Abstract：
BACKGROUND: Pakistan still has ongoing transmission of wild type polio virus. This study aims to determine changes in full vaccination with recommended Expanded Program on Immunization vaccines, including polio, by several socio-economic and demographic factors.
METHODS: We used three waves of Pakistan\'s Demographic and Health Survey, a population-based cross-sectional study from 2006-07 (N = 1471), 2012-13 (N = 1706), and 2017-18 (N = 1549), analyzed by residence, wealth, and sociodemographic factors. Analysis was limited to children aged 12-23 months in Punjab, Sindh, Northwest Frontier Province/Khyber Pakhtunkhwa and Balochistan. Full vaccination was measured as receipt of one Bacillus Calmette-Guérin dose, one measles dose, 3 polio doses, and 3 Diphtheria-Tetanus-Pertussis doses. Odds ratios (ORs) and 95 % confidence intervals (CIs) from logistic regression were used to determine associations between undervaccination and demographic variables.
RESULTS: Full vaccination coverage was 50.6 % in 2006-07, 54.7 % in 2012-13, and 68.3 % in 2017-18. In 2006-07, the odds of undervaccination were significantly higher in Sindh (OR: 1.74, 95 % CI: 1.30, 2.31) than Punjab, and disparities across province changed over time (P < 0.0001); notably, undervaccination was significantly higher in Sindh, KPK, and Balochistan than Punjab in 2017. Compared to the middle wealth quintile, the poorest had significantly higher odds of undervaccination in 2006-07 (OR: 2.58, 95 % CI: 1.76, 3.78), and this did not significantly change over time (P = 0.2168). The proportion of those with a polio birth dose increased across waves from 56.3 % in 2006-07 to 83.7 % in 2017-18; receiving three or more polio vaccine doses remained unchanged.
CONCLUSIONS: This study showed that the proportion of fully vaccinated children in Pakistan increased across three waves. Full vaccination and administration of polio vaccine birth doses have increased recently in Pakistan. The association between undervaccination with province differed significantly across the waves, with vaccination disparities between provinces increasing. Those in the poorest wealth quintile had the greatest odds of undervaccination.
METHODS: We used three waves of Pakistan\'s Demographic and Health Survey, a population-based cross-sectional study from 2006-07 (N = 1471), 2012-13 (N = 1706), and 2017-18 (N = 1549), analyzed by residence, wealth, and sociodemographic factors. Analysis was limited to children aged 12-23 months in Punjab, Sindh, Northwest Frontier Province/Khyber Pakhtunkhwa and Balochistan. Full vaccination was measured as receipt of one Bacillus Calmette-Guérin dose, one measles dose, 3 polio doses, and 3 Diphtheria-Tetanus-Pertussis doses. Odds ratios (ORs) and 95 % confidence intervals (CIs) from logistic regression were used to determine associations between undervaccination and demographic variables.
RESULTS: Full vaccination coverage was 50.6 % in 2006-07, 54.7 % in 2012-13, and 68.3 % in 2017-18. In 2006-07, the odds of undervaccination were significantly higher in Sindh (OR: 1.74, 95 % CI: 1.30, 2.31) than Punjab, and disparities across province changed over time (P < 0.0001); notably, undervaccination was significantly higher in Sindh, KPK, and Balochistan than Punjab in 2017. Compared to the middle wealth quintile, the poorest had significantly higher odds of undervaccination in 2006-07 (OR: 2.58, 95 % CI: 1.76, 3.78), and this did not significantly change over time (P = 0.2168). The proportion of those with a polio birth dose increased across waves from 56.3 % in 2006-07 to 83.7 % in 2017-18; receiving three or more polio vaccine doses remained unchanged.
CONCLUSIONS: This study showed that the proportion of fully vaccinated children in Pakistan increased across three waves. Full vaccination and administration of polio vaccine birth doses have increased recently in Pakistan. The association between undervaccination with province differed significantly across the waves, with vaccination disparities between provinces increasing. Those in the poorest wealth quintile had the greatest odds of undervaccination.
摘要：
背景：巴基斯坦仍在持续传播野生型脊髓灰质炎病毒。这项研究旨在确定推荐的扩大免疫计划疫苗全面接种的变化，包括脊髓灰质炎,几个社会经济和人口因素。
方法：我们使用了三波巴基斯坦人口与健康调查，2006-07年的一项基于人群的横断面研究(N=1471)，2012-13（N=1706），和2017-18（N=1549），按住宅分析，财富,和社会人口因素。分析仅限于旁遮普邦12-23个月的儿童，信德省,西北边境省/开伯尔-普赫图赫瓦和俾路支省。在接受一次卡介苗剂量时，进行了完全接种，一剂麻疹,3次脊髓灰质炎剂量，和3次白喉-破伤风-百日咳剂量。使用逻辑回归的赔率比（OR）和95％置信区间（CI）来确定疫苗接种不足与人口统计学变量之间的关联。
结果：2006-07年度全疫苗接种覆盖率为50.6%，2012-13年度为54.7%，2017-18年度为68.3%。在2006-07年，信德省疫苗接种不足的几率显着高于旁遮普省（OR：1.74，95％CI：1.30，2.31），各省之间的差距随着时间的推移而变化(P<0.0001)；值得注意的是，信德省的疫苗接种不足率明显更高，KPK,2017年，俾路支省比旁遮普省。与中等财富五分之一相比，最穷的人在2006-07年接种疫苗不足的几率明显更高(OR：2.58，95%CI：1.76，3.78)，随着时间的推移，这种情况没有显著变化(P=0.2168)。脊髓灰质炎出生剂量的人的比例从2006-07年的56.3%上升到2017-18年的83.7%;接受三剂或更多剂脊髓灰质炎疫苗剂量保持不变。
结论：这项研究表明，巴基斯坦完全接种疫苗的儿童比例在三波中增加。巴基斯坦的全面疫苗接种和脊髓灰质炎疫苗出生剂量的管理最近有所增加。疫苗接种不足与省份之间的关联在整个浪潮中差异很大，各省之间的疫苗接种差距越来越大。那些处于最贫穷财富五分之一的人接种疫苗不足的可能性最大。
方法：我们使用了三波巴基斯坦人口与健康调查，2006-07年的一项基于人群的横断面研究(N=1471)，2012-13（N=1706），和2017-18（N=1549），按住宅分析，财富,和社会人口因素。分析仅限于旁遮普邦12-23个月的儿童，信德省,西北边境省/开伯尔-普赫图赫瓦和俾路支省。在接受一次卡介苗剂量时，进行了完全接种，一剂麻疹,3次脊髓灰质炎剂量，和3次白喉-破伤风-百日咳剂量。使用逻辑回归的赔率比（OR）和95％置信区间（CI）来确定疫苗接种不足与人口统计学变量之间的关联。
结果：2006-07年度全疫苗接种覆盖率为50.6%，2012-13年度为54.7%，2017-18年度为68.3%。在2006-07年，信德省疫苗接种不足的几率显着高于旁遮普省（OR：1.74，95％CI：1.30，2.31），各省之间的差距随着时间的推移而变化(P<0.0001)；值得注意的是，信德省的疫苗接种不足率明显更高，KPK,2017年，俾路支省比旁遮普省。与中等财富五分之一相比，最穷的人在2006-07年接种疫苗不足的几率明显更高(OR：2.58，95%CI：1.76，3.78)，随着时间的推移，这种情况没有显著变化(P=0.2168)。脊髓灰质炎出生剂量的人的比例从2006-07年的56.3%上升到2017-18年的83.7%;接受三剂或更多剂脊髓灰质炎疫苗剂量保持不变。
结论：这项研究表明，巴基斯坦完全接种疫苗的儿童比例在三波中增加。巴基斯坦的全面疫苗接种和脊髓灰质炎疫苗出生剂量的管理最近有所增加。疫苗接种不足与省份之间的关联在整个浪潮中差异很大，各省之间的疫苗接种差距越来越大。那些处于最贫穷财富五分之一的人接种疫苗不足的可能性最大。
