Vaccination remains one of the most effective tools to protect children against life-threatening diseases like polio, diphtheria, and measles. In Bangladesh, the Expanded Program on Immunization (EPI) has contributed significantly to lowering child mortality. However, despite notable national progress, gaps in immunisation coverage still exist—particularly in densely populated urban slums.

A 2025 study conducted by icddr,b in selected wards of Dhaka South City Corporation sought to understand why some children aged 1–3 years remain incompletely vaccinated. The researchers tracked 501 children who had missed one or more doses of Oral Polio Vaccine (OPV)—used here as a sensitive indicator for missed opportunities in routine immunisation.

While Bangladesh boasts a high national immunisation coverage (97% in 2016), this study found the OPV coverage in the study areas was slightly lower at 90%. The reasons, as revealed, are complex and deeply rooted in socioeconomic and logistical realities.

The study found that children from lower-income households (average income: 18,000 BDT) were significantly more likely to have incomplete vaccination records. Larger families and lower parental education levels also played a role. Children whose household heads had no formal education were more likely to miss out on scheduled vaccines, while those with primary education had 25% lower odds of missing a dose. Notably, those whose household heads had secondary or higher education were 53% less likely to miss out.

Occupation of the household head was another key factor. Children from families where the breadwinner was a rickshaw-puller or daily wage laborer were more likely to have incomplete immunisations. These findings reflect the influence of economic insecurity and unstable working hours on health service access.

Among the top reasons cited for missed doses were: the child being unwell (25.3%), inconvenient timing (25%), not having the EPI card (21.6%), and exposure to rumors (12.8%). These findings highlight opportunities for health workers to engage communities through better scheduling, awareness campaigns, and mobile vaccination units.

Despite the challenges, the study emphasises Bangladesh’s ongoing efforts and commitment to improving immunisation equity. It suggests actionable solutions—such as integrating vaccine checks during routine health visits, community-based reminder systems, and stronger public awareness—to close the gap for zero-dose (ZD) and under-immunised (UI) children.

By identifying where the gaps lie and who is most affected, this study supports the mission of achieving universal immunisation coverage and upholding the right to health for every child in Bangladesh. 

Reference:
Determinants of incomplete immunization and factors for missed opportunities in urban Dhaka: A cross-sectional study. Researchgate.net. [cited 2025 Jul 16]. Available from: https://www.researchgate.net/publication/392763349_Determinants_of_incomplete_immunization_and_factors_for_missed_opportunities_in_urban_Dhaka_A_cross-sectional_study