Coverage, timeliness, and determinants of immunization completion in Pakistan

Figures & data

Figure 1. Factors contributing to low age-appropriate immunization coverage in Pakistan.

Figure 2. Selection of households for the 2006–07 Pakistan Demographic and Health Survey.

Table 1. Recommended and minimum acceptable ages for routine immunizations in the expanded program for immunizations (2002–2007) in Pakistan

Antigen and dose	Minimum age	Recommended	Timely	Early	Late
OPV0/ BCG	Birth	0 wk / 0 d	0–28 d	—	>28 d
OPV1/ Penta1	6 wk	6 wk / 42 d	39–70 d	<39 d	>70 d
OPV2/Penta2	10 wk	10 wk / 70 d	67–98 d	<67 d	>98 d
OPV3/Penta3	14 wk	14 wk / 98 d	95–126 d	<95 d	>126 d
Measles	26 wk	39 wk / 273 d	270–301 d	<270 d	>301 d

Table 2. Baseline characteristics of survey respondents in the Pakistan demographic and health survey (2006–2007)

	Punjab	Sindh	KPK	Baluchistan	Total
n	3705	2649	1787	1036	9177
(%)	(40.4)	(22.9)	(19.5)	(11.3)	(100)
Child median age in wk	126	126	126	130	126
(IQR)	(56.57–187.14)	(56.57–191.14)	(60.85–191.28)	(60.85–187.21)	(56.57–187.28)
Male (%)	52	52	53	53	52
Ethnicity
Punjabi (%)	62.8	5.1	0.7	1.0	27.1
Mohajir (%)	7.2	9.7	1.0	1.9	6.1
Sindhi (%)	0.0	47.0	0.1	10.1	14.7
Pakhtun (%)	2.3	3.9	77.7	45.8	22.4
Balochi (%)	0.3	7.1	0.0	26.0	5.1
Seraiki (%)	24.7	13.6	6.2	3.3	15.5
Other (%)	2.7	13.7	14.3	12.0	9.2
Urban (%)	34.5	38.3	30.7	29.3	34.3
Wealth
Lowest Quintile (%)	17.5	33.4	14.6	33.1	23.3
2nd Quintile (%)	17.2	20.4	31.4	23.8	21.6
3rd Quintile (%)	22.2	14.5	21.2	25.8	20.2
4th Quintile (%)	21.5	17.1	17.4	9.7	18.1
Highest Quintile (%)	21.6	21.6	14.5	15.6	16.8
Telephone connection (%)	46.0	38.4	47.9	33.0	42.7
Median household size	8	9	9	10	9
(IQR)	(6–11)	(6–12)	(7–13)	(7–16)	(6–12)
Median number of children Under 5 y of age	2	2	2	2	2
(IQR)	(1–3)	(2–3)	(2–3)	(2–4)	(1–3)
Median highest maternal y of education	5	5	4	4	5
(IQR)	(3–5)	(3–5)	(3–5)	(3–5)	(3–5)
Median breastfeeding duration in mo	15	14	16	16	15
(IQR)	(7–24)	(7–24)	(8–24)	(9–24)	(7–24)
Received at least 1 dose of Maternal tetanus (%)	66.2	57.6	51.3	31.9	56.8
Male household head (%)	91.5	95.6	90.0	98.4	93.2
Home delivery (%)	64.4	57.9	66.9	79.0	64.7
Antenatal visits
0 (%)	32.3	27.5	42.2	56.3	35.7
1–5 (%)	48.7	55.1	46.6	40.8	49.2
6–10 (%)	16.0	14.5	10.1	2.6	12.9
>10 (%)	3.0	2.9	1.1	0.3	2.3

Table 3. Immunization completion in children aged 0–5 y old, 2002–2007 in Pakistan

	BCG	Polio				DTP			Measles
		OPV0	OPV1	OPV2	OPV3	DTP1	DTP2	DTP3
n^a	8329	8419	8306	8192	7970	8080	7886	7733	6815
Card (%)	16.00	11.76	14.62	13.15	11.57	15.06	13.49	12.05	10.17
History (%)	59.35	38.69	73.39	72.12	68.75	54.83	49.71	43.81	52.34
Either dource (%)	75.35	50.45	88.01	85.27	80.32	69.89	63.20	55.86	62.51

^aRepresents total number of children due for vaccination based on age calculated from birth date

Table 4. Timeliness of Immunizations in Children aged 0–5 y old, 2002–2007 in Pakistan

	BCG	Polio				DTP			Measles
	BCG %	OPV0 %	OPV1 %	OPV2 %	OPV3 %	DTP1 %	DTP2 %	DTP3 %	Measles 1 %
n	1330	981	1213	1054	909	1199	1053	824	689
Early^a (estimated range)^b	-	-	16.74 (6.68–34.54)	10.67 (4.78–20.22)	7.07 (3.04–14.24)	14.93 (6.08–34.59)	10.34 (4.61–19.74)	7.09 (3.33–14.72)	21.95 (8.27–42.67)
Timely (estimated range)	70.08 (50.75–77.59)	77.06 (55.45–85.12)	47.98 (35.94–39.49)	36.42 (21.16–41.20)	27.39 (14.57–32.50)	48.96 (36.57–39.28)	35.53 (20.96–40.88)	27.39 (14.61–31.69)	41.42 (29.32–42.67)
Late^c (estimated range)	29.92 (22.41–49.25)	22.94 (14.88–44.55)	35.28 (25.97–57.38)	52.90 (38.58–74.06)	65.54 (53.26–82.39)	36.11 (26.13–57.35)	54.14 (39.38–74.44)	65.52 (53.60–82.06)	36.63 (28.01–49.06)

Early defined as vaccine administered 3 d before due date calculated from birth. Estimated Range for immunization timeliness calculated using first and last day of each month as the individual's birth-date. Late defined as vaccine administered greater than 4 wk after due date calculated from birth.

Table 5. Determinants of Immunization Completion in Children aged 0–5 y old, 2002–2007 in Pakistan

	OPV 3				DTP 3				Measles
Variable	Unadjusted OR	95% CI	Adjusted OR	95% CI	Unadjusted OR	95% CI	Adjusted OR	95% CI	Unadjusted OR	95% CI	Adjusted OR	95% CI
Age	1.00	1.00–1.00			1.00	1.00–1.00	1.00	1.00–1.00	1.00	1.00–1.00	1.00	1.00–1.00
Gender (male reference)	0.94	0.81–1.08			0.88	0.79–0.99	0.87	0.74–1.02	0.92	0.82–1.04	0.84	0.70–1.01
Ethnicity
Balochi (reference group)
Punjabi	1.33	0.93–1.89			3.37	2.47–4.60	1.68	1.15–2.45	3.50	2.34–5.23	1.71	1.13–2.57
Mohajir	1.76	1.15–2.70			4.20	2.82–6.28	1.36	0.85–2.19	3.95	2.48–6.29	1.13	0.65–1.95
Sindhi	1.32	0.91–1.91			1.46	1.03–2.06	1.02	0.67–1.55	1.19	0.78–1.82	0.82	0.53–1.27
Pushto	0.92	0.64–1.33			2.03	1.43–2.90	1.58	1.05–2.36	1.71	1.09–2.67	1.31	0.84–2.05
Seraiki	1.53	1.02–2.30			1.15	0.83–1.61	0.87	0.59–1.28	1.06	0.70–1.61	0.86	0.57–1.30
Other	0.93	0.63–1.39			1.44	0.99–2.11	1.06	0.70–1.62	1.50	0.95–2.35	1.22	0.76–1.94
Urban vs rural	1.22	1.03–1.44			2.00	1.69–2.37			2.14	1.77–2.58
Wealth
Lowest quintile (reference)
2nd Quintile	1.20	0.96–1.51	1.24	0.90–1.47	1.60	1.28–1.99	1.18	0.93–1.51	1.53	1.21–1.93	1.19	0.92–1.55
3rd Quintile	1.20	0.97–1.48	1.15	0.91–1.45	2.45	1.96–3.06	1.39	1.08–1.80	2.66	2.09–3.38	1.47	1.11–1.95
4th Quintile	1.50	1.18–1.91	1.23	0.92–1.64	0.9754716 1.60	3.04–4.82	1.74	1.33–2.28	4.17	3.26–5.33	1.93	1.44–2.58
Highest quintile	2.00	1.53–2.60	1.46	1.01–2.11	5.68	4.35–7.42	1.88	1.31–2.70	5.94	4.41–8.00	1.77	1.17–2.67
Telephone connection	1.07	0.99–1.15			1.10	1.03–1.17			1.15	1.07–1.24
Household Size	1.00	0.98–1.01			1.00	0.98–1.01			0.99	0.98–1.01
Children 5 and under	0.97	0.92–1.02			0.97	0.92–1.02			0.95	0.90 -1.01
Maternal education
None (reference)
Primary	1.31	1.01–1.71	1.17	0.90–1.50	2.35	1.93–2.88	1.37	1.08–1.73	2.31	1.83–2.90	1.25	0.97–1.62
Secondary	1.76	1.36–2.29	1.20	0.88–1.63	3.31	2.64–4.14	1.55	1.21–2.00	3.89	2.96–5.11	1.62	1.18–2.22
Higher	2.16	1.49–3.14	1.57	0.98–2.52	5.43	4.06–7.27	1.85	1.23–2.79	7.08	4.81–10.41	2.43	1.38–4.29
Received maternal tetanus	1.59	1.35–1.86	1.35	1.14–1.60	3.36	2.84–3.96	2.54	2.13–3.02	3.76	3.08–4.59	2.78	2.27–3.40
Breastfeeding (mo)	1.01	1.00–1.01			1.00	1.00–1.00			0.99	0.99–1.00
Female head of Household	0.93	0.72–1.22			1.23	0.95–1.61	1.06	0.78–1.43	1.36	1.03–1.79	1.33	0.95–1.86
Hospital delivery	1.17	1.00–1.36			2.17	1.89–2.49	1.12	0.93–1.34	2.42	2.07–2.82	1.23	1.01–1.50
Antenatal visits
0 (reference)
1–5	1.31	1.11–1.54	1.04	0.87–1.25	1.87	1.57–2.22	1.14	0.94–1.40	1.94	1.61–2.33	1.08	0.87–1.32
6–10	1.66	1.26–2.19	1.08	0.78–1.49	3.27	2.50–4.26	1.26	0.92–1.73	3.70	2.74–4.99	1.25	0.88–1.77
>10	1.63	0.91–2.92	0.99	0.54–1.80	4.94	2.95–8.26	1.59	0.87–2.90	6.42	3.07–13.43	1.55	0.68–3.53
Goodness of fit F-statistic (P value)			0.64 (0.76)					1.08 (0.37)			0.28 (0.98)