Determinants of timeliness in early childhood vaccination among mothers with vaccination cards in Sindh province, Pakistan: a secondary analysis of cross-sectional survey data

Abstract

ObjectiveUntimely vaccination refers to receiving the given dose before (early) or after (delayed) the recommended time window. The purpose of this study was to assess the extent of timeliness of childhood vaccinations and examine the determinants of vaccination timeliness in Sindh province, Pakistan.DesignCross-sectional analysis of data from the 2013 and 2014 Maternal and Child Health Program Indicator Surveys.SettingCommunity-based maternal and child health surveys.ParticipantsAmong 10 200 respondents of Maternal and Child Health Program Indicator Surveys, 1143 women who had a live birth in the 2 years preceding the survey were included.OutcomesAt the participants’ home, an interviewer asked mothers to show their children’s vaccination cards, which contained information regarding vaccinations. Children’s vaccination status was categorised into timely or early/delayed compared with vaccination schedule. A logistic regression analysis using Firth’s penalised likelihood was performed to identify factors associated with timeliness of vaccinations.Results238 children (20.8% of children who received a full set of basic vaccinations) received all vaccinations on schedule among children who received a full set of basic vaccinations. The percentages of timely vaccinations ranged from 2.3% for second measles vaccination to 89.3% for bacillus Calmette-Guérin. Child’s age and place of delivery were associated with timely vaccinations. Older child age and institutional delivery were associated with decreased timely vaccination rate.ConclusionsHome-based vaccination record is a key tool to improve the timeliness of vaccinations. The redesigned vaccination cards, the new electronic registries for vaccination card information and the vaccination tracking system to remind the second/third vaccination visits may be helpful to improve timely vaccinations for children under 2 years old.

Timely completion of vaccination and its determinants among children in Northwest, Ethiopia: A multilevel analysis

“…In Ethiopia, urban areas might have easier access to health services and better transportation available whereas the introduction of the health extension program might have increased access to vaccinations in rural areas with well-established rural outreach immunization efforts, which may account for the insignificant results in this study. This finding corroborates with a finding from Pakistan where residence has no effect on timeliness of vaccination (52). This finding is inconsistent with other findings from Bangladesh (50), Vietnam (51) and Nigeria (68) where children from urban areas have better timeliness for vaccination.…”

“…Otherwise, it was not considered as on-time full vaccination if at least one vaccine dose was given early, late or missed at all (30,31,43,44,48,(50)(51)(52)(53).…”

Vaccination timeliness and associated factors among children aged 12-23 months in northwest Ethiopia: community-based study

“…This nding was higher than the studies done in Menz Lalo district, northeast Ethiopia, 6.2 % (22) and Kenya 6.1% (20). However, the nding was lower than the results in Pakistan 20.8% (29), Israel 22% (30), Ghana 50.5% (31) and Senegal 72.3% (32).…”

“…It is higher than the ndings in Ethiopia (23.9%) (23) and Bangladesh (24%) (33). On the contrary, this nding was lower than compared to studies conducted outside in Pakistan (89.3%) (29), Ghana (88.9%) (31), and Senegal (88.25%) (32). Similarly, 42.9% (95%CI: 38.9-47.0) children were vaccinated measles vaccine in the recommended time interval.…”

“…Besides, this study also revealed that 16.4% (95%CI: 13.3-19.8) of children were received measles vaccine earlier than the recommended time interval. The nding was higher than a study conducted in Bangladesh (12%) (33) and lower than a study done in Pakistan (90%) (29). The possible justi cation might be health workers' appointment before nine months of age to prevent open dose vial wastage, mothers/caregivers being too busy on appointment day and forgotten vaccination appointment (22).…”