Status of Childhood Immunization in Pakistan

Status of Childhood Immunization in Pakistan

(PSLM 2019-20 District Survey)

One of the sections of the 2019-20 district level Pakistan Social and Living Standards Measurement Survey (PSLM) provides information on the immunization status of children as this is one of the most feasible and cost-effective ways to reduce infant and child morbidity and mortality. In 1978, the Government of Pakistan laid the foundation of the Expanded Program on Immunization (EPI) which is composed of 6 antigens against tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, and measles. The World Health Organization (WHO) guidelines specify that BCG is given at birth or at first clinical contact, pentavalent vaccines (Penta 1, 2 and 3) at 6, 10 and 14 weeks and measles vaccine administered soon after 9 months.

This blog provides a comparative analysis of the immunization status of children living in Punjab and Balochistan, laying explicit emphasis on regional heterogeneity. With respect to whether a child has ever been immunized, the reported results are similar across both urban and rural regions. In urban areas, 97.97% of children sampled were immunized while in rural areas this percentage was reported to be 97.47%. As Punjab is the most developed province with high rates of education, such high rates of child immunization should not come as a surprise. In the case of Balochistan however, the rate of immunization is lower than that reported in Punjab. However, what is interesting is that the vaccination coverage is higher in rural areas of Balochistan at 94.84% than in urban areas at 92.75%.

A critical concern arising when determining whether children have been vaccinated is whether parents/guardians are able to provide adequate evidence in the form of an immunization card that helps to keep an official record of when and the type of vaccination administered to the child in question. A cursory analysis reveals interesting insights as revealed by statistics of Punjab and Balochistan. In both urban and rural Punjab and urban Balochistan, the highest percentage of the population surveyed (61.68% and 58.06% in urban and rural Punjab respectively and 51.33% in urban Balochistan) reported having a card but failed to show it to the field researchers. In the case of rural Balochistan, 38.18% of the respondents reported having an immunization card (but failed to provide evidence) while 55.95% reported not having a card altogether. Another finding is that the percentage of respondents showing the immunization card is significantly higher in Punjab (25.05% in urban Punjab and 28.39% in rural Punjab) as compared to in Balochistan (6.97% in urban and 5.86% in rural Balochistan). Along the same lines, a considerably lower proportion of the population surveyed reported having no card in Punjab (13.27% in urban and 13.55% in rural Punjab) as compared to in Balochistan (41.7% in urban and 55.95% in rural Balochistan).

The next two figures help compare the vaccination status in Punjab and Balochistan with respect to the type of vaccination received. Here as well, it must be noted that verified responses as a percentage of total responses where the respondents were able to produce the vaccination card are in all cases, in both Punjab and Balochistan accounting for regional heterogeneity and vaccination type, lower than responses recorded on the basis of mere recall as a percentage of total responses. The interprovincial comparison reveals that a significantly higher proportion of children are not vaccinated in Balochistan as compared to in Punjab. This holds consistently across all types of vaccinations and across urban and rural regions. In Punjab, as the type of immunization required changes as a child becomes older, the proportion of unimmunized changes accordingly in ascending order. For example, the lowest proportion of unimmunized are those of BCG, the vaccine required at the time of birth or at first clinical contact, and is reported to be as low as 1.48% in urban and 2.96% in rural Punjab respectively. As a child ages and so does his required vaccine, the proportion unimmunized also rises with the highest proportion being unimmunized reported at 31.87% in urban and 31.35% in rural Punjab respectively for Measles 2. This reveals an interesting finding: people are more inclined to vaccinate their children at an earlier age and this tendency tapers off as child ages. In the case of Balochistan, this holds true observing urban and rural areas independently. For urban Balochistan, 13.58% of children were not immunized by the BCG vaccine and this percentage rises to 37.39% for unimmunized children for Measles 2. Similarly, in rural areas, the lowest proportion of those unimmunized are for the BCG vaccine at 29.82% while the highest proportion of the unimmunized is for Measles 2 at 50.37%. Such high percentages are a stark reminder of how imperative it is for Pakistan to ensure that children are adequately immunized from preventable diseases.

This blog post is written by Rida Hameed.