Child immunization coverage in rural hard-to-reach Haor areas of Bangladesh: possible alternative strategies.
This article assessed the status of childhood vaccination coverage and the possibility of using selected alternative vaccination strategies in rural hard-to-reach haor (low lying) areas of Bangladesh. Data were collected through survey, in-depth interviews, group discussion, and observations of vaccination sessions. Complete immunization coverage among 12- to 23-month-old children was found to be significantly lower in study areas when compared with the national coverage levels. The study identified reasons for low complete immunization coverage in hard-to-reach areas, including irregular/cancelled extended program on immunization (EPI) sessions, less time spent in EPI spots by field staff, and absence of any alternative strategy for remote areas. The findings indicated that the existing service delivery strategy is not sufficient to improve immunization coverage in hard-to-reach areas. However, most of the strategies assessed are considered possible to implement by health care providers in hard-to-reach areas. The study suggested that before implementing alternative strategies in hard-to-reach areas, feasibility and effectiveness of the possible strategies need to be tested to identify evidence-based strategies.
Uddin
Md Jasim
MJ
Health Systems and Infectious Diseases Division, ICDDR,B, Mohakhali, Dhaka, Bangladesh. jasim@icddrb.org
Larson
Charles P
CP
Oliveras
Elizabeth
E
Khan
Azharul Islam
AI
Quaiyum
Md Abdul
MA
Chandra Saha
Nirod
N
D000328:Adult; D001459:Bangladesh; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D017589:Immunization Programs / Q000458:organization & administration*; D007223:Infant; D008297:Male; D008507:Medically Underserved Area; D009035:Mothers; D020380:Needs Assessment; D019035:Rural Health Services / Q000458:organization & administration*