Socioeconomic and Urban-Rural factors influencing BCG Vaccination coverage in Pakistan: Evidence from MICS6 (2017-2020)

Despite Pakistan’s high tuberculosis burden, BCG vaccination coverage remains suboptimal (71.8%) with pronounced urban-rural disparities. This study analyses IPUMS-MICS6 data (2017-2020; n=17,872 children aged 0-24 months) using survey weighted logistic regression and average marginal effects to quantify the influence of child, maternal, educational and socioeconomic determinants on BCG receipt, stratified by urban and rural residence. Maternal higher education demonstrated the highest absolute association with vaccination probability (21.3 percentage-point increase), followed by strong wealth gradients in rural populations (up to 13.1pp increase). Pre-term birth was associated with substantially higher predicted uptake in urban settings (14.5pp increase), with no comparable effect in rural areas, indicating contextual heterogeneity in access pathways. These findings reveal structurally patterned inequalities in early life immunisation focused on BCG receipt, highlighting persistent barriers to equitable EPI coverage. Policy response should priorities integrated social protection and health system strategies with education-focused interventions and demand-side support for targeting rural and socioeconomically disadvantaged households.