Immunization Coverage and Factors Associated with Failure to Complete Childhood Immunization

Main Article Content

Imran Khan
Ahmed Ameen
Rizwan Anwar
Amjad Ur Rahman
Mohammad Wajid Ali
Muhammad Omair
Muhammad Babar Alam


Background: Immunization is a cornerstone of public health, aiming to reduce morbidity and mortality among children. Despite global efforts to increase vaccination coverage, gaps in immunization persist, influenced by a variety of socio-economic and demographic factors. Understanding these factors is crucial for improving vaccination strategies and achieving herd immunity.

Objective: The study aimed to assess the immunization coverage among children aged 12 to 23 months and identify factors associated with incomplete immunization in a peri-urban area of Peshawar.

Methods: A cross-sectional survey was conducted from September 15, 2021, to November 15, 2022, involving 239 children aged 12 to 23 months from five villages selected through multi-stage cluster sampling. Data on demographic and socio-economic factors, along with immunization status, were collected through interviews with mothers and caretakers using a semi-structured questionnaire. Immunization coverage was assessed, and factors associated with failure to complete immunization were analyzed. Statistical analysis was performed using SPSS version 25.

Results: The study revealed that 50.2% (120/239) of children were fully immunized, 35.5% (85/239) were partially immunized, and 14.2% (34/239) were unimmunized. Factors contributing to incomplete immunization included lack of information (31/239), lack of motivation (17/239), accessibility issues (9/239), vaccine availability (7/239), and family-related challenges (22/239). No significant gender discrimination in immunization coverage was observed. Children from families with lower socioeconomic status and parents with education less than secondary level were more likely to be incompletely immunized.

Conclusion: While there has been progress in immunization coverage, significant barriers remain, particularly among children from low socioeconomic backgrounds and families with lower levels of parental education. Addressing these challenges through targeted public health interventions and enhanced community awareness is essential for improving immunization coverage and protecting children against vaccine-preventable diseases.

Article Details

How to Cite
Khan, I., Ameen, A., Anwar, R., Rahman, A. U., Ali, M. W., Omair, M., & Alam, M. B. (2024). Immunization Coverage and Factors Associated with Failure to Complete Childhood Immunization. Journal of Health and Rehabilitation Research, 4(1), 979–983.
Author Biographies

Imran Khan, EPI Department of Health KP Pakistan.

Coordinator EPI, Public Health.

Ahmed Ameen, EPI Department of Health KP Pakistan.

NSTOP Officer, Public health.

Rizwan Anwar, EPI Public Health WHO.

Area Coordinator.

Amjad Ur Rahman, EPI Public Health WHO.

Immunization Officer.

Mohammad Wajid Ali, EPI Department of Health KP Pakistan.

Member of Service, Department of Health.

Muhammad Omair, Health Department KP Pakistan.

Medical Officer.

Muhammad Babar Alam, Division of Health Systems and Services WHO.

MBBS, MPH, MPP, PhD, Head of WHO Sub Office, KP.


Braga C, Reis-Santos B. Immunization Agenda 2030 and Brazil’s challenges. SciELO Public Health; 2023. p. e2023822.

Sáfadi MAP. The importance of immunization as a public health instrument. SciELO Brasil; 2023. p. S1-S3.

Hussain I, Khan A, Rhoda DA, Ahmed I, Umer M, Ansari U, et al. Routine immunization coverage and immunization card retention in Pakistan: Results from a cross-sectional national survey. The Pediatric Infectious Disease Journal. 2023;42(3):260.

Dekimpe MG, van Heerde HJ. Retailing in times of soaring inflation: What we know, what we don't know, and a research agenda. Journal of Retailing. 2023.

Otaigbe I. A narrative review of strategies to improve childhood vaccination coverage in Low-and Middle-Income Countries: Improvement of Childhood Vaccination Coverage. Babcock University Medical Journal. 2023;6(2):202-14.

Kaur G. Status of New Vaccine Introduction—Worldwide, 2016–2021. MMWR Morbidity and Mortality Weekly Report. 2023;72.

Mezen MK, Lemlem GA, Biru YB, Yimer AM. Association of War With Vaccination Dropout Among Children Younger Than 2 Years in the North Wollo Zone, Ethiopia. JAMA network open. 2023;6(2):e2255098-e.

Nisa TU, Ahmad A. Surveillance studies for Rota virus vaccine implication in Pakistan. Pakistan Journal of Medicine and Dentistry. 2018;7(4):5-.

Nisar N, Mirza M, Qadri MH. Knowledge, Attitude and Practices of mothers regarding immunization of one year old child at Mawatch Goth, Kemari Town, Karachi. Pak J Med Sci. 2010;26(1):183-6.

Odira J, Gitahi MW, Orago AS. Uptake of indoor residual spray as a malaria vector control strategy among the residents in Migori County, Kenya. International Journal of Community Medicine and Public Health. 2023;10(11):4062.

Organization WH. Background document on the inactivated vaccine Sinovac-CoronaVac against COVID-19: background document to the WHO interim recommendations for use of the inactivated COVID-19 vaccine, CoronaVac, developed by Sinovac, 24 May 2021. World Health Organization; 2021.

Atteraya MS, Song IH, Ebrahim NB, Gnawali S, Kim E, Dhakal T. Inequalities in Childhood Immunisation in South Asia. International journal of environmental research and public health. 2023;20(3):1755.

Cordonier L, Cafiero F. ‪ The link between interest in alternative medicine and vaccination coverage‪. Revue européenne des sciences sociales. 2023:175-97.‬‬

Huang J, Cheung CK, Keung VM, Lo AS, Chan SC, Pang WS, et al. Factors associated with vaccination uptake among young children: A follow-up study of 1799 toddlers. Vaccines. 2023;11(3):535.

Matrajt L, Eaton J, Leung T, Brown ER. Vaccine optimization for COVID-19: Who to vaccinate first? Science Advances. 2021;7(6):eabf1374.

Perry M, Cottrell S, Gravenor MB, Griffiths L. Determinants of Equity in Coverage of Measles-Containing Vaccines in Wales, UK, during the Elimination Era. Vaccines. 2023;11(3):680.

Summan A, Nandi A, Shet A, Laxminarayan R. The effect of the COVID-19 pandemic on routine childhood immunization coverage and timeliness in India: retrospective analysis of the National Family Health Survey of 2019–2021 data. The Lancet Regional Health-Southeast Asia. 2023;8.

Florez AR, Shepard LN, Frey ME, Justice LB, Constand SE, Gilbert GE, et al. The Concise assessment of leader management tool: evaluation of healthcare provider leadership during real-life pediatric Emergencies. Simulation in Healthcare. 2023;18(1):24-31.

Kimuli D, Nakaggwa F, Kasule K, Kiconco I, Nyakwezi S, Sevume S, et al. Level of minimum acceptable diet and its associated factors among children aged 12–23 months in Ugandan districts. PloS one. 2023;18(10):e0293041.

de Oliveira Roque e Lima J, Pagotto V, Rocha BS, Scalize PS, Guimarães RA, de Lima MD, et al. Low Vaccine Coverage and Factors Associated with Incomplete Childhood Immunization in Racial/Ethnic Minorities and Rural Groups, Central Brazil. Vaccines. 2023;11(4):838.

Dadari I, Belt RV, Iyengar A, Ray A, Hossain I, Ali D, et al. Achieving the IA2030 coverage and equity goals through a renewed focus on urban immunization. Vaccines. 2023;11(4):809.

Grimée M, Tacoli C, Sandfort M, Obadia T, Taylor AR, Vantaux A, et al. Using serological diagnostics to characterize remaining high-incidence pockets of malaria in forest-fringe Cambodia. Malaria Journal. 2024;23(1):1-12.

Tripathi V, Wisniewski SJ, Rowan J, Ruger K. Establishing a baseline for multilingual capabilities of medical students at the Michigan State University College of Osteopathic Medicine. Journal of Osteopathic Medicine. 2023;123(5):243-8.

Alsuwaidi AR, Hammad HAA-K, Elbarazi I, Sheek-Hussein M. Vaccine hesitancy within the Muslim community: Islamic faith and public health perspectives. Human Vaccines & Immunotherapeutics. 2023;19(1):2190716.

Bruni L, Saura-Lázaro A, Montoliu A, Brotons M, Alemany L, Diallo MS, et al. HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010–2019. Preventive medicine. 2021;144:106399.

Damete DD, Terefe ZA. Vaccination Coverage and associated factors among under-five children in Ethiopia: Mini Demographic and Health Survey 2019. 2023.

Datta SS, Martinón-Torres F, Berdzuli N, Cakmak N, Edelstein M, Cottrell S, et al. Addressing Determinants of Immunization Inequities Requires Objective Tools to Devise Local Solutions. Vaccines. 2023;11(4):811.

Dhungana M, Hoben M, O’Brien C, MacDonald SE. Immunization status of children at kindergarten entry in Alberta, Canada. Canadian Journal of Public Health. 2023;114(1):82-92.

Siddiqi N, Khan A, Nisar N, Siddiqi A. Assessment of EPI (expanded program of immunization) vaccine coverage in a peri-urban area. Jpma. 2007;57(8):391-5.

Masood A, Nisar MA. Crushed between two stones: Competing institutional logics in the implementation of maternity leave policies in Pakistan. Gender, Work & Organization. 2020;27(6):1103-26.

Sakas Z, Hester KA, Rodriguez K, Diatta SA, Ellis AS, Gueye DM, et al. Critical success factors for high routine immunization performance: A case study of Senegal. Vaccine: X. 2023;14:100296.

Shay DK, Shimabukuro TT, DeStefano F. Myocarditis occurring after immunization with mRNA-based COVID-19 vaccines. JAMA cardiology. 2021;6(10):1115-7.

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