Determinants of timeliness in early childhood vaccination among mothers with vaccination cards in Sindh province, Pakistan: A secondary analysis of cross-sectional survey data

Jin Won Noh; Young Mi Kim; Nabeel Akram; Ki Bong Yoo; Jooyoung Cheon; Lena J. Lee; Young Dae Kwon; Jelle Stekelenburg

doi:10.1136/bmjopen-2019-028922

Determinants of timeliness in early childhood vaccination among mothers with vaccination cards in Sindh province, Pakistan: A secondary analysis of cross-sectional survey data

Jin Won Noh, Young Mi Kim, Nabeel Akram, Ki Bong Yoo, Jooyoung Cheon, Lena J. Lee, Young Dae Kwon, Jelle Stekelenburg

Bloomberg School of Public Health

Research output: Contribution to journal › Article › peer-review

Abstract

Objective Untimely vaccination refers to receiving the given dose before (early) or after (delayed) the recommended time window. The purpose of this study was to assess the extent of timeliness of childhood vaccinations and examine the determinants of vaccination timeliness in Sindh province, Pakistan. Design Cross-sectional analysis of data from the 2013 and 2014 Maternal and Child Health Program Indicator Surveys. Setting Community-based maternal and child health surveys. Participants Among 10 200 respondents of Maternal and Child Health Program Indicator Surveys, 1143 women who had a live birth in the 2 years preceding the survey were included. Outcomes At the participants' home, an interviewer asked mothers to show their children's vaccination cards, which contained information regarding vaccinations. Children's vaccination status was categorised into timely or early/delayed compared with vaccination schedule. A logistic regression analysis using Firth's penalised likelihood was performed to identify factors associated with timeliness of vaccinations. Results 238 children (20.8% of children who received a full set of basic vaccinations) received all vaccinations on schedule among children who received a full set of basic vaccinations. The percentages of timely vaccinations ranged from 2.3% for second measles vaccination to 89.3% for bacillus Calmette-Guérin. Child's age and place of delivery were associated with timely vaccinations. Older child age and institutional delivery were associated with decreased timely vaccination rate. Conclusions Home-based vaccination record is a key tool to improve the timeliness of vaccinations. The redesigned vaccination cards, the new electronic registries for vaccination card information and the vaccination tracking system to remind the second/third vaccination visits may be helpful to improve timely vaccinations for children under 2 years old.

Original language	English (US)
Article number	e028922
Journal	BMJ open
Volume	9
Issue number	9
DOIs	https://doi.org/10.1136/bmjopen-2019-028922
State	Published - Sep 1 2019

Keywords

international health services
paediatric infectious disease & immunisation
public health

ASJC Scopus subject areas

General Medicine

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10.1136/bmjopen-2019-028922

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@article{cf2d61fa8d634a4ca84570d7485ab0dd,

title = "Determinants of timeliness in early childhood vaccination among mothers with vaccination cards in Sindh province, Pakistan: A secondary analysis of cross-sectional survey data",

abstract = "Objective Untimely vaccination refers to receiving the given dose before (early) or after (delayed) the recommended time window. The purpose of this study was to assess the extent of timeliness of childhood vaccinations and examine the determinants of vaccination timeliness in Sindh province, Pakistan. Design Cross-sectional analysis of data from the 2013 and 2014 Maternal and Child Health Program Indicator Surveys. Setting Community-based maternal and child health surveys. Participants Among 10 200 respondents of Maternal and Child Health Program Indicator Surveys, 1143 women who had a live birth in the 2 years preceding the survey were included. Outcomes At the participants' home, an interviewer asked mothers to show their children's vaccination cards, which contained information regarding vaccinations. Children's vaccination status was categorised into timely or early/delayed compared with vaccination schedule. A logistic regression analysis using Firth's penalised likelihood was performed to identify factors associated with timeliness of vaccinations. Results 238 children (20.8% of children who received a full set of basic vaccinations) received all vaccinations on schedule among children who received a full set of basic vaccinations. The percentages of timely vaccinations ranged from 2.3% for second measles vaccination to 89.3% for bacillus Calmette-Gu{\'e}rin. Child's age and place of delivery were associated with timely vaccinations. Older child age and institutional delivery were associated with decreased timely vaccination rate. Conclusions Home-based vaccination record is a key tool to improve the timeliness of vaccinations. The redesigned vaccination cards, the new electronic registries for vaccination card information and the vaccination tracking system to remind the second/third vaccination visits may be helpful to improve timely vaccinations for children under 2 years old.",

keywords = "international health services, paediatric infectious disease & immunisation, public health",

author = "Noh, {Jin Won} and Kim, {Young Mi} and Nabeel Akram and Yoo, {Ki Bong} and Jooyoung Cheon and Lee, {Lena J.} and Kwon, {Young Dae} and Jelle Stekelenburg",

note = "Funding Information: This publication was made possible through support provided by the US Agency for International Development (USAID), under the terms of Associate Cooperative Agreement No. AID-391-LA-13- 00001; Maternal, Newborn and Child Health Services Project. Funding Information: Funding This publication was made possible through support provided by the US Agency for International Development (USAID), under the terms of Associate Cooperative Agreement No. AID-391-LA-13-00001; Maternal, Newborn and Child Health Services Project. Publisher Copyright: {\textcopyright} 2019 Author(s).",

year = "2019",

month = sep,

day = "1",

doi = "10.1136/bmjopen-2019-028922",

language = "English (US)",

volume = "9",

journal = "BMJ open",

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TY - JOUR

T1 - Determinants of timeliness in early childhood vaccination among mothers with vaccination cards in Sindh province, Pakistan

T2 - A secondary analysis of cross-sectional survey data

AU - Noh, Jin Won

AU - Kim, Young Mi

AU - Akram, Nabeel

AU - Yoo, Ki Bong

AU - Cheon, Jooyoung

AU - Lee, Lena J.

AU - Kwon, Young Dae

AU - Stekelenburg, Jelle

N1 - Funding Information: This publication was made possible through support provided by the US Agency for International Development (USAID), under the terms of Associate Cooperative Agreement No. AID-391-LA-13- 00001; Maternal, Newborn and Child Health Services Project. Funding Information: Funding This publication was made possible through support provided by the US Agency for International Development (USAID), under the terms of Associate Cooperative Agreement No. AID-391-LA-13-00001; Maternal, Newborn and Child Health Services Project. Publisher Copyright: © 2019 Author(s).

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Objective Untimely vaccination refers to receiving the given dose before (early) or after (delayed) the recommended time window. The purpose of this study was to assess the extent of timeliness of childhood vaccinations and examine the determinants of vaccination timeliness in Sindh province, Pakistan. Design Cross-sectional analysis of data from the 2013 and 2014 Maternal and Child Health Program Indicator Surveys. Setting Community-based maternal and child health surveys. Participants Among 10 200 respondents of Maternal and Child Health Program Indicator Surveys, 1143 women who had a live birth in the 2 years preceding the survey were included. Outcomes At the participants' home, an interviewer asked mothers to show their children's vaccination cards, which contained information regarding vaccinations. Children's vaccination status was categorised into timely or early/delayed compared with vaccination schedule. A logistic regression analysis using Firth's penalised likelihood was performed to identify factors associated with timeliness of vaccinations. Results 238 children (20.8% of children who received a full set of basic vaccinations) received all vaccinations on schedule among children who received a full set of basic vaccinations. The percentages of timely vaccinations ranged from 2.3% for second measles vaccination to 89.3% for bacillus Calmette-Guérin. Child's age and place of delivery were associated with timely vaccinations. Older child age and institutional delivery were associated with decreased timely vaccination rate. Conclusions Home-based vaccination record is a key tool to improve the timeliness of vaccinations. The redesigned vaccination cards, the new electronic registries for vaccination card information and the vaccination tracking system to remind the second/third vaccination visits may be helpful to improve timely vaccinations for children under 2 years old.

AB - Objective Untimely vaccination refers to receiving the given dose before (early) or after (delayed) the recommended time window. The purpose of this study was to assess the extent of timeliness of childhood vaccinations and examine the determinants of vaccination timeliness in Sindh province, Pakistan. Design Cross-sectional analysis of data from the 2013 and 2014 Maternal and Child Health Program Indicator Surveys. Setting Community-based maternal and child health surveys. Participants Among 10 200 respondents of Maternal and Child Health Program Indicator Surveys, 1143 women who had a live birth in the 2 years preceding the survey were included. Outcomes At the participants' home, an interviewer asked mothers to show their children's vaccination cards, which contained information regarding vaccinations. Children's vaccination status was categorised into timely or early/delayed compared with vaccination schedule. A logistic regression analysis using Firth's penalised likelihood was performed to identify factors associated with timeliness of vaccinations. Results 238 children (20.8% of children who received a full set of basic vaccinations) received all vaccinations on schedule among children who received a full set of basic vaccinations. The percentages of timely vaccinations ranged from 2.3% for second measles vaccination to 89.3% for bacillus Calmette-Guérin. Child's age and place of delivery were associated with timely vaccinations. Older child age and institutional delivery were associated with decreased timely vaccination rate. Conclusions Home-based vaccination record is a key tool to improve the timeliness of vaccinations. The redesigned vaccination cards, the new electronic registries for vaccination card information and the vaccination tracking system to remind the second/third vaccination visits may be helpful to improve timely vaccinations for children under 2 years old.

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KW - paediatric infectious disease & immunisation

KW - public health

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ER -

Determinants of timeliness in early childhood vaccination among mothers with vaccination cards in Sindh province, Pakistan: A secondary analysis of cross-sectional survey data

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