Factors Contributing to Low Immunization coverage among urban slum children in Bangladesh

Abstract

Objective: Describe the extent of immunization coverage in the urban slum of Zone 3 of the Dhaka City Corporation, and identify the factors contributing to the low immunization coverage. Methodology: Childhood immunization coverage and socioeconomic data were collected from 651 women who had a child aged 12-23 months from the Urban Panel Survey (UPS) of the Urban MCH-FP Extension Project of ICDDR,B. Thirteen immunization service providers were interviewed, and 33 children were observed when obtaining their vaccination. Bivariate analysis was done to identify the association between the low immunization coverage and the sociodemographic characteristics Results: The results of the study showed that the complete immunization coverage of the children aged 12-23 months in the study area was 60.2%. However, in the slum area, the immunization coverage was 48%, whereas in the non-slum cluster, it was 67%. The drop-out rale in the slum cluster from DPT1 to DPT3 was also higher than that in the non-slum cluster (21.7% vs. 9.3%). The characteristics of the urban slum children who completed their immunization series were strongly associated with the following variables: maternal education, maternal employment, family income, father's occupation, household possessions, and the number of living children. Provision-related factors that influence the low immunization coverage in urban slums were: inadequate location and timing of clinics, improper supervision, lack of referral, missed opportunities for vaccination, and lack of coordination among different service provider organizations. Conclusion: The immunization coverage should be improved through strengthening routine immunization services and increasing the integration and coordination among the service providers. The Expanded Programme on Immunization (EPI) should develop a "Slum Strategy" to ensure that high-risk slum children are vaccinated properly. The EPI services should also be linked with development organizations to improve the overall health status of the slum dwellers. Further, health system research is needed to identify operational problems of EPI.