Programmatic aspects of dropouts in child vaccination in Bangladesh: findings from a prospective study

Area of Science:

• Public Health
• Global Health
• Pediatric Medicine

Background:

• Childhood immunization is crucial for preventing infectious diseases.
• Vaccination dropout rates remain a challenge in many low- and middle-income countries.
• Understanding programmatic factors influencing dropout is essential for improving vaccine coverage.

Purpose of the Study:

• To identify programmatic factors associated with child vaccination dropouts in Bangladesh.
• To explore reasons for incomplete immunization schedules from caregiver and provider perspectives.

Main Methods:

• A mixed-methods approach combining cross-sectional surveys, prospective follow-up, in-depth interviews, and observation of Expanded Programme on Immunization (EPI) sessions.
• Study conducted in 6 subdistricts of Bangladesh with a total survey sample of 2700 children and a follow-up subsample of 1064 children.

Main Results:

• Irregular EPI sessions were the primary cause of dropouts, especially in underperforming areas.
• Other significant factors included lack of reminders, poor vaccinator behavior/attendance, lost vaccination cards, vaccine stock-outs, and short session durations.
• Healthcare providers cited financial and staffing issues (vacant health assistant positions) as major constraints.

Conclusions:

• Addressing irregular EPI sessions and implementing reminder systems can reduce vaccination dropouts.
• Improving vaccinator conduct, ensuring vaccine availability, and optimizing session duration are critical programmatic adjustments.
• Programmatic modifications, including addressing provider constraints, can substantially enhance full vaccination schedule completion.