{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:24:36Z","timestamp":1783596276966,"version":"3.55.0"},"reference-count":44,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Gates Foundation","doi-asserted-by":"publisher","award":["INV-025171"],"award-info":[{"award-number":["INV-025171"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["gatesopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Gates Open Res"],"abstract":"<ns5:p>Despite global gains in vaccination coverage, Pakistan continues to lag in achieving universal immunization, with vaccine-preventable diseases (VPDs) contributing to approximately 15% of all deaths annually. We explored missed opportunities for vaccination (MOV) when eligible children failed to receive vaccines when their mothers visited healthcare facilities for unrelated medical needs. Secondary data analysis was conducted using the Pakistan Social and Living Standards Measurement Survey (PSLM) 2019-20, comprising 195,000 households and 103,464 eligible children. MOV was defined as the failure to administer an age-appropriate dose of either pentavalent (Penta-1, 2, 3) or measles (Measles-1, 2) vaccines during a maternal health visit. Weighted multivariate binomial logistic regression was used to explore the association between maternal visits to private healthcare facilities and MOV, adjusting for sociodemographic variables. Geospatial analysis was used to visualize district-level disparities using ArcGIS. Approximately 25% of children aged 1-5 years missed at least one dose of pentavalent or measles vaccination with regional variations. The rates of missed doses were similar for the first, second, and third antigen doses. Rural areas, male children, and households with uneducated mothers had more missed vaccinations, while missed opportunities were more common when mothers visited private healthcare facilities, particularly in urban settings (adjusted Odds Ratio (OR): 1.563 for Penta-1, Confidence Interval (CI): 1.519-1.608) where the private sector predominates and because the public sector accounts for nearly all vaccinations. However, since nearly all vaccinations are in the public sector and the bulk of healthcare seeking is in the private sector, opportunities to vaccinate missed children are lost. Policy and technological solutions that can identify and refer to these children for vaccination can close the national gap in universal vaccination.<\/ns5:p>","DOI":"10.12688\/gatesopenres.16388.1","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:44:06Z","timestamp":1783593846000},"page":"39","update-policy":"https:\/\/doi.org\/10.12688\/gatesopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Missed Opportunities for Childhood Immunization in Pakistan:\u00a0Failure to Vaccinate Despite Health System Contact"],"prefix":"10.12688","volume":"10","author":[{"given":"Areesh","family":"Fatmee","sequence":"first","affiliation":[{"name":"Islamabad Pakistan 44000 Research and development solutions"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zia un","family":"Nisa","sequence":"additional","affiliation":[{"name":"Islamabad Pakistan 44000 Research and development solutions"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Islamabad Pakistan 44000 Research and development solutions"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha","family":"Irum","sequence":"additional","affiliation":[{"name":"Islamabad Pakistan 44000 Research and development solutions"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Khan","sequence":"additional","affiliation":[{"name":"Islamabad Pakistan 44000 Research and development solutions"},{"name":"Islamabad 44000 Akhter Hameed Khan Foundation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3816-3943","authenticated-orcid":false,"given":"Adnan","family":"Ahmad  Khan","sequence":"additional","affiliation":[{"name":"Islamabad Pakistan 44000 Research and development solutions"},{"name":"Islamabad 44000 Ministry of National Health Services, Regulations and Coordination (MoNHSRC)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"25-31","DOI":"10.1007\/s00103-019-03066-x","article-title":"New immunization strategies: adapting to global challenges.","volume":"63","author":"C Mantel","year":"2020","journal-title":"Bundesgesundheitsbl. 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Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version, which might arise from this submission. The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":0,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}