Immunisation and infant mortality in Pakistan.

Pakistan has been engaged with the Expanded Program on Immunization since 1982. In January 1991 an evaluation was conducted in order to ascertain coverage results for children aged 12-23 months of age, tetanus toxoid coverage for mothers of infants aged 0-11 months of age, and to review management of the program at all levels. The survey was based on information provided in the mother's history of children aged 12-23 months and by the immunization card in urban and rural clusters. Coverage included 8651 households in 240 clusters, 1968 children aged 12-23 months, and 1965 mothers of infants aged 0-11 months. The results showed high coverage in Punjab, Northwest Frontier Province, and Azad Jammu and Kashmir. Tetanus toxoid coverage of mothers could be improved. Provinces which had low coverage included Sindh and Balochistan. Between 1984-85 and 1990-91 infant mortality was reduced from 106.4 deaths/1000 live births to 100.9 deaths/1000 live births. In the Punjab immunization coverage among children aged 0-11 months was 56.3% in urban areas and 93.8% in rural areas with outreach and a mobile team. Hospital administration of vaccines was lower in rural areas (4.8%) compared to urban areas (22.1%) in the Punjab. Most children were immunized through outreach or a mobile team (56.3% in urban and 93.8% in rural areas of the Punjab). Outreach in Northwest Frontier Province was 30.6% in urban areas and 70.7% in rural areas. Hospital coverage was 36.5% in urban areas and 24.4% in rural areas. Coverage in Balochistan was 64.9% by outreach, 24.7% for health centers, and 9.1% for hospitals. Among partially immunized children, 10.3% indicated lack of awareness of need and 15.0% indicated lack of awareness of need for a subsequent visit. Fear of side effects affected 3.1% of those partially vaccinated. Lack of information affected 33.0%. Motivation was a reason for 4.1%. 62.9% indicated obstacles such as distance, time, health personnel absent, busy mother, family problems, and illness.