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

Area of Science:

• Public Health
• Epidemiology
• Pediatrics

Background:

• Pakistan's Expanded Program on Immunization (EPI) faces challenges, with vaccine-preventable diseases contributing to high infant and child mortality.
• Despite established immunization programs, significant gaps in vaccine coverage and timeliness persist in rural areas.

Purpose of the Study:

• To determine the differential vaccine coverage rates among children in rural Pakistan.
• To identify socio-demographic factors associated with vaccine uptake and adherence to the immunization schedule.

Main Methods:

• A cohort of children under two years old was enrolled in the Matiari Demographic Surveillance System, Sindh, Pakistan (October 2014 - September 2018).
• Socio-demographic data and vaccination histories were collected.
• Multivariable logistic regression was used to analyze determinants of missed and untimely vaccinations.

Main Results:

• Only 48.4% of children received all recommended Expanded Program on Immunization (EPI) vaccines, with only 21.2% administered at the appropriate age.
• Measles (29.3%) and rotavirus (1.8%) vaccines had the lowest coverage.
• Higher parental education and enrollment in later study years were protective against missed/delayed vaccination, while greater distance from a major road was associated with non-adherence.

Conclusions:

• Low and often delayed vaccine uptake was observed in the study population.
• Parental education and geographical accessibility are key determinants of vaccination success.
• Targeted interventions and improved outreach may enhance vaccine coverage and timeliness in similar settings.