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Free Content Determinants of third dose of diphtheria–tetanus–pertussis (DTP) completion among children who received DTP1 at rural immunization centres in Pakistan: a cohort study

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Summary Objective  In Pakistan, a high proportion of children fail to complete third dose of diphtheria-tetanus-pertussis (DTP3) after having received the first dose (DTP1). A cohort study was conducted to identify the factors predicting three doses of diphtheria–tetanus–pertussis (DTP3) completion among children who have received DTP1 at six centres of Expanded Programme on Immunization (EPI) in rural Pakistan. Method  We analyzed a cohort of mother–child pairs enrolled at DTP1 between November 2005 and May 2006 in the standard care group of a larger randomized controlled trial. Data were collected from mothers on a structured questionnaire at enrolment, and each child was followed up at clinic visits for 90 days to record dates of DTP2 and DTP3. Multivariable log-binomial regression analysis was performed to identify the independent predictors of DTP3 completion. Results  Only 39% (149/378) of enrolled children completed DTP3 during the follow-up period. After adjusting for the centre of enrolment in multivariable analysis, DTP3 completion was higher among children who were ≤60 days old at enrolment [adjusted risk ratio (Adj. RR) 1.39, 95% confidence interval (CI): 1.06–1.82], who were living in a household with monthly household income >Rs. 3000 (US$ 50) (Adj. RR 1.76, 95% CI: 1.16–2.65), and who were living ≤10 min away from EPI centre (Adj. RR 1.31, 95% CI: 1.04–1.66). Conclusions  Interventions targeting childhood immunization dropouts should focus on bringing more children to EPI centres on-time for initial immunization. Relocation of existing EPI centres and creation of new EPI centres at appropriate locations may decrease the travel time to the EPI centres and result in fewer immunization dropouts.


Identifier les facteurs prédictifs de la complétion du vaccin DTC3 chez les enfants qui ont reçu DTC1 dans six Centres du Programme Elargi de Vaccination (PEV) dans les régions rurales du Pakistan. Méthode: 

Etude de cohorte de paires ‘mère-enfant’ recrutées pour le DTC1 entre novembre 2005 et mai 2006, dans le groupe de soins de référence d’un vaste essai randomisé contrôlé. Les données ont été collectées auprès des mères à partir d’un questionnaire structuréà l’inscription et chaque enfant a été suivi au cours des visites à la clinique pendant 90 jours pour noter les dates du DTC2 et DTC3. L’analyse de régression log-binomiale multivariée a été appliquée afin d’identifier les facteurs prédictifs indépendants de la complétion du DTC3. Résultats: 

Seuls 39% (149/378) des enfants inscrits ont complété le DTC3 au cours de la période de suivi. Après ajustement dans l’analyse multivariée pour le centre d’inscription, la complétion du DTC3 était plus élevée chez les enfants qui avaient ≤ 60 jours avant d’inscription (rapport de risque ajusté [Adj. RR]= 1,39; intervalle de confiance 95% [IC]: 1,06-1,82), qui vivaient dans un ménage dont le revenu mensuel > 3000 Rs (50 $US) (adj. RR= 1,76; IC95%: 1,16-2,65) et qui vivaient ≤ 10 minutes du centre PEV (Adj. RR= 1,31; IC95%: 1,04-1,66). Conclusions: 

Les interventions ciblant les désistements dans la vaccination des enfants devraient se concentrer à attirer plus enfants aux centres de PEV à temps pour la vaccination initiale. Le reclassement des centres de PEV existants et la création de nouveaux centres de PEV à des endroits appropriés pourraient diminuer le temps de voyage vers les centres de PEV et mener à moins de désistements pour la vaccination.
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Keywords: DTC; DTP; Expanded Programme on Immunization; Pakistan; Pakistán; childhood immunization; cohort study; completar; complétion; determinants; dropouts; estudio de cohortes; facteurs déterminants; factores determinantes; étude de cohorte

Document Type: Research Article

Affiliations: 1:  Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA 2:  Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston, TX, USA 3:  Vanderbilt University School of Medicine, Nashville, TN, USA 4:  Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan

Publication date: 2010-01-01

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