460 eligible children aged between 12-36 months were included in the analyses: 54.6% (n=251) were male, 54.4% (250) children had mothers aged between 25 and 44 years and 56.2% (258) children had mothers having secondary school or higher education background (Table 2). Out of total sample population, 46.2% (213) belonged to Dalit and Janjati ethnicity and 44.5% (205) lived in rural areas. 70.4% of mothers had antenatal visit more than three times during the pregnancy. (Table 2).
Crude and age-appropriate vaccine coverage
The crude vaccination coverage ranged from 91.5% (95% CI, 88.5-93.7) for PE3 to 97.8% (95.8-98.7) for BCG. Although the crude coverage of all the vaccines was above 90%, the age-appropriate coverage was significantly low ranging from 41.5% (36.5-46.6) for PE3 to 73.9 % (69.2-78.1) for PE1. (Table 3)
Figure 1 and figure 3 show the age-appropriate coverage of BCG, vaccine at national and regional level. As shown in figure 1 and table 3, 54.6% (95% CI, 49.3-59.7) of the children were vaccinated for BCG within the recommended age-range. At regional level, Province 3 has the highest age-appropriate coverage that was 73.3% (59.6-83.6) followed by Province 4 that was 70.7% (56.8-81.7). Province 2 had the lowest age-appropriate BCG coverage which was 31.9% (20.4-46.0) followed by Province 6, 44.9% (25.5-65.9) (Figure 3).
For the MMR1 vaccine, 53.8% (95% CI, 48.5-59.0) of the children were vaccinated within the recommended age-range (Figure 1 and table 3). The proportion of delayed vaccination was 31.2% (30.3-40.4) (Table 3). At regional level, Province 4 has the highest age-appropriate coverage for MMR1 vaccine 65.4% (51.1-77.4) followed by Province 6, 63.3% (39.3-82.1). Similar to OPV and PE vaccine, Province 2 has the lowest age-appropriate coverage for MMR1, 36.1% (24.3-49.9) (Figure 3).
Figure 2 and figure 4 shows the age-appropriate coverage of OPV1-OPV3 (OPV1, OPV2, and OPV3) vaccines received by children over time at national and regional levels. As shown in figure 2 and Table 3, for the OPV1 vaccine 73.13% (95% CI, 68.3-77.5) of the children received it at recommended age. For OPV second and third doses (OPV2 and OPV3) these number were 60.1% (54.9-65.1) and 41.7% (36.7-46.9), respectively. The proportions of delayed vaccination for OPV1, OPV2, and OPV3 were 21.8% (17.9-26.4), 38.1% (33.2-43.2), and 57.9% (52.7-62.9) respectively (Table 3). At regional level, Province 4 has the highest age-appropriate coverage of OPV1, and OPV2 while Province 3 has highest age-appropriate coverage of OPV3 vaccines. Province 2 has the lowest age-appropriate coverage for all doses of OPV vaccine (Figure 4).
Figure 2 and figure 5 presents children who received age-appropriate PE1-PE3 (PE1, PE2, and PE3) vaccines over time at national and regional levels. For PE1-PE3 vaccines, 73.9% (95% CI, 69.2-78.1), 60.6% (55.6-65.4), and 41.2% (36.5-46.6) children were vaccinated within the recommended age-range respectively (Table 3). The proportions of delayed vaccination for PE1, PE2, and PE3 were 21.4% (17.5-25.8), 37.8% (33.1.7-42.9), and 58.4% (53.3-63.3). At regional level, Province 4 has the highest age-appropriate coverage for the first dose of pentavalent vaccine; 84.9 (72.4-92.3) followed by Province 3; 84.3 (72.9-91.5). Province 3 had highest age-appropriate coverage of second and third doses of pentavalent vaccine; 72.5% (60.0-82.2), and 57.0 (44.1-68.9) respectively. Province 2 has the lowest age-appropriate coverage for all the doses of PE vaccine among all (Figure 5).
Factors associated with age-appropriate vaccination of BCG, OPV1-OPV3, PE1-PE3 and MMR vaccines
The significant results from multilevel logistic regression models are shown in Table 4 and table 5. The regression analysis showed that the children born in spring and winter had significantly higher odds of receiving age-appropriate BCG vaccines (odds ratio [OR], 2.34, 95% CI, 1.21-4.54) for spring, (3.86, 1.83-8.13) for winter compared to those born in summer. Children in Province 2 and Province 6 have significantly lower odds of receiving timely vaccination for BCG, OPV1, OPV2, PE1, and PE2 compared to children in other provinces. (Table 4 and table 5). Other factors did not show significant association.