Health-care provision factors associated with child immunization coverage in a city centre and a rural area in Kabul, Afghanistan

A total of 1327 households were surveyed in Kabul province, Afghanistan to evaluate child immunization coverage and its association with distance to health facilities, attendance at antenatal care, the place of delivery and contact by outreach activity. The proportion of fully immunized children, those who had received at least 1 dose of BCG, 3 doses of DPT, and 1 dose of measles vaccine, was 84.5% in the city centre and 60.7% in the rural area. Fully immunized status was positively associated with close proximity to a health facility (odds ratio [OR] = 1.92, [95%CI, 1.08, 3.39]), and attendance at antenatal care (OR = 1.39, [95%CI, 1.00, 1.93]) in the city centre, and outreach contact (OR = 11.6, [95%CI, 6.92, 19.4]) in the rural area after adjustment for demography, socio-economic factors, participation in health education and experiences of hardship. Attendance at antenatal care in the rural area (OR = 1.91, [95%CI, 1.35, 2.72]), and institutional delivery in the city centre and rural area (OR = 2.83, [95%CI, 1.20, 6.71]; OR = 2.17, [95%CI, 1.01, 4.64], respectively) were positively associated with antigen specific coverage. Improving multiple community conditions including health-care provision and socio-economic factors through close partnership among various sectors promotes the immunization program.