Timeliness of routine vaccination among children and determinants associated with age-appropriate vaccination in Mongolia

Abstract

Introduction: Routine vaccination at the recommended age is crucial to minimize the risk of acquiring vaccine preventable diseases. This study aimed to assess the proportion of children receiving routine immunization at the recommended age and determinants of timely (age-appropriate) vaccination in Mongolia. Material and method: A total of 879 eligible children aged 12-23 months were included in this study. We investigated age-appropriate administration of Bacillus Calmette-Guerin vaccine (BCG); hepatitis B vaccine (Hep B); oral polio vaccine (OPV); pentavalent vaccine; and measles, mumps, and rubella vaccine (MMR) using Kaplan-Meier method. Multilevel logistic regression with random intercept at cluster level was used to assess the determinants of age-appropriate vaccination. Results: Overall, the crude vaccination coverage for routine vaccinations were above 90% for all vaccines except MMR1 which was 86.0% (95% CI, 83.6-88.2). While the first dose of almost all the vaccines given at birth; BCG, Hep B, and OPV0, were administered in a timely manner, a substantial proportion of second and third doses of these vaccines were not given in a timely manner with age-appropriate vaccination coverage ranging from 35.9% (32.8-39.1%) for MMR1 to 67.7% (64.5-70.7%) for OPV1 respectively. Factors associated with age-appropriate administration of the investigated vaccines included socioeconomic status of household, religion of household heads, area of residence, owning mobile phone, and season of childbirth. For instance, children belonging to households from richer wealth quintile had higher possibilities of getting age-appropriate OPV1-OPV3, PE1-PE3 and MMR1 vaccines compared to those from the poorest household wealth quintile. Conclusion: Our findings suggest that the commonly used indicator 'crude vaccination coverage' could be supplemented by 'age-appropriate vaccination' to help to identify gaps in timely vaccinations and stimulate interventions in Mongolia. Factors such as household wealth quintile, place of residence and religion associated with timely vaccination in our study could be considered to promote effective intervention aiming to improve adequate vaccination coverage.

Age-appropriate vaccination coverage and its determinants in children aged 12-36 months in Nepal: a national and subnational assessment

“…17,28 The reasons behind the low age-appropriate vaccines coverage rate might include a lack of awareness about the immunization schedule, low socio-economic status, hard to access health care facilities, reluctancy in administering vaccines, hesitancy of parents regarding vaccination, insu cient infrastructure to transport and store the vaccine in hard to reach areas, and occurrence of unusual events such as natural disaster, disease outbreak (pandemic situation). 20,26,27,[29][30][31][32][33] The huge earthquake of 2015 in Nepal signi cantly affected the healthcare services in different provinces throughout the country. 34 Our study was conducted after the earthquake.…”

“…Several studies conducted in similar settings in different countries estimated low age-appropriate coverage of childhood vaccines. 12,20,[24][25][26][27] The recent increase in number of measles and tuberculosis cases in Nepal could be attributed to untimely vaccination in Nepal. 17,28 The reasons behind the low age-appropriate vaccines coverage rate might include a lack of awareness about the immunization schedule, low socio-economic status, hard to access health care facilities, reluctancy in administering vaccines, hesitancy of parents regarding vaccination, insu cient infrastructure to transport and store the vaccine in hard to reach areas, and occurrence of unusual events such as natural disaster, disease outbreak (pandemic situation).…”

“…32,33 Province 3 had the highest coverage of almost all the vaccines as it is the central region with most of the areas urbanized and developed. 19,41 As highlighted in the previous study 20 , the analysis of vaccine data using the DHS has several limitations. First, only children who had vaccination records in the mother and child health book (the vaccination card) were included.…”

“…The grace period for age-appropriate vaccination was decided based on previous studies. 20,21 The administration date of the vaccines was calculated by subtracting the date of birth from the date of the vaccination. Children receiving the vaccines after the recommended age-range were considered to have received delayed vaccination.…”

Mapping routine measles vaccination and factors related to uncompleted vaccination in Japan: An ecological study

“…[6] In comparison, countries and regions in the Northern Hemisphere have higher coverage rates. On a more micro-scale, regional differences have been shown in studies examining the distribution of vaccination coverage among regions in Asia, such as Bangladesh, [7] Mongolia, [8] and Indonesia. [9] Studies examining geographic differences in immunisation coverage include those that determined association of immunisation coverage with either individual-level characteristics (maternal age and education), [10,11] or regional-level factors (urban versus suburban areas, [12,13] access to good health care providers, [14] and the state of social infrastructure in areas of residence).…”