title: Maternal determinants of timely vaccination coverage among infants in rural Bangladesh.
abstract: 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].
  
  
  CONCLUSIONS
  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.
authors.affiliation: Duke Global Health Institute, Durham, NC, United States; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Lavanya
authors.initials: L
authors.lastname: Vasudevan
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. Electronic address: alabriqu@jhsph.edu.
authors.forename: Alain B
authors.initials: AB
authors.lastname: Labrique
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Sucheta
authors.initials: S
authors.lastname: Mehra
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Lee
authors.initials: L
authors.lastname: Wu
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Bill and Melinda Gates Foundation, Seattle, WA, United States.
authors.forename: Orin
authors.initials: O
authors.lastname: Levine
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Danny
authors.initials: D
authors.lastname: Feikin
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Rolf
authors.initials: R
authors.lastname: Klemm
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Keith P
authors.initials: KP
authors.lastname: West
mesh_terms: D001459:Bangladesh; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D016015:Logistic Models; D009035:Mothers; D016032:Randomized Controlled Trials as Topic; D012424:Rural Population; D012959:Socioeconomic Factors; D013997:Time Factors; D014611:Vaccination / Q000706:statistics & numerical data*
keywords: Antenatal care; Bangladesh; Crude vaccination; Expanded Program on Immunization (EPI); Maternal determinants; Tetanus toxoid vaccination; Timely vaccination; Timely vaccination score