Primary Immunization among Children in Malaysia
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Journal of Vaccines & Vaccination published an article titled: Primary Immunization among Children in Malaysia: Reasons for Incomplete which mainly focuses on immunization in Malaysia children.
Incomplete primary immunization against vaccine-preventable diseases is a significant public health problem. This study aimed to identify the population at-risk for incomplete immunization and their associated factors. Data on immunization module from the National Health and Morbidity Survey (NHMS) 2016 was analyzed. This survey was conducted as a nation-wide community-based survey using a stratified random sampling design. Immunization history of children aged 12 to 23 months from the randomly selected addresses was taken from their mothers by face-to-face interviews using a mobile device. The information was verified with vaccination cards. Results: Out of 11,388 eligible respondents, 10,140 responded to the survey; 89.0% response rate. The prevalence of incomplete immunization was 4.5%, while non-immunized was 0.1%. Logistic regression analysis revealed that children at-risk of incomplete immunization or being non-immunized were girls, residing in urban areas, have mothers who do not believe that vaccines can prevent the spread of disease and mothers who had pregnancy care at private healthcare facilities. Among reasons given for incomplete or non-uptake of immunization were due to either private healthcare facilities reasons; vaccine stock shortage or not due for immunization yet, or personal reasons; 'no time', forgotten', 'refused vaccine', and 'doubt halal status'. Children with incomplete immunization in Malaysia were more likely to come from urban areas and received care at private healthcare facilities. A standard schedule for all healthcare facilities and a single registry may be suitable strategies to be implemented, in order to ensure high vaccination coverage in Malaysia.
The survey found that 4.6% of children aged 12-23 months were reported as not completing their primary immunization as scheduled. Another 8.6% were self-reported as having completed their primary immunization but were unable to produce documentation for verification. As such, there is a possibility of a higher prevalence of incomplete immunization if we combine these two figures. However, the prevalence of incomplete primary immunization among children in Malaysia is still low as compared to Vietnam, 24.4% in 2014, and Thailand, 25% in 2012, and countries in the African region which ranged from 28.3% to 62.8% which used similar tools and methodology. The prevalence of incomplete immunization in this study is observed to be slightly higher than the prevalence in the United Kingdom; 3.3% incomplete immunization and 1.1% not immunized. Our study found that girls were at risk of not receiving primary immunization as scheduled, compared to boys. This finding is contradictory to the findings from the study of defaulters in Sabah, Malaysia, which found higher defaulter rates among boys, while another study in Kenya did not show any association between the child’s sex and immunization status. Possible reasons for this sex difference might be due to parents who tend to perceive that girls will be more susceptible to side ejects of vaccine such as fever and delay the immunization to a later date if girls were noted to be unwell and subsequently forgotten. Our study found that almost one-fifth of the mothers stated ‘child unwell’ as the reason given for not completing immunization as scheduled.
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Journal of Vaccines & Vaccination