Coverage and predictors of COVID-19 vaccination in rural districts of Pakistan

Background: One of the keys to preventing a re-emergence of the COVID-19 pandemic is the attainment and maintenance of high vaccination coverage in urban and rural areas. Aims: To estimate the coverage of COVID-19 vaccination in a rural population and identify the determinants of vaccination. Methodology: A cross-sectional survey was conducted in April 2023 in 5 rural districts of Sindh Province, Pakistan. From each district, 30 clusters (villages) were randomly selected, and 7 households were randomly sampled from each cluster using the 30/7 technique. Household members above 12 years of age were included. Vaccination status was categorized as non -vaccinated, partially vaccinated (either with 1 dose or without booster) and completely vaccinated (2 doses with 1 booster). Adjusted odds ratios with 95% confidence intervals using multinomial logistic regression were computed to determine the factors associated with partial and complete vaccination. Data was analysed using SPSS version 20. Results: Among the 3545 individuals surveyed across 1050 households, 25.9% were not vaccinated, 55.0% were partially vaccinated, and 19.1% were fully vaccinated. Younger age, lack of formal education and residing in flood -affected districts were significantly negatively associated with being vaccinated, while living at <5 km from a vaccination facility was significantly positively associated with partial and complete vaccination. Residents of Dadu (OR=0.03, 95% CI=0.01- 0.04), Jamshoro (OR=0.05, 95% CI=0.03-0.08), Hyderabad (OR=0.03, 95% CI=0.02-0.05), and Tando Allahyar (OR=0.09, 95% CI=0.05-0.15) districts were significantly less likely to be completely vaccinated than those in Tharparkar. The most common reasons for not being vaccinated were, the perception that COVID-19 is mild (34.5%), fear of side -effects (22.7%), unavailability of the vaccine (19.8%), and fear of acquiring COVID-19 infection through the vaccine (15.8%). Conclusion: Vaccination coverage was low in some of the districts, particularly the flood -affected districts, mainly due to certain myths. There is a need for community outreaches to debunk myths about COVID-19 vaccination among these rural populations.