Department of Statistics, Lahore College for Women, University, Lahore, Pakistan.
Department of Mathematics and Statistics, International Islamic University Islamabad, Islamabad, Pakistan.
BMC Public Health. 2023 Aug 24;23(1):1620. doi: 10.1186/s12889-023-16508-8.
Immunization is one of the most effective public health initiatives, saving millions of lives and lowering the risk of diseases such as diphtheria, tetanus, influenza, and measles. Immunization saves an estimated 2-3 million lives per year. A study of the regional variations in incomplete immunization will be useful in identifying gaps in the performance of immunization programs that are not noticed by standard vaccination programs monitoring. The primary goal of this study was to identify factors influencing child immunization status and to examine regional variations in incomplete immunization among children aged 12 to 23 months in Pakistan.
For the current study, the data were taken from the Demographic and Health Survey for Pakistan (PDHS 2017-2018). Ever-married women who had children aged 12-23 months were included in this study. The immunization status of children was used as an outcome variable. In order to determine the effects of different factors on incomplete immunization, multilevel logistic model was used. To study the geographical variation of incomplete immunization, hotspot analysis was done using ArcGIS 10.7 and SaTScan software and to identify significant predictors of incomplete immunization, GWR 4 software was used.
Place of delivery, gender of child, mother's educational level and region were identified as significant determinants of incomplete immunization of children in Pakistan. Chances of incomplete immunization of children were found significantly lower for educated mothers (AOR = 0.52, 95% CI 0.34-0.79) and mothers who had delivered children in the health facilities (AOR = 0.51, 95% CI 0.32-0.83). Female children were more likely (AOR = 1.44, 1.95% CI 1.04-1.99) to be incompletely immunized as compared to male children. FATA (AOR = 11.19, 95% CI 4.89-25.6), and Balochistan (AOR = 10.94, 95% CI 5.08-23.58) were found at the highest risk of incomplete immunization of children as compared to Punjab. The significant spatial heterogeneity of incomplete immunization was found across Pakistan. The spatial distribution of incomplete immunization was clustered all over Pakistan. The high prevalence of incomplete immunization was observed in Balochistan, South Sindh, North Sindh, South KPK, South FATA, Gilgit Baltistan, Azad Jammu Kashmir, South and East Punjab. Drang and Harcho were identified as hotspot areas of incomplete immunization in Gilgit Baltistan. Secondary clusters with a high risk of incomplete immunization were found in regions Balochistan, Sindh and FATA.
Gender biasedness towards female children, regarding complete immunization of children prevailed in Pakistan. Spatial heterogeneity was also found for incomplete immunization of children. To overcome the problem access to health facilities is the foremost step. Government should target hotspot areas of incomplete immunization of children to provide primary health care facilities by opening health care units in these areas. The government in collaboration with the media should launch awareness campaigns in those areas to convince people that complete immunization is the right of every child regardless of gender.
免疫接种是最有效的公共卫生措施之一，它挽救了数百万人的生命，并降低了白喉、破伤风、流感和麻疹等疾病的风险。免疫接种每年估计可挽救 200 万至 300 万人的生命。研究区域内免疫接种不完全的差异情况，有助于发现标准疫苗接种监测未发现的免疫接种规划执行方面的差距。本研究的主要目的是确定影响儿童免疫接种状况的因素，并检查巴基斯坦 12 至 23 个月儿童免疫接种不完全的区域差异。
本研究的数据来自巴基斯坦人口与健康调查（PDHS 2017-2018 年）。本研究纳入了曾生育过 12-23 个月大子女的已婚妇女。儿童的免疫接种状况被用作结局变量。为了确定不同因素对免疫接种不完全的影响，采用多水平逻辑模型进行分析。为了研究免疫接种不完全的地理变异情况，使用 ArcGIS 10.7 和 SaTScan 软件进行热点分析，并使用 GWR 4 软件确定免疫接种不完全的显著预测因子。
分娩地点、儿童性别、母亲的教育程度和地区被确定为影响巴基斯坦儿童免疫接种不完全的重要决定因素。研究发现，受过教育的母亲（AOR=0.52，95%CI 0.34-0.79）和在卫生机构分娩的母亲（AOR=0.51，95%CI 0.32-0.83）的儿童免疫接种不完全的几率明显较低。与男性儿童相比，女性儿童更有可能（AOR=1.44，1.95%CI 1.04-1.99）未完全免疫接种。与旁遮普邦相比，联邦直辖部落地区（FATA）（AOR=11.19，95%CI 4.89-25.6）和俾路支省（AOR=10.94，95%CI 5.08-23.58）的儿童免疫接种不完全的风险最高。巴基斯坦各地都存在免疫接种不完全的显著空间异质性。免疫接种不完全的空间分布在巴基斯坦各地呈聚类分布。在俾路支省、南信德省、北信德省、南开伯尔-普赫图赫瓦省、南联邦直辖部落地区、吉尔吉特-巴尔蒂斯坦、阿扎德查谟和克什米尔、旁遮普省南部和东部发现了高比例的免疫接种不完全。吉尔吉特-巴尔蒂斯坦的德拉格和哈乔被确定为免疫接种不完全的热点地区。在俾路支省、信德省和联邦直辖部落地区发现了具有较高免疫接种不完全风险的二级聚类。
在巴基斯坦，人们普遍存在对女性儿童免疫接种不完全的性别偏见。儿童免疫接种不完全也存在空间异质性。要克服这一问题，首先要获得卫生保健服务。政府应针对儿童免疫接种不完全的热点地区采取行动，在这些地区开设医疗保健单位，提供初级卫生保健服务。政府应与媒体合作，在这些地区开展宣传运动，让人们相信，每个儿童都有获得完全免疫接种的权利，无论其性别如何。
