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Age-appropriate vaccination coverage and its determinants in children aged 12-36 months in Nepal: a national and
Santosh Kumar Rauniyar1, Yoko Iwaki2, Daisuke Yoneoka3,4
1Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. rauniyar.sam@gmail.com.
Insights
Childhood vaccination in Nepal shows high crude coverage but low age-appropriate rates, undermining vaccine effectiveness. Timeliness monitoring and tailored provincial strategies are crucial for improving immunization coverage.
Area of Science:
- Pediatrics
- Public Health
- Immunization Practices
Background:
- Vaccination is vital for protecting children against life-threatening diseases.
- Nepal's immunization program aims for high crude vaccine coverage.
Purpose of the Study:
- To analyze age-appropriate vaccination coverage in Nepal at national and subnational levels.
- To identify factors associated with timely vaccination in children.
Main Methods:
- Analysis of data from 460 children (12-36 months) from the Nepal Demographic and Health Survey (NDHS) 2016-17.
- Kaplan Meier method for estimating age-appropriate coverage of BCG, OPV, Pentavalent (PE), and MMR vaccines.
- Multilevel logistic regression to identify factors associated with timely vaccination.
Main Results:
- Crude vaccine coverage exceeded 90%, but age-appropriate coverage ranged from 41.5% to 73.9%.
- Significant disparities in timely vaccination coverage were observed across provinces, with Province 2 and Province 6 showing the lowest rates.
- Timeliness of vaccination was significantly associated with subnational regions and the season of childbirth.
Conclusions:
- Despite high crude coverage, low age-appropriate vaccination rates in Nepal compromise vaccine effectiveness.
- Monitoring vaccination timeliness alongside crude coverage is essential at all administrative levels.
- Provincial governments must develop targeted strategies to improve timely childhood immunization.
Background:
Vaccination is one of the effective ways to develop immunity against potential life-threatening diseases in children in early age. This study is focused on analysing the age-appropriate vaccination coverage at national and subnational levels and identify the factors associated with age-appropriate coverage in Nepal.
Methods:
460 children aged 12-36 months were included in the study. The data was obtained from Nepal Demographic and Health Survey (NDHS) 2016-17. Age-appropriate coverage of Bacillus Calmette-Guerin vaccine (BCG), oral polio vaccine (OPV) doses 1-3, pentavalent vaccine (PE) doses 1-3, and first dose of measles, mumps, and rubella vaccine (MMR) were estimated using Kaplan Meier method. Multilevel logistic regression with random intercept was used to identify the factors associated with age-appropriate vaccination.
Results:
The crude coverage of the vaccines included in the study ranged from 91.5% (95% CI, 88.5-93.7) for PE3 to 97.8% (95.8-98.7) for BCG. Although the crude coverage of all the vaccines was above 90%, the age-appropriate coverage was significantly low, ranging from 41.5% (36.5-46.6) for PE3 to 73.9% (69.2-78.1) for PE1. Furthermore, high disparity in timely vaccination coverage was observed at regional level. Compared to the age-appropriate vaccination coverage in other provinces, Province 2 had the lowest coverage of all, followed by that in Province 6. The timeliness of vaccination was significantly associated with subnational regions i.e., provinces and the season of childbirth.
Conclusion:
Although the immunization program in Nepal has achieved the target of 90% crude coverage of all the childhood vaccines, the age-appropriate coverage is significantly low which undermines the effectiveness of the vaccines administered. Thus, along with crude coverage, timeliness of the vaccines administered should be taken into consideration and thoroughly monitored at national and subnational levels. Provincial government should formulate tailored strategies to ensure the timely administration of the childhood vaccines.
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