Jhpiego, Baltimore, Maryland, United States of America.
USAID/Pakistan, Karachi, Pakistan.
East Mediterr Health J. 2018 Jun 25;24(4):333-344. doi: 10.26719/2018.24.4.333.
Efforts to improve immunization rates are urgently needed in Pakistan but national statistics mask important local differences in immunization levels and determinants.
In this study we aimed to determine how similar or different are recent trends and levels of immunization coverage in Pakistan's 4 main provinces [Punjab, Sindh, Khyber Pakhtunkhwa (KPK) and Balochistan], and what factors are associated with complete childhood immunization in each province.
We analysed data from the 2006-07 and 2012-13 Pakistan Demographic and Health Surveys. Trends in immunization coverage among children aged 12-23 months were calculated for each province. Bivariate and multivariate analyses were conducted to identify factors associated with complete immunization.
The proportion of children completely immunized had risen significantly in Punjab but had fallen significantly in Balochistan. Complete coverage ranged from 16.4% in Balochistan to 65.8% in Punjab (2012-13). Tetanus toxoid injection during pregnancy was a significant predictor of complete immunization everywhere. Other predictors in specific provinces were: urban residence in Balochistan, wealth in Sindh and KPK, mother's education in Punjab and KPK, and distance to the facility in Punjab.
Although some strategies to increase immunization coverage are relevant nationwide, programme managers need to seek solutions specific to provincial trends and predictors. This analysis demonstrates that viewing childhood immunization in Pakistan through a provincial lens can help achieve a deeper understanding of the challenges and potential strategies to boost coverage.
巴基斯坦迫切需要努力提高免疫接种率，但全国统计数据掩盖了免疫水平和决定因素方面的重要地方差异。
本研究旨在确定巴基斯坦 4 个主要省份（旁遮普省、信德省、开伯尔-普赫图赫瓦省和俾路支省）最近的免疫接种率趋势和水平是否相似或不同，以及哪些因素与每个省的儿童完全免疫接种有关。
我们分析了 2006-07 年和 2012-13 年巴基斯坦人口与健康调查的数据。计算了每个省 12-23 个月儿童的免疫接种覆盖率趋势。进行了单变量和多变量分析，以确定与完全免疫相关的因素。
旁遮普省完全免疫接种的儿童比例显著上升，但俾路支省显著下降。完全覆盖率范围从俾路支省的 16.4%到旁遮普省的 65.8%（2012-13 年）。怀孕期间接种破伤风类毒素是所有地方完全免疫的重要预测因素。在特定省份的其他预测因素包括：俾路支省的城市居住、信德省和开伯尔-普赫图赫瓦省的财富、旁遮普省和开伯尔-普赫图赫瓦省的母亲教育程度，以及旁遮普省的设施距离。
尽管一些提高免疫接种率的策略在全国范围内是相关的，但方案管理人员需要寻找针对省级趋势和预测因素的解决方案。本分析表明，从省级角度看待巴基斯坦的儿童免疫接种可以帮助深入了解提高覆盖率的挑战和潜在策略。
