DPT3 coverage and the role of the private sector in vaccinating children 12-23 months of age, in Karachi : a cross sectional survey

Date of Award


Document Type


Degree Name

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


Community Health Sciences


Introduction: Vaccines are one of the most cost — effective intervention for saving human lives. Despite the availability of vaccines through routine government public health programs such as the Expanded Programme of Immunization (EPI), approximately 2 million children under 5 years still die each year from diseases which can be easily prevented by routine vaccination. The private sector plays a pivotal role in providing curative health care services in Pakistan. Its contribution in providing disease prevention services such as vaccination to children is not well-established. Given the high burden of vaccine preventable diseases in Pakistan and the low vaccine coverage, understanding the private sector's role in vaccinating children in Pakistan is important. This study aims to assess DPT3 coverage (proposed by WHO as a means to assess vaccination coverage in any area), factors associated with vaccination completion and factors which influence families to utilize private sector vaccination services. Subjects and Methods: Between August — October 2008, we conducted a population-based cross-sectional survey in Karachi, Pakistan. A pilot-tested, structured questionnaire was used to collect data on demographic, socioeconomic and vaccination status of young children. Multistage cluster sampling technique was used to select parents/caretaker of children 12-23 months old living in different areas of Karachi who were socioeconomically and ethnically representative of the population of Karachi. Binary logistic regression, controlling for cluster sampling, was used to identify factors for vaccination completion and factors which influence families to seek vaccinations from the private sector. Results: 14011 participants were approached and 1391 out of them consented to participate. Overall, 1038(74.6%) were completely vaccinated (up to DPT3), out of these 724 (69.7%) were vaccinated from public sector whereas 314 (30.3%) children received vaccination from the private sector. The factors significantly associated with utilization of the private sector vaccination facilities are the extended family structure (OR adj=1.49 95% CI 1.05-2.11),high socioeconomic status (OR 4=36.33 95% CI 18.96-69.61 ) Hindu religion (OR adj= 5.32 95% CI 2.31-12.26),higher maternal education (graduate and above OR adj=2.40 95% CI 1.15- 5.00) and higher paternal education (graduate and above OR 4=2.81 95% CI 1.31-6.04). The factors significantly associated with the vaccination completion of the child are extended family structure (OR adt1.64 95% CI 1.25-2.15), high socio-economic status (OR adj=1.99 95% CI 1.12-3.55), high maternal education (graduate and above OR adj=25.36 95% CI 5.68-113.14) and higher paternal education (OR ad; for secondary pass fathers 2.5 with 95% CI 1.42-4.33 and for graduate and above OR adt 1.81 95% CI 1.24-2.65). Conclusion: Vaccination coverage in the mega-metropolis of Karachi falls short of the WHO recommended coverage of at least 90% children completely immunized. Although the public sector remains the primary source of vaccination for children in Karachi, the private sector contributes significantly to raising the overall vaccination coverage rate and must be included in programs and strategies aimed at improving coverage in urban areas in Pakistan. The factors associated with the vaccination completion of the child and the utilization of the private sector services are almost the same and indicate towards the importance of parental literacy, playing a major role in providing the essential preventive care through vaccination of the child.

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