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Abstract:
Nepal has made significant progress in child
health by achieving consistently high
coverage of childhood vaccination. However,
the overall trend of children not being
vaccinated has increased in recent years.
This study aimed to examine trends in and
determinants of vaccination coverage among
children age 12–23 months. Trends were
analyzed using data from the last three
rounds of the Nepal Demographic and Health
Survey (NDHS) (n=1,000 in 2011, n=1,034 in
2016, and n=954 in 2022). Determinants were
analyzed among data from the 954 children
included in the 2022 NDHS.
We found an increasing trend in no
vaccination at both national and provincial
levels, with large gaps in vaccination status
by wealth quintile. Bagmati province had the
highest rate of no vaccination in 2022, while
Madhesh province had the highest rates of
partial immunization in all three NDHS
surveys. Approximately one-third of Muslim
children, one in four Dalit children, and one
in five children from the Terai caste had
received only partial vaccination.
Statistically significant associations were
found between no vaccination and both number
of antenatal care visits and whether children
were born in health facilities. If mothers
were not aware of health mothers’ groups in
their wards, their children were more likely
to be partially immunized.
In the context of increasing rates of partial
and no vaccination among children, and equity
gaps between privileged and disadvantaged
groups, health system efforts must focus on
both supply- and demand-side factors. To
create awareness of and demand for child
immunization, communication among health care
providers, parents, and other caretakers
needs to emphasize the heightened risks of
vaccine-preventable disease outbreaks.
Communication barriers can be addressed by
distributing linguistically appropriate
materials in Madhesh province. Additionally,
reminder systems, such as text messages or
phone calls to mothers who miss vaccinations,
could encourage mothers to bring their
children to upcoming vaccination clinics.
Integration of antenatal care checkups and
immunization clinics could enhance children’s
vaccination rates. Additionally, Nepal’s
National Immunization Program could leverage
and ensure the involvement of female
community health volunteers in leading health
mothers’ group meetings at the local level.
Conducting annual social audits of incomplete
child immunization could effectively identify
target children in each health post
catchment.
Trends in and Determinants of Vaccination Among Children Age 12–23 Months, 2011–2022 Nepal DHS Surveys (PDF, 3021K)