Aamir J. Khan1, Stephen P. Luby1 , Rasool Bux1, Murad Bux2

1Department of Community Health Sciences, AKU 2Wadhela Baloch Social Welfare Organization

We introduced computer-based vaccination surveillance into a 12 year old Maternal and Child Health (MCH) program centered around Dur Mohammad Goth, 30 km from Karachi, in which EPI is the sole provider of vaccination services to the target population. Health workers entered birth and vaccination dates from records maintained at the MCH center and used EpiInfo database/analysis software to generate reports on the first 5 of 26 villages under surveillance.

561 (72%) of the 781 children born in the 5 villages since January 1983 had been registered at the MCH center and provided vaccination cards. A household census revealed that unregistered children had never been vaccinated. BCG vaccine had been given to 286 (51%) of 561 registered children by 2 months of age and 367 (65%) by 12 months. OPV/DPT vaccination appropriate for age had been given to 18 (3%) by 2 months, 84 (15%) by 4 months, 164 (29%) by 7 months, and 208 (37%) by 12 months. Measles vaccination had been given to 72 (13%) by age 10 months, 104 (18%) by age 12 months, and 140 (25%) by age 18 months.

Comparison of vaccination rates of the periods January 1983 to December 1988 with January 1989 to July 1994 revealed significantly higher rates among the latter for BCG at 2 months (62% vs 40%; p< 0.001) and at 12 months (74% vs 57%; p< 0.001) and OPV/DPT at 4 months (19% vs 11%; p= 0.005) and at 7 months (33% vs 25%; p= 0.03). Over the same period of time, no significant increase in rates was seen for measles vaccination nor OPV/DPT vaccination beyond 7 months of age.

WHO and UNICEF report near 80% vaccination coverage in Pakistan. In this surveillance area, while BCG vaccination rates approach that reported by EPI, OPV/DPT and Measles vaccination rates are substantially below EPI targets. Two possible explanations for these data exist. Either the low vaccination rates in these peri-urban villages readily accessible from Karachi do not reflect other areas surveyed by EPI or the high vaccination rates reported by EPI do not accurately represent the entire country.

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