Sultana Habibullah, Junaid Ashraf.
Assessment of hepatitis B vaccination coverage in children under 5 years of age in two major public sector hospitals of Karachi.
Pak J Med Res Jan ;53(1):3-6.

Objectives: To assess Hepatitis B Vaccination coverage of children under 5 years of age attending Paedriatic units of Civil Hospital and National Institute of Child Health Karachi and to identify the reasons for non-compliance. Study type, settings and duration: Descriptive cross-sectional survey conducted in Paedriatic units of Civil Hospital and National Institute of Child Health of Karachi over period of eleven months. Subjects and Methods: A total 971 children under 5 years of age attending the selected hospitals were randomly selected. A structured questionnaire was used which included age, gender, EPI vaccination status, age at first dose of hepatitis B vaccination (Pentavalent vaccine), services utilized and payment if any, birth history, educational status of the respondent, knowledge about Hepatitis B vaccination, history of Hepatitis B in the family and reasons for non-compliance. SPSS version 15 was used for data analysis and chi-sq at 0.05 alpha level for statistical significance. Univariate and multivariate analysis were used for association of the variables. Results: Out of 971 children who were enrolled, data of 969 children was analyzed. Majority (71%) were out door cases and only 284(29%) were indoor patients. Age distribution showed 447(46 %) up to 12 months of age and overall male to female ratio was 1.3:1. Almost 80% children had received one dose of Hepatitis B vaccine, 72% had received two and 65% received all three doses. Age at vaccination showed that 677(70%) children were age appropriately vaccinated and out of these 469(48%) had received their first dose of Hepatitis B vaccination at six weeks. Reasons for non-compliance were parental/family objection 172(18%), intercurrent illness of children 44(5%), and other causes including no knowledge for the vaccination, long distance, loss of vaccination cards and non-availability of vaccine in 63(6%) cases. Univariate analysis showed that children who were vaccinated for BCG, Polio and Measles were more likely to be also vaccinated with Hepatitis B vaccine (significant). Multivariate analysis showed that apart from above variables education of the respondent and place of delivery were significantly associated with Hepatitis B vaccination of the children. Conclusion: Only 65% children had received all three doses of vaccine and 48% received first dose at six weeks. Major reasons for non-compliance were parental/family objection. Policy message: Efforts should be made to increase the uptake of all 3 doses to ensure full protection against hepatitis B along with education of public to remove misconceptions about vaccination.

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