• Asif Khaliq Baqai Institute of Health Sciences, Baqai Medical University, Karachi, Pakistan http://orcid.org/0000-0001-6878-2895
  • Sayeeda Amber Sayed Alberta Health Services – Calgary Zone, Canada
  • Syed Abdullah Hussaini Ziauddin University, Karachi, Pakistan
  • Kiran Azam Department of Health & Hospital Management, Institute of Business Management, Karachi, Pakistan
  • Mehak Qamar Department of Health & Hospital Management, Institute of Business Management, Karachi, Pakistan


Background: Immunization is the safest and effective measure for preventing and eradicating various communicable diseases. A glaring immunization gap exists between developing and industrialized countries towards immunization, because the developing countries including Pakistan are still striving to provide basic immunization to their children. The purpose of this study was to access the prevalence and factors of missing immunization among under 5-year children of Karachi. Methods: A cross sectional study was conducted from June 2015 to October 2015 among different outpatient clinics of Karachi. Parents who had child less than 5 year of age were approached by non-probability purposive sampling. Data was analysed by using Statistical Package of Social Sciences. Results: There were around 59.09% (n=156) and 64.43% (n=165) parents who have correctly responded regarding the number of essential immunization visit during the first and second year of their child life respectively. About 28.12% (n=108) parents responded that they do not know about the name and number of missed doses of vaccines. 31.78% (n=122) parents responded that their children have missed either one or more than one doses of routine immunization vaccines. Of which 34.42% (n=42) children have missed more than one vaccine. Lack of knowledge regarding immunization schedule 28.68% (n=34), concern about vaccine side effects 21.31%, (n=26), child sickness 17.21% (n=21), and lack of trust about government 10.65%, (n=13) were the major barriers identified by parents for missed immunization opportunities. Conclusion: Parents have inadequate knowledge regarding routine immunization visits, immunization schedule and vaccine doses. The practices of parents for routine childhood immunization are also poor. Parents refuse to immunize their child because of lack of immunization visit knowledge and also because of their doubts regarding vaccine potency and side effects.  A proper system of immunization promotion, advocacy and reminder systems with proper follow-up mechanism need to be developed by all healthcare centres.Keywords: Child; Immunization; Health System; Healthcare Providers; Karachi


Qidwai W, Ali SS, Ayub S. Knowledge, attitude and practice regarding immunization among family practice patients. J Dow Univ Health Sci 2007;1(1):15–9.

Asim M, Tanwir F, Hussain S, Shahzad AR, Shawar D. An Assessment of Adoption Level of Mothers Regarding Immunization of their Children among Minorities in Rural Areas of District Faisalabad. Pak J Life Soc Sci 2010;8(2):106–10.

WHO. Emergency Preparedness, Response: Small Pox. [Internet]. [cited 2017 Jan 1]. Available from: http://www.who.int/csr/disease/smallpox/en/

Maurice JM, Davey S. State of the world’s vaccines and immunization. 3rd ed. Geneva: World Health Organization; 2009. p.169.

Restrepo-Méndez MC, Barros AJ, Wong KL, Johnson HL, Pariyo G, Wehrmeister FC, et al. Missed opportunities in full immunization coverage: findings from low-and lower-middle-income countries. Global Health Action 2016;9(1):30963.

The World Bank. Mortality rate, infant (per 1,000 live births) | Data [Internet]. [cited 2017 Jan 1]. Available from: https://data.worldbank.org/indicator/SP.DYN.IMRT.IN?name_desc=false

Afzal U, Yusuf A. The state of health in Pakistan: An overview. Lahore J Econ 2013;18.

Khowaja AR, Zaman U, Feroze A, Rizvi A, Zaidi AK. Routine EPI Coverage Subdistrict Inequalities and Reasons for Immunization Failure in a Rural Setting in Pakistan. Asia Pac J Public Health 2015;27(2):NP1050–9.

Immunisation coverage: Pakistan losing immunity to health disasters - The Express Tribune [Internet]. [cited 2017 Jan 1]. Available from: https://tribune.com.pk/story/596647/immunisation-coverage-pakistan-losing-immunity-to-health-disasters/

WHO. Suboptimal routine immunization coverage causing measles outbreaks, 2 January 2013. [Internet]. [cited 2017 Jan 1]. Available from: http://www.emro.who.int/pak/pakistan-news/suboptimal-routine-immunization-coverage-causing-measles-outbreaks.html

Lakew Y, Bekele A, Biadgilign S. Factors influencing full immunization coverage among 12–23 months of age children in Ethiopia: evidence from the national demographic and health survey in 2011. BMC Public Health 2015;15:728.

Zaidi AK, Awasthi S, deSilva HJ. Burden of infectious diseases in South Asia. children 2004;328(7443):811–5.

OpenEPI. Sample Size for a Proportion or Descriptive Study. [Internet]. [cited 2017 Jun 30]. Available from: http://www.openepi.com/SampleSize/SSPropor.htm

Wain ZN, Masood RA, Ali RW, Bashir I. An overview of immunization practices in Pakistan. Int Curr Pharm J 2016;5(11):94–6.

Bugvi AS, Rahat R, Zakar R, Zakar MZ, Fischer F, Nasrullah M, et al. Factors associated with non-utilization of child immunization in Pakistan: evidence from the Demographic and Health Survey 2006-07. BMC Public Health 2014;14:232.

Jan M, Khan MS, Raheel A, Iqbal S, Arif BA. Social Marketing and Awareness about Routine Immunization among the Parents of Children under 5 Years Coming to a Private Hospital in Khyber Pakhtunkhwa. J Med Stud 2015;1(1):1–9.

Russo G, Miglietta A, Pezzotti P, Biguioh RM, Boutiang Mayaka G, Sobze MS, et al. Vaccine coverage and determinants of incomplete vaccination in children aged 12–23 months in Dschang, West Region, Cameroon: a cross-sectional survey during a polio outbreak. BMC Public Health 2015;15(1):630.

Memon Z, Zaidi S, Riaz A. Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan. Glob J Health Sci 2015;8(7):47–57.

Qutaiba B Al-lela O, Bahari MB, Al-Qazaz HK, Salih MR, Jamshed SQ, Elkalmi RM. Are parents' knowledge and practice regarding immunization related to pediatrics' immunization compliance? a mixed method study. BMC Pediatr 2014;14(1):20.

Ali Z, Pongpanich S, Kumar R, Gaffar A, Murred S, Safdar RM. Routine immunization status among children under 5 years of age living in rural district of Pakistan. Int J Health Res Innov 2015;3(2):13–20.

Harvey H, Reissland N, Mason J. Parental reminder, recall and educational interventions to improve early childhood immunisation uptake: a systematic review and meta-analysis. Vaccine 2015;33(25):2862–80.

Than SL, Mongkolcharti A, Laosee O. Determinants of incomplete immunization among hill tribe children aged under two years in Myanmar. J Public Health Dev 2016;14(2):17–31.