Zareen Faish, Ejaz Hussain, Zulfiqar Ali.
Risk factors for complete Un-immunization & Under Immunization of children under 2 years of age in third world countries.
Pak Paed J Jan ;24(4):145-52.

Objectives:- Identification of risk factors for complete un-immunization or under immunization of children under 2 years of age and its implication on national immunization program targeted to improve vaccination coverage. Setting:- Large Karachi Dockyard Board Tertiary Hospital. Design:- Prospective cross sectional study - children not vaccinated or incompletely vaccinated compared with children up to date by vaccination cards/. Participants:- A cohort of 2000 children. Attending Pediatric outpatient, inpatient and pediatric casualty between 1st October and 31" May 2000. Maximum Outcome measures:- Timeliness of vaccination factors associated with under vaccination and nature of missed opportunities. Results:- Best estimate of coverage of entire primay immunization was 26.5% by 2 years of age. Delivery at a hospital was associated with 67.8% vaccination while delivery at home was associated with 32.2% vaccination RR=2.2 (confidence interval 1.6-2.9) as was awareness of significance of vaccination by parents RR=5.6 (confidence interval 3.3-10. 1). Children followed up by the pediatricians were more likely to be upto-date than children followed by general practitioners. Educational level of the mother was associated with higher percentage of vaccination RR 1.4 (confidence interval 1.2-1.6). The children who were not up to date had at least one missed opportunity for vaccination If vaccination had been offered at all visits 90% of the children could be vaccinated by 2 years of age. Conclusion:- Offering free vaccination in a "barrier free" system will not ensure vaccination level of 90%. Education of mothers and delivery at a hospital/matcmity home will result in >90% vaccination coverage. Health care providers should offer vaccination during acute, non-well visits to improve coverage.

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