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Missed Immunization Opportunities Among Children Under 5 Years of Age Dwelling in Karachi City Asif Khaliq Aga Khan University, [email protected]

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Missed Immunization Opportunities Among Children Under 5 Years of Age Dwelling in Karachi City Asif Khaliq Aga Khan University, Asif.Khaliq@Aku.Edu eCommons@AKU Department of Paediatrics and Child Health Division of Woman and Child Health October 2017 Missed immunization opportunities among children under 5 years of age dwelling In Karachi city Asif Khaliq Aga Khan University, [email protected] Sayeeda Amber Sayed Aga Khan University Syed Abdullah Hussaini Alberta Health Service Kiran Azam Ziauddin Medical University, Karachi Mehak Qamar Institute of Business Management, Karachi Follow this and additional works at: https://ecommons.aku.edu/ pakistan_fhs_mc_women_childhealth_paediatr Part of the Immunology and Infectious Disease Commons, and the Pediatrics Commons Recommended Citation Khaliq, A., Sayed, S., Hussaini, S., Azam, K., Qamar, M. (2017). Missed immunization opportunities among children under 5 years of age dwelling In Karachi city. Journal of Ayub Medical College, Abbottabad : JAMC, 29(4), 645-649. Available at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/388 J Ayub Med Coll Abbottabad 2017;29(4) ORIGINAL ARTICLE MISSED IMMUNIZATION OPPORTUNITIES AMONG CHILDREN UNDER 5 YEARS OF AGE DWELLING IN KARACHI CITY Asif Khaliq, Sayeeda Amber Sayed*, Syed Abdullah Hussaini**, Kiran Azam***, Mehak Qamar*** Department of Paediatrics and Child Health, The Aga Khan University Hospital, Karachi, *Alberta Health Services, Calgary-Zone- Canada, **Ziauddin Medical University, Karachi, ***Department of Health and Hospital Management, Institute of Business Management, Karachi-Pakistan Background: Immunization is the safest and effective measure for preventing and eradicating various communicable diseases. A glaring immunization gap exists between developing and industrialized countries towards immunization, because the developing countries including Pakistan are still striving to provide basic immunization to their children. The purpose of this study was to access the prevalence and factors of missing immunization among under 5-year children of Karachi. Methods: A cross sectional study was conducted from June 2015 to October 2015 among different outpatient clinics of Karachi. Parents who had child less than 5 year of age were approached by non-probability purposive sampling. Data was analysed by using Statistical Package of Social Sciences. Results: There were around 59.09% (n=156) and 64.43% (n=165) parents who have correctly responded regarding the number of essential immunization visit during the first and second year of their child life respectively. About 28.12% (n=108) parents responded that they do not know about the name and number of missed doses of vaccines. 31.78% (n=122) parents responded that their children have missed either one or more than one doses of routine immunization vaccines. Of which 34.42% (n=42) children have missed more than one vaccine. Lack of knowledge regarding immunization schedule 28.68% (n=34), concern about vaccine side effects 21.31%, (n=26), child sickness 17.21% (n=21), and lack of trust about government 10.65%, (n=13) were the major barriers identified by parents for missed immunization opportunities. Conclusion: Parents have inadequate knowledge regarding routine immunization visits, immunization schedule and vaccine doses. The practices of parents for routine childhood immunization are also poor. Parents refuse to immunize their child because of lack of immunization visit knowledge and also because of their doubts regarding vaccine potency and side effects. A proper system of immunization promotion, advocacy and reminder systems with proper follow-up mechanism need to be developed by all healthcare centres. Keywords: Child; Immunization; Health System; Healthcare Providers; Karachi J Ayub Med Coll Abbottabad 2017;29(4):645–9 INTRODUCTION Pakistan is among the South Asian countries, where the infant mortality rate has decline from 78 The high morbidity, complications and treatment to 66 per 1000 live births,6 but still Pakistan ranks cost of diseases has transformed the focus of 8th among countries with high new-born mortality healthcare providers from disease treatment to rate.6,7 The infant mortality rate is a basic indicator disease prevention1. Immunization is one of the for nation’s health status. The health related MDGs effective and acceptable methods of disease (Millennium Development Goals) were not achieve prevention.1,2 The global immunization campaign by Pakistan in 2015.8 All of these facts reflect that has successfully eradicated Small pox from the Pakistan has abysmally poor healthcare system. world in 19803 and almost wipe-off Polio from the Pakistan is still striving to provide basic whole world. vaccination to their children, where the Every year immunization saves the life of immunization coverage of Pakistan according to more than 2 million children from many PDHS (Pakistan Demographic and Health Survey) communicable diseases, such as diphtheria, report of 2012–2013 is 57.8%9. This means pertussis, tetanus, tuberculosis, polio and measles Pakistan has not reached the target of optimal etc.2,4 Despite of intensive immunization, routine immunization coverage of 80% or more10. throughout the world, around 20% of world A myriad of factors such as: low literacy level of children fail to receive complete immunization parents, poverty, female gender, religion, and doses aimed at their 1st year of life.4,5 household expenditure has deprived the children of Pakistan from complete immunization.11,12 http://www.jamc.ayubmed.edu.pk 645 J Ayub Med Coll Abbottabad 2017;29(4) Moreover, low immunization coverage, lack of 10% (n=38) respondents and the reliability of the interest of health providers and lack of innovation questionnaires was done by test-retest method and are also seemed as major hurdle for effective R value of 0.714 was obtained for reliability immunization program. analysis. The data of this study was analysed by Paediatric vaccination on time offers using SPSS 19.0 version. multiple benefits. It prevents the children from vaccine-preventable diseases, reduces the mortality RESULTS rate and provides herd immunity to unvaccinated In this study there were 77.86% (n=299) were or medically contraindicated children5. A glaring mother and 22.14% (n=185) were father of immunization practice gap exists between the children under 5 years of age. Majority of the developed and developing nations like Pakistan. In respondents (32.03%, n=123) were Urdu speaking, areas where immunization coverage is reported following by Sindhi speaking (20.83%, n=80), high, the proportion of fully immunized child is Pashtoon (17.96%, n=69), and rest of them were not up to mark as well. Punjabi, Baloch & others (29.18%, n=111). Therefore, the basic purpose of this study The education level of 40.88% (n=157) was to investigate the frequency and underlying parents were graduate followed by Matric & reasons of missed vaccines dose among the Intermediate (33.84%, n=130), and rest of the 25% children of Karachi. However, the secondary (n=96) parents who were either illiterate or have objective of this study was to identify the role of no any formal education. The table 2 reveals that healthcare providers and healthcare institution in on an average each family has 3.3±1.7 children, the successful implementation of vaccination but the average number of under-5-year children in program. a family was 2.2±0.8. Around 70% parents claimed that they know about number of visits in MATERIAL AND METHODS Healthcare centre during first and second year of This cross-sectional study was conducted in their child life for vaccination, but unfortunately Outpatient setting of 3 healthcare centres from among these parents only 59–60% parents actually June to October 2015. These healthcare centres know about the immunization visits. were selected because they granted permission to There were 28.12% (n=108) parents who conduct the study in their Outpatient waiting area. refused to answer about the vaccines schedule Moreover, these healthcare centres provide basic because of lack of their knowledge and illiteracy. healthcare facilities to mother and child health, Only 71.88% (n=276) parents responded about the like antenatal care, postnatal care, maternal, vaccine preventable diseases immunization schedule. neonate and child immunization services. 65.88% (n=253) parents responded correctly about In this study, parents of children under 5 tuberculosis vaccination, that it is given at the time of years were approached by non-probability birth. The knowledge of parents regarding the purposive sampling technique. Parents who have vaccines for Hepatitis-A, Chicken pox, MMR and visited the selected healthcare centres with a child Diarrhoea vaccine (Rotarix) was comparatively low, age 5 year or less were included. Likewise, those i.e., 8.07%, 10.93%, 12.7% and 8.85% respectively. parents living in Karachi since last 2 years and The statistics in table-3 is indicating that those who were able to communicate in local 31.78% (n=122) children have missed either one or language were also included. Whereas, more than one doses of their routine immunization. grandparents, uncle/aunts, neighbours, siblings Around 34.42% (n=42) children have missed more were excluded. The sample size of this study was than one vaccine. There were 38.52% (n=47) 384 and this was derived from OpenEPI calculator, parents don’t know the name of vaccine which has keeping ±5% margin of error, 95% confidence been missed, but they know that their children interval and 50% population distribution.13 have not receive vaccine. The different vaccines The data in this study was collected by 3 doses which were missed by children were of authorized researchers and a structured Measles 8.19% (n=10), Pneumococcal 7.37% questionnaire that was constructed by reading (n=9), MMR 6.55% (n=8), and other like OPV, different literatures was used for data collection. BCG & pentavalent 5.71% (n=7). The questionnaire after construction was The major reasons identified for missing developed in Urdu language, so that participants vaccination were lack of knowledge regarding can easily comprehend and answer. The immunization schedule 28.68%, (n=34), concern questionnaire was then sent to 2 public health about vaccine side effects 21.31%, (n=26), child specialists for content validity.
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