Geographic and Temporal Variations in Immunization Coverage in Nepal: An Ecological Time-Trend Analysis

Area of Science:

• Public Health
• Vaccination Programs
• Health Disparities

Background:

• Immunization is crucial in Nepal, but significant disparities exist.
• This study examines national immunization program performance from 2009-2022.
• District-level vaccination coverage and dropout rates were analyzed.

Purpose of the Study:

• To evaluate Nepal's national immunization program performance.
• To identify trends and disparities in routine vaccinations.
• To inform targeted public health interventions.

Main Methods:

• Secondary ecological analysis of administrative data.
• Literature search for national immunization reports.
• Classification of 77 districts into performance categories based on coverage and dropout rates.

Main Results:

• Only 10.4% of districts consistently achieved high coverage and low dropout.
• 50.7% of districts had median high coverage, low dropout status.
• BCG vaccine had the highest coverage, while Tetanus Toxoid had the lowest.

Conclusions:

• Consistent high immunization performance was limited to a few districts.
• Category 4 districts (low coverage, high dropout) persisted, especially in 2009 and 2019.
• Targeted interventions are needed to address geographic and temporal variations in performance.