title: Programmatic aspects of dropouts in child vaccination in Bangladesh: findings from a prospective study.
abstract: The present study investigated prospectively programmatic factors relating to dropouts in child vaccination in 6 subdistricts of Bangladesh. A cross-sectional survey (n = 2700) was conducted estimating overall coverage of immunization using cluster sampling. The eligible subsample of children (n = 1064) was followed up prospectively to understand reasons for dropouts. In-depth interviews (n = 73) with mothers/caregivers and service providers were done and EPI (Expanded Programme on Immunization) sessions were observed (n = 131). Irregular EPI sessions were the prime cause of dropouts particularly in low-performing subdistricts. The other programmatic factors linked with dropouts were (a) no reminder about subsequent session/doses, (b) unfriendly behavior or absence of vaccinator, ( c) refusal due to lost card or vaccine exhausted, and (d) short duration of sessions. Providers highlighted constraints such as financial problems for transportation, particularly in the hard-to-reach areas and vacancies of the posts of health assistants. The barriers to completing full schedules of vaccination can be removed to a large extent through programmatic adjustments.
authors.affiliation: International Centre for Diarrhoeal Disease Research Bangladesh, Mohakhali, Dhaka, Bangladesh.
authors.forename: Md Abdul
authors.initials: MA
authors.lastname: Quaiyum
authors.forename: Rukhsana
authors.initials: R
authors.lastname: Gazi
authors.forename: Azharul I
authors.initials: AI
authors.lastname: Khan
authors.forename: Jasim
authors.initials: J
authors.lastname: Uddin
authors.forename: Meghla
authors.initials: M
authors.lastname: Islam
authors.forename: Faiz
authors.initials: F
authors.lastname: Ahmed
authors.forename: Nirod C
authors.initials: NC
authors.lastname: Saha
mesh_terms: D001459:Bangladesh; D002662:Child Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D017589:Immunization Programs / Q000458:organization & administration* / Q000706:statistics & numerical data*; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D015397:Program Evaluation; D011446:Prospective Studies; D036301:Qualitative Research; D016079:Refusal to Treat; D017010:Reminder Systems; D013997:Time Factors