In line with Gavi 5.0’s strategy to enhance vaccination equity; Gavi, the Vaccine Alliance has embarked on a pioneering initiative to establish Zero-Dose (ZD) Country Learning Hubs (CLHs) in Bangladesh, Mali, Nigeria, and Uganda, which underscores their commitment to addressing immunisation disparities. This research feature delves into the significant findings unveiled by a Rapid Assessment report conducted to identify, comprehend, and overcome barriers related to ZD and Under-Immunised (UI) children in Bangladesh.
The rapid assessment, conducted from December 2022 to May 2023, employs a comprehensive methodology involving both secondary and primary data sources. The analytical framework consists of two primary steps: identifying ZD and UI children through data from the Bangladesh Coverage Evaluation Survey (CES) and administrative EPI data, followed by confirmation and validation via Lot Quality Assurance Sampling (LQAS) and field visits. This two-step process ensures meticulous identification of missed communities harbouring ZD and UI children.
The assessment reveals stark disparities in immunisation coverage across various geographic regions in Bangladesh. Specifically, six areas, encompassing rural and urban locales, exhibited significant concentrations of ZD and UI children. These regions include Sunamganj, Gaibandha, Noakhali, and Sherpur districts, along with urban clusters within Dhaka North City Corporation. This spatial distribution underlines the multifaceted nature of the challenges in achieving universal immunisation.
Insights gained through LQAS in the identified missed communities offer a vivid picture of the socio-economic landscape. These communities predominantly consist of marginalised households beset by poor access to education and healthcare infrastructure. Issues such as inadequate transportation and substandard living conditions compound the immunisation challenges. The assessment further highlights the correlation between occupation and location, revealing a prevalence of farming and day labouring among household heads.
The Bangladesh Demographic and Health Survey (BDHS) analysis illuminates vital socio-economic determinants influencing ZD and UI children. Mothers’ education level, access to media, antenatal visits, and regional factors emerge as significant predictors. Notably, mothers’ education emerges as a crucial determinant, underscoring the need for gender-equitable access to education and healthcare. These findings advocate for broader interventions targeting gender-based inequalities.
The assessment also uncovers a complex interplay of demand and supply-side factors contributing to ZD and UI children. Migration due to environmental factors, misconceptions about minor side effects, and preoccupations with family duties emerge as pivotal demand-side barriers. Meanwhile, supply-side challenges encompass shortages of health assistants, inadequate inter-personal communication opportunities, and logistical hurdles.
The assessment comes to an end with a set of informed conclusions and recommendations, poised to shape the trajectory of immunisation programs in Bangladesh. Among the salient suggestions are enhancing data quality through DHIS2 (District Health Information Software), adopting geographic information systems (GIS) for resource allocation, and leveraging community engagement to strengthen immunisation uptake. Policy interventions such as crash programs, evening sessions for urban mothers, and digital monitoring systems are suggested to narrow the immunisation gap.
The research findings resonate beyond Bangladesh, offering valuable insights to inform similar initiatives globally. Additionally, these findings will empower policymakers, program managers, and international organisations alike to recalibrate immunisation strategies, ensuring every child is reached. The assessment’s meticulous methodology, comprehensive findings, and actionable recommendations collectively foster a research landscape primed for equitable immunisation coverage.