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Measles immunization
Measles is a vaccine-preventable disease that has a high case-fatality rate. Public health experts estimate that
one percent of all under-five deaths could be prevented with universal measles immunization coverage Jones
et al. 2003. Afghanistan still has outbreaks of measles across the country, highlighting the importance of
achieving high measles vaccination coverage.
More than half of 12-23-month-olds 56 percent were reported to have been immunized for measles see Table 8.4.
This level was similar to the mean national measles coverage found in the 2005 NRVA survey of 55 percent. This varied significantly by residence, with urban children much more likely to be immunized than rural children 73 percent
compared to 54 percent, respectively. Less than one-quarter of Kuchi children were reported to have been immunized for measles 24 percent. Education of children’s mothers was an important factor related to immunization status, and
mothers with any education were significantly more likely to have their children immunized for measles.
Table 8.4 Percentage of vaccinated children 12-23 month old, by a residence, b educational attainment of mother
Residence and education of mother
Vaccination No
vaccination BCG
OPV3 DTP3
Measles Full immunization
a. Residence
Urban 88
87 72
73 63
7 Rural
73 68
39 54
33 15
Kuchi 41
59 16
24 13
31
b. Educational attainment of mother
No education 73
70 41
54 35
15 Primary school
86 88
66 70
57 6
Secondary school 93
88 77
84 70
6 College or more
92 92
83 89
83 7
Total 74
71 43
56 37
15
DPT3 and OPV immunization
DPT3 vaccination, effective in preventing diphtheria, pertussis and tetanus, was defined as receiving at least three doses of DPT, among children aged 12 to 23 months. It is a good proxy measure of how the health system is reaching children,
as it has to be given multiple times, either through static facilities or outreach teams. Unlike OPV oral polio vaccine, DPT is not given during National Immunization NID campaigns, which might explain why OPV3 vaccination rates are
usually higher than those for DPT. Overall rates of DPT3 in the NRVA 20078 were 43 percent, while those for OPV3 are much higher at 71 percent. Receipt of DPT dropped off after the first dose: DPT1 rates were 63 percent, dropping to 56
percent for immunization with two doses of DPT. Although the rate of DPT3 is low overall, it is significantly higher than the national rate of 19 percent found in the 2005 NRVA.
Similar to measles, DPT3 rates were significantly higher among urban dwellers compared to rural dwellers 72 percent versus 39 percent. Both rural and urban groups in the NRVA had significantly higher DPT3 coverage than Kuchis,
whose children had only 16 percent full DPT immunization. Educated mothers were also significantly more likely to have their children fully immunized for DPT: 70 percent of those with primary education compared to 41 percent of those with
no education.
The DPT3 estimates should be interpreted with caution. DPT requires that three doses be remembered, making it harder for respondents to recall accurately. Oral polio vaccine also requires that three doses be remembered, but it is also given
through outreach campaigns, which may be more easily recalled. The fact that estimates for measles, which is given
MDG Indicator 4.3: Proportion of 1 year-old children immunized against measles
This indicator is used to measure progress towards the goal of reducing child mortality. The NRVA 20078 figure of 56 percent is among the
lowest in the world and implies hardly any change compared to the NRVA 2005. The corresponding UN estimates for Pakistan and Iran
are 80 and 97 percent, respectively.
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after the third dose of DPT, is higher than DPT, raises concern. As explained in the 2006 Afghanistan Health Survey Ministry of Public Health 2008, there are several possible reasons for this: 1 recent outreach campaigns provide
measles but not DPT vaccination to populations without regular access to facilities and DPT3 immunizations; 2 some children receive measles vaccination from the health system, but do not have a chance to make sufficient numbers of
visits thereafter to receive all catch-up DPT vaccines; and 3 error in mother’s recall of vaccinations. Any combination of the aforementioned reasons is possible.
Immunization against tuberculosis
The schedule recommended by the WHO on immunization against tuberculosis TB – to give BCG as the first vaccine given at birth – is adopted in Afghanistan. The NRVA 20078 found that almost three-quarters 74 percent of children
aged 12-23 months had received a BCG vaccination. This indicates that these children had at least initial contact with the health care system.
Full immunization
Afghanistan has low rates of full childhood immunization. According to NRVA 20078, full immunization, consisting of BCG, OPV3, DPT3, and measles vaccinations, among children aged 12-23 months, is estimated at only 37 percent.
Furthermore, 15 percent of children have never been immunized. Full immunization rates among urban children were nearly double those among rural children 63 versus 33 percent, and rural children in turn had more than twice the
immunization rate of Kuchi children 13 percent. The low rates of all vaccinations among Kuchi children, which yield the extremely low rate of full vaccination among this migrant population, are cause for concern.
The national full vaccination rate according to the 20078 NRVA was nearly triple that found in the 2005 NRVA 33 percent versus 12 percent. Education was significantly related to full immunization status, with full immunization rates
much higher among educated women 83 percent than non-educated women 35 percent.
Figure 8.2 Percentage of children aged 12-23 months who received full immunization, by province
