Texila International Journal of Public Health ISSN: 2520-3134 DOI: 10.21522/TIJPH.2013.09.01.Art019 Corresponding Author: drvisheshkumar@gmail.com Determinants of Immunization Coverage and Associated Factors among Children aged under Two-Year-Old in the National Immunization Program of Mewat district, Haryana (2019-2020) Vishesh Kumar Doctor of Medicine, Texila American University, India Abstract Background: Vaccination against childhood communicable diseases through Expanded Program on Immunization is one of the most cost-effective public health interventions. Additional 1.5 million child deaths can be prevented if global vaccination coverage is improved. Mewat district has one of India’s lowest immunization rates despite a long-standing Universal Immunization Program and continues to sustain a high prevalence of vaccine-preventable diseases. This study investigates determinants of immunization status among children aged 0-23 months. Methods: A community-based cross-sectional study was conducted from December 2019 to June 2020, among 800 children aged 0- 23months, randomly selected in one rural and one urban ward each from all 4 blocks of Mewat. Socio-demographic conditions and vaccine-related data were collected using a semi-structured questionnaire. Immunization was assessed by vaccination card and by mother’s recall where the card was unavailable. Results:Mewat has increased full immunization coverage from 13.1% in 2015-16 to 59.4%. Immunization card was available with 68.5% (292/426) beneficiaries. Dropout rates for Pentavalent1 to Pentavalent3 was 27.5% and 54% for Bacillus Calmette-Guerin to measles. After adjusting for the state of residence, religion, gender, paternal education, health professional presence during birth, place of vaccination and knowledge of mother on due dose were significantly associated with full immunization. Awareness gap and fear of side effects for vaccines were main reasons of vaccine hesitancy. Conclusion: Full immunization coverage in the district is sub optimal and behind the desired coverage goal, mainly due to vaccine hesitancy. Enhancing community knowledge about the benefits of vaccination is recommended. Keywords: Below two years children, immunization, reasons for partial immunization, drop out, full immunization. Introduction Vaccination against childhood communicable diseases through the Expanded Programme on immunization (EPI) is one of the most cost-effective public health interventions. Vaccination contributes substantially to the achievement of Sustainable Development Goals (SDGs) by reducing mortality and morbidity among children. Globally around 29% of under-five deaths were due to vaccine-preventable diseases (VPD) in 2017 as estimated by the United Nations inter- agency group for child mortality estimation [1]. India accounted for the highest number of under-five deaths globally in 2015 [2]. Routine immunization is the nation’s strategic investment and an essential strategy for saving lives and protecting health of population. The Global Vaccine Action Plan 2011–2020 (GVAP) was unanimously endorsed in 2012 by the World Health Assembly (WHA). Globally, 19.7 million children and 70% of whom were zero-dose children still remain unvaccinated with basic childhood vaccines in 2018 [3]. GVAP had put a goal to reach immunization coverage of at least 90% children in each nation and 80% in every district by 2020. GVAP goals could potentially avert 25 million vaccine- preventable deaths by the end of the 2020 [4, 5]. India launched the Expanded Program on Immunization in 1978 and converted to the Universal Immunization Program (UIP) in 1985. It is one of the world’s largest programs and currently catering to an annual cohort of 26.7 million infants and 30 million pregnant women. An estimated 38% of children still 1