% children are fully vaccinated in the super-high-risk union councils districts of Pakistan.•Vaccination coverage varies considerably across the super-high-risk union council districts.•Dropout rate between vaccine visits is as higher as 60.5% and as low as 4.9% in the districts.•Full immunization is associated with parental education level. The current polio epidemiology in Pakistan poses a unique challenge for global eradication as the country is affected by ongoing endemic poliovirus transmission. Across the country, 40 union councils (UCs) which serve as core reservoirs for poliovirus with continuous incidences of polio cases are categorized as super-high-risk union councils (SHRUCs). A cross-sectional survey was conducted in 39 SHRUCs using a two-stage stratified cluster sampling technique. 6,976 children aged 12–23 months were covered. A structured questionnaire was used for data collection. Data were analyzed using STATA version 17. Based on both vaccination records and recall, 48.3% of children were fully-, 35.4 % were partially-, and 16.3% were non-vaccinated in the SHRUC districts. A child is considered fully vaccinated when h/she completed vaccination for BCG, OPV0, OPV 1-3, Penta 1-3, PCV 1-3, IPV, and MCV1. Vaccination cards were seen for over half of the children in the SHRUC districts of Khyber Pakhtunkhwa (KP) and the majority of the SHRUC districts in Sindh, except for the SHRUC district of Malir the districts of Balochistan. Results for polio vacancies show that 60.9% of children from the SHRUC districts were vaccinated with at least three doses of OPV and one dose of IPV, while 20.4% were vaccinated with any OPV doses or IPV and 18.7% of children did not receive any polio vaccines. The dropout rate between vaccine visits was higher than the WHO-recommended cutoff point of 10% for all vaccine doses in the SHRUC districts. The likelihood of being fully vaccinated was higher among the children of educated parents. Full vaccination was found significant among the children of any SHRUC districts compared to district Killa Abdullah. Context-specific strategies with more focus on community engagement and targeted mobilization, along with robust monitoring mechanisms, would help address the underlying challenges of under-immunization in the SHRUCs.