Using lot quality assurance sampling to improve immunization coverage in Bangladesh.
OBJECTIVE
To determine areas of low vaccination coverage in five cities in Bangladesh (Chittagong, Dhaka, Khulna, Rajshahi, and Syedpur).


METHODS
Six studies using lot quality assurance sampling were conducted between 1995 and 1997 by Basic Support for Institutionalizing Child Survival and the Bangladesh National Expanded Programme on Immunization.


RESULTS
BCG vaccination coverage was acceptable in all lots studied; however, the proportion of lots rejected because coverage of measles vaccination was low ranged from 0% of lots in Syedpur to 12% in Chittagong and 20% in Dhaka's zones 7 and 8. The proportion of lots rejected because an inadequate number of children in the sample had been fully vaccinated varied from 11% in Syedpur to 30% in Dhaka. Additionally, analysis of aggregated, weighted immunization coverage showed that there was a high BCG vaccination coverage (the first administered vaccine) and a low measles vaccination coverage (the last administered vaccine) indicating a high drop-out rate, ranging from 14% in Syedpur to 36% in Dhaka's zone 8.


CONCLUSIONS
In Bangladesh, where resources are limited, results from surveys using lot quality assurance sampling enabled managers of the National Expanded Programme on Immunization to identify areas with poor vaccination coverage. Those areas were targeted to receive focused interventions to improve coverage. Since this sampling method requires only a small sample size and was easy for staff to use, it is feasible for routine monitoring of vaccination coverage.
Tawfik
Y
Y
Academy for Educational Development, Support for Analysis and Research in Africa (SARA) Project, 1875 Connecticut Avenue, North West, Washington, DC 20009, USA. ytawfik@aed.org
Hoque
S
S
Siddiqi
M
M
D001500:BCG Vaccine / Q000008:administration & dosage; D001459:Bangladesh; D006801:Humans; D017589:Immunization Programs / Q000592:standards / Q000706:statistics & numerical data*; D007223:Infant; D008458:Measles Vaccine / Q000008:administration & dosage; D011203:Poverty; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012494:Sampling Studies; D014505:Urban Population
D001500:BCG Vaccine; D008458:Measles Vaccine