title: Factors associated with non-utilization of child immunization in Pakistan: evidence from the Demographic and Health Survey 2006-07.
abstract: BACKGROUND
  The proportion of incompletely immunized children in Pakistan varies from 37-58%, and this has recently resulted in outbreaks of measles and polio. The aim of this paper is to determine the factors associated with incomplete immunization among children aged 12-23 months in Pakistan.
  
  
  METHODS
  Secondary analysis was conducted on nationally representative cross-sectional survey data from the Pakistan Demographic and Health Survey, 2006-07. The analysis was limited to ever-married mothers who had delivered their last child during the 23 months immediately preceding the survey (n=2,435). 'Complete immunization' was defined as the child having received twelve doses of five vaccines, and 'incomplete immunization' was defined if he/she had missed at least one of these twelve doses. The association between child immunization status and determinants of non-utilization of vaccines was assessed by calculating unadjusted and adjusted odds ratios (AOR) with 95% confidence intervals using a multivariable binary logistic regression.
  
  
  RESULTS
  The findings of this research showed that nearly 66% of children were incompletely immunized against seven preventable childhood diseases. The likelihood of incomplete immunization was significantly associated with the father's occupation as a manual worker (AOR=1.47; 95% CI: 1.10-1.97), lack of access to information (AOR=1.35; 95% CI: 1.09-1.66), non-use of antenatal care (AOR=1.33; 95% CI: 1.07-1.66), children born in Baluchistan region (AOR=1.74; 95% CI: 1.12-2.70) and delivery at home (AOR=1.39; 95% CI: 1.14-1.69).
  
  
  CONCLUSIONS
  Despite governmental efforts to increase rates of immunization against childhood diseases, the proportion of incompletely immunized children in Pakistan is still high. Targeted interventions are needed to increase the immunization rates in Pakistan. These interventions need to concentrate on people with low socioeconomic and educational status in order to improve their knowledge of this topic.
authors.forename: Ayesha Siddiqa
authors.initials: AS
authors.lastname: Bugvi
authors.forename: Rahla
authors.initials: R
authors.lastname: Rahat
authors.forename: Rubeena
authors.initials: R
authors.lastname: Zakar
authors.forename: Muhammad Zakria
authors.initials: MZ
authors.lastname: Zakar
authors.affiliation: Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany. f.fischer@uni-bielefeld.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Fischer
authors.forename: Muazzam
authors.initials: M
authors.lastname: Nasrullah
authors.forename: Riffat
authors.initials: R
authors.lastname: Manawar
mesh_terms: D022126:Access to Information; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010154:Pakistan; D010290:Parents; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult