Associated Factors for Dropout of First Vs Third Doses of Diphtheria Tetanus Pertussis (DPT) Vaccination in Nepal

Abstract

Background. Immunization acts as a key intervention to reduce under-five mortality and morbidity. Despite global progress on vaccination, difficulties in the utilization of this service in developing countries have been observed. According to Nepal Demographic and Health Survey (NDHS) 2016, only 78% of children received a complete dose of vaccine among which the first-dose receiver of DPT is 98%, whereas only 83% received a third dose. This study aims to explore the influencing factors of DPT vaccination dropout in Nepal. Methods. The explorative study was done through secondary data analysis of NDHS 2016. The KR file was used for the analysis of information for 2883 children. Factors influencing dropout of DPT vaccination were explored against the independent variables such as external environment, predisposing factors, and enabling resources. All the analyses were weighted before the analysis. The descriptive, bivariate, and multivariate analyses were performed. The variables showing collinearity have been removed in the final model. Results. A higher dropout was reported in Terai (18.9%) and province 2 (22.0%), among uneducated mothers (18.1%) and uneducated fathers (19.4%), less than once a week internet users (22.2%), the nonradio listener (17.4%), who had <4 ANC visits (22.7%), home delivery (19.2%), no advised SBA (19.1%), long distance to health facility (17.9%), no iron supplementation in pregnancy (24.3%), and PNC by TBA/others (21.1%). All these tested relationships were found statistically significant ( P value <0.05). The aOR for dropout was found to be 7.94 (4.07–15.51) for mothers with less than 4 or no ANC visit, long distance to health facility 4.68 (1.98–10.67), province 2 3.53 (1.13–11.03), and mother without formal employment 2.33 (1.52–3.55). Conclusion. Factors related to health services, distance, provinces, and socioeconomic status of the family were influencers for vaccine dropout. Targeted intervention towards disadvantaged regions, counseling the mother during ANC, improving the education status of parents, access to the health facility, and use of mass media for advocacy are hereby recommended.

Association of War With Vaccination Dropout Among Children Younger Than 2 Years in the North Wollo Zone, Ethiopia

“…Residing in rural areas doubles the risk of vaccination dropout. This finding was in accordance with the findings of other studies conducted in northwest Ethiopia, 15 Nepal, 29 and Shewa Robit. 30 This could be due to the fact that health services are inaccessible in rural areas compared with urban areas.…”

The Effect of War on Expaned Program on Immunization in North East Ethiopia, 2022

“…It was found that both can affect the dropout rate. This nding was also con rmed in other studies such as the study done in northwest Ethiopia, Nepal, EDHS 2016 and Shewarobit (18, [22][23][24]. The possible explanation for this might be health facilities in the rural areas can be far for mothers, and it may take time to rehabilitate and reconstruct the health system in the rural areas.…”

“…Home delivery increases the risk of drop out of immunization by 75%. This nding is also supported by studies conducted in Nepal and western Ethiopia (11,23). Mothers who give birth at home are likely to have limited communication with health professionals and information about immunization.…”

Vaccination dropout among children in Sub-Saharan Africa: Systematic review and meta-analysis

“…Long travel distances to medical facilities, living in a rural region, and having a mother without a regular work were reported to be risk factors for immunization dropout in Nepal. 30 Children in other parts of Ghana were more likely to drop out of school if they lacked immunization records than those who did. 31 Last but not least, a randomized controlled experiment conducted in urban Pakistan found that receiving both a redesigned card and center-based education was expected to significantly enhance DPT3 completion compared to the control group.…”