title: Determinants of third dose of diphtheria-tetanus-pertussis (DTP) completion among children who received DTP1 at rural immunization centres in Pakistan: a cohort study.
abstract: OBJECTIVE
  In Pakistan, a high proportion of children fail to complete third dose of diphtheria-tetanus-pertussis (DTP3) after having received the first dose (DTP1). A cohort study was conducted to identify the factors predicting three doses of diphtheria-tetanus-pertussis (DTP3) completion among children who have received DTP1 at six centres of Expanded Programme on Immunization (EPI) in rural Pakistan.
  
  
  METHODS
  We analyzed a cohort of mother-child pairs enrolled at DTP1 between November 2005 and May 2006 in the standard care group of a larger randomized controlled trial. Data were collected from mothers on a structured questionnaire at enrollment, and each child was followed up at clinic visits for 90 days to record dates of DTP2 and DTP3. Multivariable log-binomial regression analysis was performed to identify the independent predictors of DTP3 completion.
  
  
  RESULTS
  Only 39% (149/378) of enrolled children completed DTP3 during the follow-up period. After adjusting for the centre of enrollment in multivariable analysis, DTP3 completion was higher among children who were < or =60 days old at enrolment [adjusted risk ratio (Adj. RR) 1.39, 95% confidence interval (CI): 1.06-1.82], who were living in a household with monthly household income >Rs. 3000 (US$ 50) (Adj. RR 1.76, 95% CI: 1.16-2.65), and who were living < or =10 min away from EPI centre (Adj. RR 1.31, 95% CI: 1.04-1.66).
  
  
  CONCLUSIONS
  Interventions targeting childhood immunization dropouts should focus on bringing more children to EPI centres on-time for initial immunization. Relocation of existing EPI centres and creation of new EPI centres at appropriate locations may decrease the travel time to the EPI centres and result in fewer immunization dropouts.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, AL 35294-0022, USA. hussain@uab.edu
authors.forename: Hussain R
authors.initials: HR
authors.lastname: Usman
authors.forename: Sibylle
authors.initials: S
authors.lastname: Kristensen
authors.forename: M Hossein
authors.initials: MH
authors.lastname: Rahbar
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Faiza
authors.initials: F
authors.lastname: Habib
authors.forename: Eric
authors.initials: E
authors.lastname: Chamot
mesh_terms: D000293:Adolescent; D000328:Adult; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage*; D004812:Epidemiologic Methods; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D008297:Male; D032541:Mass Vaccination; D010154:Pakistan; D010349:Patient Compliance / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D019035:Rural Health Services; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine