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Routine Immunization Coverage and Immunization Card Retention in Pakistan: Results From a Cross-sectional National

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Improving childhood immunization coverage in Pakistan is crucial. Key barriers include lack of faith in vaccines, misinformation, and distance to facilities, necessitating targeted interventions.

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Area of Science:

  • Public Health
  • Epidemiology
  • Global Health

Background:

  • Immunization is a vital public health intervention, saving millions of lives annually.
  • Improving immunization coverage is a national priority for Pakistan, essential for achieving universal health coverage.

Purpose of the Study:

  • To assess national and provincial immunization coverage for children aged 12-23 months in Pakistan.
  • To identify determinants of vaccination status, including full, partial, and unvaccinated.
  • To evaluate antigen-wise coverage, home-based vaccination record retention, dropout rates, timeliness, and missed opportunities for simultaneous vaccination (MOSV).

Main Methods:

  • A descriptive, cross-sectional national household survey conducted across Pakistan.
  • Inclusion of 110,790 children aged 12-23 months and their caregivers.
  • Adaptation of the World Health Organization (WHO)-Expanded Program on Immunization (EPI) Survey questionnaire and data analysis using WHO Vaccination Coverage Quality Indicators (VCQI) software and Stata 17.

Main Results:

  • National full immunization coverage was 76.5% (excluding AJK and GB).
  • Higher vaccination likelihood was associated with educated parents, higher wealth quintiles, and residence outside Balochistan.
  • Primary reasons for non-vaccination included lack of faith, vaccine rumors, and facility distance; 66.2% had home-based vaccination records (HBR).
  • Dropout rates were higher for later vaccine doses, with significant delays in receiving the last doses.
  • Missed opportunities for simultaneous vaccination (MOSV) occurred in 17.6% of documented vaccination visits.

Conclusions:

  • Current immunization coverage rates offer a roadmap for strategic improvements in Pakistan.
  • Immediate and long-term actions are needed to combat vaccine-preventable diseases.
  • Recommendations include integrated immunization campaigns, outreach, mobility support, and behavioral interventions to enhance awareness and address misconceptions.