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Maternal determinants of timely vaccination coverage among infants in rural Bangladesh
Lavanya Vasudevan1, Alain B Labrique2, Sucheta Mehra2
1Duke Global Health Institute, Durham, NC, United States; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Insights
Infant vaccination rates in rural Bangladesh are critically low, with only 19% of infants receiving timely immunizations. Maternal employment and antenatal care access positively influenced timely infant vaccination.
Area of Science:
- Public Health
- Pediatrics
- Global Health
Background:
- Timely infant vaccination is crucial for preventing mortality and achieving global health goals.
- Rural and underprivileged infants often face delays in vaccination, increasing vulnerability to diseases.
- This study investigated timely vaccination rates in 24,435 infants from rural Bangladesh (2001-2007).
Purpose of the Study:
- To assess the rates of timely vaccination among infants in rural Bangladesh.
- To identify maternal characteristics associated with timely infant vaccination.
- To understand barriers to routine immunization performance in the study area.
Main Methods:
- Assessed vaccinations due by 14 weeks postpartum via maternal interviews (11-18 weeks postpartum).
- Developed a Timely Vaccination (TV) score to categorize infants as on-schedule or not.
- Employed multivariable logistic regression to analyze associations between maternal factors and timely vaccination.
Main Results:
- Only 19% of infants received vaccinations on time by 11-18 weeks postpartum.
- Positive associations with timely vaccination included maternal paid employment, tetanus toxoid vaccination, antenatal care, and higher socioeconomic status.
- Maternal perception of small infant size was negatively associated with timely vaccination.
Conclusions:
- Infant timely vaccination coverage in rural Gaibandha and Rangpur is alarmingly low.
- Significant shortcomings exist in routine immunization performance against the 1-year benchmark.
- Interventions targeting maternal determinants and system/programmatic barriers are needed to improve timely infant vaccination in rural Bangladesh.
Background:
Timely vaccination, i.e., the receipt of all scheduled vaccinations in an age-appropriate fashion, is critical for the prevention of deadly diseases in infants and achievement of the UN Millennium Development Goal to reduce infant mortality. Infants, especially in rural or underprivileged settings often receive delayed vaccinations leaving them susceptible to vaccine-preventable illnesses early in the first year of life. In this study, we examined rates of timely vaccination among 24,435 infants born in Gaibandha and Rangpur rural districts of Bangladesh from 2001 to 2007.
Methods:
Vaccinations due by 14 weeks of age and administered through routine government immunization services were assessed using interviews with enrolled mothers between 11 and 18 weeks postpartum. We created a Timely Vaccination (TV) score to classify infants as vaccinated fully and on schedule (TV=1) or not (TV=0), and used multivariable logistic regression to identify maternal characteristics associated with infant's timely vaccination status.
Results:
Our results suggest that only 19% of infants in this cohort received scheduled vaccinations on time by 11-18 weeks postpartum. Mothers' engagement in paid employment [OR=1.13, 95% CI: 1.03-1.23], receipt of tetanus toxoid vaccination [OR=1.24, 95% CI: 1.11-1.38], history of antenatal care [OR=1.22, 95% CI: 1.12-1.32], or higher socioeconomic status [OR=1.07, 95% CI: 1.03-1.11] were positively associated with timely vaccination of their infants. Mother's perception of small infant size at birth was negatively associated with timely vaccination [OR=0.89, 95% CI: 0.82-0.97].
Conclusion:
Timely vaccination coverage of infants in rural Gaibandha and Rangpur districts is extremely low. This analysis identifies important shortcomings associated with the 1-year vaccination benchmark of routine immunization performance and suggests the need for specific interventions based on potential maternal determinants as well as known system and programmatic barriers of timely vaccination among infants in rural Bangladesh.
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