Peer-reviewed article
Missed Opportunities for Childhood Immunization in Pakistan: Failure to Vaccinate Despite Health System Contact.
Areesh Fatmee, Zia Un Nisa, Muhammad Ibrahim, Aisha Irum, Ayesha Khan et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed data from nearly 195,000 Pakistani households to understand why children miss vaccinations even when their mothers visit healthcare facilities. About 25% of children aged 1-5 years missed at least one dose of pentavalent or measles vaccine. The research found that missed vaccination opportunities were more common when mothers visited private healthcare facilities, particularly in urban areas, because vaccination services are concentrated in the public sector while most healthcare seeking occurs in private clinics.
Key points
- Approximately 25% of children aged 1-5 years in Pakistan missed at least one dose of pentavalent or measles vaccination, with regional variations
- Missed vaccination opportunities were significantly more common when mothers visited private healthcare facilities (adjusted OR: 1.563 for Penta-1, CI: 1.519-1.608)
- Rural areas, male children, and households with uneducated mothers experienced higher rates of missed vaccinations
- Rates of missed doses were similar across the first, second, and third antigen doses
- A key gap exists because nearly all vaccinations are provided in the public sector while the bulk of healthcare seeking occurs in the private sector
Limitations
This is a secondary data analysis from a cross-sectional survey, so it cannot establish causation or explain the mechanisms behind why private facility visits result in missed opportunities. The study does not provide information about the quality of vaccination services or individual-level barriers parents face in accessing vaccination.
Abstract
Despite global gains in vaccination coverage, Pakistan continues to lag in achieving universal immunization, with vaccine-preventable diseases (VPDs) contributing to approximately 15% of all deaths annually. We explored missed opportunities for vaccination (MOV) when eligible children failed to receive vaccines when their mothers visited healthcare facilities for unrelated medical needs. Secondary data analysis was conducted using the Pakistan Social and Living Standards Measurement Survey (PSLM) 2019-20, comprising 195,000 households and 103,464 eligible children. MOV was defined as the failure to administer an age-appropriate dose of either pentavalent (Penta-1, 2, 3) or measles (Measles-1, 2) vaccines during a maternal health visit. Weighted multivariate binomial logistic regression was used to explore the association between maternal visits to private healthcare facilities and MOV, adjusting for sociodemographic variables. Geospatial analysis was used to visualize district-level disparities using ArcGIS. Approximately 25% of children aged 1-5 years missed at least one dose of pentavalent or measles vaccination with regional variations. The rates of missed doses were similar for the first, second, and third antigen doses. Rural areas, male children, and households with uneducated mothers had more missed vaccinations, while missed opportunities were more common when mothers visited private healthcare facilities, particularly in urban settings (adjusted Odds Ratio (OR): 1.563 for Penta-1, Confidence Interval (CI): 1.519-1.608) where the private sector predominates and because the public sector accounts for nearly all vaccinations. However, since nearly all vaccinations are in the public sector and the bulk of healthcare seeking is in the private sector, opportunities to vaccinate missed children are lost. Policy and technological solutions that can identify and refer to these children for vaccination can close the national gap in universal vaccination.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Identification of missed vaccination opportunities when mothers visit private healthcare facilities, with policy and technological solutions proposed to refer children to vaccination services
- Population
- Children aged 1-5 years in Pakistan and their mothers (103,464 eligible children from 195,000 households)
Key finding
Approximately 25% of children aged 1-5 years missed at least one dose of pentavalent or measles vaccination
Fatmee et al. · PubMed (US National Library of Medicine) · 23 Jun 2026