Coverage, timeliness, and determinants of immunization completion in Pakistan: evidence from the Demographic and Health Survey (2006-07).
BACKGROUND
Immunization coverage data and determinants for completion are not well described for Pakistan. This study determines immunization coverage rates and timeliness based on the 2006-07 Pakistan Demographic and Health Survey (DHS) and identifies determinants for completion of immunizations.


METHODS
DHS data from 9177 randomly selected households from across Pakistan were analyzed to assess immunization coverage and timeliness for children aged 0-5 years, and to investigate determinants of immunization completion through logistic regressions.


RESULTS
The proportion of children immunized for a third dose of the oral poliovirus vaccine (OPV3) was 80.3%, and combination diphtheria, tetanus, and pertussis vaccines (DTP3) was 55.9%. Measles coverage was 62.5%. Late immunizations were most likely to occur for third doses of the OPV (65.5%) and DTP series (65.5%). Early doses were most likely to be administered for measles (21.9%). The proportion of children not immunized for any vaccine was 6.2%. Receiving a dose of maternal tetanus was a major determinant for immunization completion for OPV3 (OR 1.35, 95% CI: 1.14-1.60), DTP3 (OR 2.54, 95% CI: 2.13-3.02), and measles (OR 2.78, 95% CI: 2.27-3.40). Other independent variables associated with improved immunization completion included higher household wealth and maternal education.


CONCLUSIONS
Poor routine immunization coverage and timeliness were identified through the DHS in Pakistan. Encouraging maternal tetanus uptake among women of child-bearing age and greater integration of immunization services with antenatal care may help improve childhood immunization completion.
Interactive Research & Development; Karachi, Pakistan.
Syed Mohammad Asad
SM
Zaidi
Interactive Research & Development; Karachi, Pakistan.
Saira
S
Khowaja
Interactive Research & Development; Karachi, Pakistan.
Vijay
V
Kumar Dharma
Interactive Research & Development; Karachi, Pakistan.
Aamir J
AJ
Khan
Interactive Research & Development; Karachi, Pakistan.
Subhash
S
Chandir
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006306:Health Surveys; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D011897:Random Allocation; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
Demographic Health Survey; Pakistan; immunization coverage; immunization determinants; immunization timeliness