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      Factors affecting complete and timely childhood immunization coverage in Sindh, Pakistan; A secondary analysis of cross-sectional survey data

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          Abstract

          Background

          Pakistan has a high burden of newborn mortality, which would be significantly preventable through appropriate routine immunization. The purpose of this study was to measure the basic timely childhood immunization coverage and to identify determinants of factors influencing childhood immunization coverage in Sindh, Pakistan.

          Methods

          Data from Maternal and Child Health Program Indicator Survey 2013–2014 which was conducted in Sindh province of Pakistan was used. Outcome measure was full coverage of the basic immunization schedule from child’s vaccination card. The association of receiving basic immunization with demographic factors, socioeconomic status, mother and child health information sources, and perinatal care factors were tested by binary logistic regression.

          Results

          Among 2,253 children, 1,156 (51.3%) received age-based full basic immunization. The basic immunization rates were 69.1% for under five weeks old, 38.3% for six to nine weeks, 18.8% for 10–13 weeks, 44.0% for 14 weeks-eight months, 60.4% for nine to 11 months, and 59.1% for over one year. Child’s age, number of living children, parents’ education level, wealth, the source of mother and child health information, number of antenatal care, and assistance during delivery were associated with completing basic immunization.

          Conclusions

          The overall full basic immunization coverage in Pakistan was still low. Policy makers should identify children at risk of low immunization coverage and obstacles of receiving antenatal care, implement educational interventions targeting on less educated parents, and conduct mass immunization campaigns for timely and complete immunization.

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          Most cited references32

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          The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey

          Background Public trust in immunization is an increasingly important global health issue. Losses in confidence in vaccines and immunization programmes can lead to vaccine reluctance and refusal, risking disease outbreaks and challenging immunization goals in high- and low-income settings. National and international immunization stakeholders have called for better monitoring of vaccine confidence to identify emerging concerns before they evolve into vaccine confidence crises. Methods We perform a large-scale, data-driven study on worldwide attitudes to immunizations. This survey – which we believe represents the largest survey on confidence in immunization to date – examines perceptions of vaccine importance, safety, effectiveness, and religious compatibility among 65,819 individuals across 67 countries. Hierarchical models are employed to probe relationships between individual- and country-level socio-economic factors and vaccine attitudes obtained through the four-question, Likert-scale survey. Findings Overall sentiment towards vaccinations is positive across all 67 countries, however there is wide variability between countries and across world regions. Vaccine-safety related sentiment is particularly negative in the European region, which has seven of the ten least confident countries, with 41% of respondents in France and 36% of respondents in Bosnia & Herzegovina reporting that they disagree that vaccines are safe (compared to a global average of 13%). The oldest age group (65+) and Roman Catholics (amongst all faiths surveyed) are associated with positive views on vaccine sentiment, while the Western Pacific region reported the highest level of religious incompatibility with vaccines. Countries with high levels of schooling and good access to health services are associated with lower rates of positive sentiment, pointing to an emerging inverse relationship between vaccine sentiments and socio-economic status. Conclusions Regular monitoring of vaccine attitudes – coupled with monitoring of local immunization rates – at the national and sub-national levels can identify populations with declining confidence and acceptance. These populations should be prioritized to further investigate the drivers of negative sentiment and to inform appropriate interventions to prevent adverse public health outcomes.
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            Vaccines: correlates of vaccine-induced immunity.

            The immune system is redundant, and B and T cells collaborate. However, almost all current vaccines work through induction of antibodies in serum or on mucosa that block infection or interfere with microbial invasion of the bloodstream. To protect, antibodies must be functional in the sense of neutralization or opsonophagocytosis. Correlates of protection after vaccination are sometimes absolute quantities but often are relative, such that most infections are prevented at a particular level of response but some will occur above that level because of a large challenge dose or deficient host factors. There may be >1 correlate of protection for a disease, which we term "cocorrelates." Either effector or central memory may correlate with protection. Cell-mediated immunity also may operate as a correlate or cocorrelate of protection against disease, rather than against infection. In situations where the true correlate of protection is unknown or difficult to measure, surrogate tests (usually antibody measurements) must suffice as predictors of protection by vaccines. Examples of each circumstance are given.
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              Mapping vaccine hesitancy—Country-specific characteristics of a global phenomenon

              Highlights • Vaccine hesitancy is a global problem that is complex and multilayered. Vaccine hesitancy is context, time, place and vaccine specific. • Interviews with immunization managers were conducted to determine the breadth and perceived drivers of vaccine hesitancy at the countries’ level. • Our study results, not unexpectedly, revealed a wide variation in the reported basis for vaccine hesitancy across countries.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: MethodologyRole: Project administrationRole: Writing – original draft
                Role: ConceptualizationRole: Writing – review & editing
                Role: Project administrationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draft
                Role: Writing – original draft
                Role: Writing – original draft
                Role: ConceptualizationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                31 October 2018
                2018
                : 13
                : 10
                : e0206766
                Affiliations
                [1 ] Department of Healthcare Management, Eulji University, Seongnam, Korea
                [2 ] Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
                [3 ] Jhpiego, Johns Hopkins University, Baltimore, Maryland, United States of America
                [4 ] Department of Health Administration, College of Health Sciences, Yonsei University, Wonju, Korea
                [5 ] National Institutes of Health Clinical Center, Bethesda, Maryland, United States of America
                [6 ] Department of Nursing Science, Sungshin University, Seoul, Korea
                [7 ] Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Healthcare Management, The Catholic University of Korea, Seoul, Korea
                [8 ] Department of Obstetrics and Gynecology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
                University of Campania, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-8781-6832
                Article
                PONE-D-18-23248
                10.1371/journal.pone.0206766
                6209382
                30379947
                c7a1bda1-30de-4d95-9b84-6756ace58e67

                This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                History
                : 7 August 2018
                : 18 October 2018
                Page count
                Figures: 2, Tables: 3, Pages: 15
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000200, United States Agency for International Development;
                Award ID: AID-391-LA-13-00001
                Award Recipient :
                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. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Immunology
                Vaccination and Immunization
                Medicine and Health Sciences
                Immunology
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                Preventive Medicine
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                Asia
                Pakistan
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
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                Public and Occupational Health
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