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Immunization divide: who do get vaccinated in Bangladesh?
A Mushtaque R Chowdhury1, Abbas Bhuiya, Simeen Mahmud
1Bangladesh Rural Advancement Committee, Mohakhali, Dhaka 1212, Bangladesh. mc2218@columbia.edu
Insights
Vaccination coverage in Bangladesh is unequal, with disadvantaged groups like girls and the poor receiving less immunization. Addressing these disparities is crucial for improving overall child immunization rates.
Area of Science:
- Public Health
- Health Equity
- Epidemiology
Background:
- Vaccination is a cornerstone of child survival and disease prevention.
- Inequities in healthcare access and utilization persist globally, impacting vulnerable populations.
- Understanding these disparities is vital for effective public health interventions.
Purpose of the Study:
- To analyze socioeconomic and demographic inequalities in vaccination service access and utilization in Bangladesh.
- To identify specific disadvantaged groups with lower immunization coverage.
- To inform targeted strategies for improving national immunization programs.
Main Methods:
- Analysis of national and small area-based datasets in Bangladesh.
- Examination of immunization coverage across various demographic factors (gender, maternal education, paternal occupation, socioeconomic status, location).
- Comparison of coverage rates between different administrative regions and ethnic groups.
Main Results:
- Female children and those from poorer households exhibited lower immunization coverage.
- Higher maternal education and higher-status paternal employment were associated with increased immunization.
- Urban children, particularly those in slums, and ethnic minorities showed disparities in coverage.
Conclusions:
- Significant inequalities in vaccination access and utilization exist in Bangladesh, disproportionately affecting disadvantaged groups.
- Targeted interventions and affirmative actions are necessary to address these disparities and enhance overall immunization coverage.
- Program managers must focus on removing group-specific barriers to achieve equitable health outcomes.
Abstract:
This paper examines inequalities in the use of, and access to, vaccination service in Bangladesh by analyzing national and small area-based datasets. The analysis showed that female children had a lower immunization coverage than male children--the difference persists for all antigens and widens against girls for higher doses. The immunization coverage was higher for children whose mothers were more educated. Children whose fathers had a higher-status occupation (salaried employment) were two-and-a-half times more likely to be immunized than children whose fathers held a lower-status job, e.g. day-labourer. The coverage for the poorest quintile was 70% of the well-to-do. Children residing in urban areas were more likely to be fully immunized than their rural counterparts (70% vs 59% for children aged 12-23 months). Within urban areas, the situation in slums was worse. Large differences existed among the various administrative regions of the country. Ethnic minorities in the Chittagong Hill Tracts had a lower immunization coverage than the Bangalees. In Sylhet, children of non-local workers in Bangladesh-owned tea estates had a lower coverage than their counterparts in foreign-owned tea estates. The study identifies children of various disadvantaged groups as having a lower coverage. Managers of immunization programmes must realize that only through removal of such disparities among groups will overall coverage be increased. Affirmative actions in targeting could be effective in reaching such groups.
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