Prevalence of and factors associated with low expanded program on immunization (EPI) coverage in District Charsadda, North West frontier Province, Pakistan

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Prevalence and Factors Associated with Low Expanded Program on Immunization (EPI) Coverage in District Charsadda, North West Frontier Province, Pakistan Summary Childhood communicable diseases are major health problem causing significant morbidity and mortality around the world. The Expanded Program on Immunization (EPI) was launched in 1974 following a resolution of World Health Assembly, with the objective of reducing the burden of childhood vaccine-preventable diseases. Despite initiation of EPI in Pakistan in 1978, its coverage still remains reportedly unsatisfactory, owing to low literacy levels, false beliefs regarding vaccination, lack of motivation, lack of awareness among the parents, distance from the vaccination center, larger family sizes, inaccessibility to mass media and low socioeconomic status. Therefore the aim of this study was to estimate the prevalence of EPI coverage in children 12-36 months of age in district Charsadda and to evaluate the factors associated with low vaccination coverage. In this cross-sectional study, a two-stage cluster sampling technique was employed. A total of 50 clusters were chosen with probability proportional to size of the clusters and 14 households with eligible child were selected systematically from each cluster. The study population comprised 698 children aged 12-36 months whose parents were permanent residents of Charsadda. Eight lady health workers administered a structured questionnaire to mothers/caretaker, and recorded information regarding vaccination status, demographic characteristics and hypothesized factors. To assess the factors independently associated with the vaccination status (fully vaccinated or under-vaccinated), a multiple logistic regression analysis was carried out. Among 698 children, 72% of the children were fully vaccinated and 28% under-vaccinated. Vaccination status for 46% of the study children could be verified through vaccination cards while for the rest it was verified only by verbal history. The study population comprised of 422 (60%) male children and276 (40%) female. The proportion of educated fathers was 48% whereas only 11% mothers were literate in our study sample. In the final multivariate model, factors independently associated with vaccination V status were: parent's knowledge of vaccination [adjusted odds ratio (aOR) : 2.1, 95% confidence interval (CI): 1.3, 3.5], restriction on vaccination (aOR : 8.6, 95% CI:2.8, 26.4), verification of vaccination status by cards vs. verbal history (aOR : 1.9, 95% Cl: 1.3,2.8), awareness of vaccine availability (aOR :2.8, 95% CI: 1.9, 4.1) and odds ratio with confidence interval for six monthly interval increase in the age (aOR : 0.7, 95% C.I. 0.6, 0.9). The recommendations based on the findings of the study are almost entirely related to the mothers of the children. Strategies are required for improving mother's knowledge, awareness and motivation regarding vaccination.

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