806 Journal of the College of Physicians and Surgeons Pakistan 2010, Vol. 20 (12): 806-810 INTRODUCTION Expanded Program on Immunization (EPI) was launched in 1974 to prevent children from vaccine preventable diseases. 1 It is estimated that over two million deaths are averted through vaccination every year. 2 Since its inception, immunization programs led to eradication of poliomyelitis in most, and measles in many regions of the world. 3-5 Despite substantial reductions in vaccine preventable diseases over the past few decades, they still are responsible for considerable morbidity and mortality, especially in developing nations. Around 2.5 million deaths in children under 5 years of age are due to vaccine preventable diseases occurring mainly in Africa and Asia. 6 The recent annual report of UNICEF terms vaccination as a vital intervention for child survival and development to achieve the Millennium Develop- ment Goal 4 to reduce under-5 mortality by two thirds by the year 2015. 7 The vaccination coverage varies in the developed and developing regions of the world. The average coverage of child immunization for all vaccines in Europe is more than 90% while it ranges from 50-80% in the African region. 8 Expanded Program on Immunization (EPI) was launched in Pakistan in 1978. 9 EPI coverage in Pakistan has improved substantially since its launch. Accelerated Health Plan (AHP) of the Government in 1982 provided the impetus which improved the coverage from as low as 5% in 1982 to as high as 70% in 1984. 10 In the last decade and a half national immunization days (NIDs) and the 'mopping-up' campaigns (door-to-door vaccination in high-risk areas) have been introduced to improve the coverage further, particularly for polio. Few studies have been conducted in different areas of Pakistan regarding the factors affecting the immunization. Lack of education, poor incentives and restricted mobility of the vaccinating staff have been reported to hamper the immunization coverage in Pakistan. 11-13 By 2012, EPI program aims to improve the overall coverage to 90% and achieve at least 80% coverage in all the districts of Pakistan. There is a need to gather more concrete information about the status of coverage and factors affecting the vaccination to achieve this target. Gambat is a sub-district town in district Khairpur in the province of Sind. The administration of Gambat Institute ABSTRACT Objective: To estimate the proportion of children 1-4 years of age vaccinated in the first year of their life and determine socio-demographic factors associated with vaccination in the rural sub-district Khairpur, Sindh, Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: The study was conducted in 9 Union Councils of sub-district Gambat, district Khairpur, Sindh, from August to October 2008. Methodology: A questionnaire based representative multi-stage cluster survey was conducted. A total of 549 children aged 1-4 years were assessed for coverage and predictors of vaccination. Univariate and multivariate analysis was done using logistic regression to determine the unadjusted and adjusted relationship between socio-demographic predictor and outcome (vaccination status). Results: The coverage for complete vaccination was 71.9% (95%CI=68.1%-75.7%). Educational level of mother (p=0.042), father (p=0.001) and child birth at hospital (p=0.006) were significantly associated with the vaccination status. Mother's educational level of intermediate and above was the strongest predictor (OR=12.19, 95%CI=1.57-94.3) for vaccination. Conclusion: Education of parents, particularly mother's education was important determinant of vaccination status of the children. In addition, distance from taluka health facility and misconception of parents were among the main reasons of not getting the children vaccinated. There is a need to educate the parents especially mothers about the importance of vaccination and organize EPI services at Basic Health Unit level to improve the vaccination coverage in rural areas of Pakistan. Key words: Vaccination. Rural area. Children. Mother education. Hospital delivery. Department of Community Health Sciences, The Aga Khan University, Karachi. Correspondence: Dr. Ambreen Kazi, House No. 4A/II, 4th North Street, Phase-I, DHA, Karachi. E-mail: ambreen.kazi@aku.edu Received September 09, 2009; accepted November 05, 2010. Coverage and Predictors of Vaccination Among Children of 1-4 Years of Age in A Rural Sub-District of Sindh Shiraz Shaikh, Tahir M. Taj, Ambreen Kazi, Jamil Ahmed and Zafar Fatmi ORIGINAL ARTICLE