Child immunization coverage in urban slums of Bangladesh: impact of an intervention package

Mj, Uddin; Cp, Larson; Oliveras, Elizabeth; Ai, Khan; Ma, Qibin; Nc, Saha

doi:10.1093/heapol/czp041

Cited by 44 publications

(41 citation statements)

References 3 publications

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“…Of the 15 studies, two (13%) studies scored a ‘high’ or ‘unclear’ risk of bias on more than two domains [13,14], three (20%) studies scored a ‘high’ or ‘unclear’ risk of bias on two domains [15–17], five (33%) studies scored a ‘high’ or ‘unclear’ risk of bias on one domain, [18–22] and five (33%) studies scored a ‘low’ risk of bias on all domains; [23–27] these studies (three RCTs and two pre/post studies) were the most methodologically sound.…”

Section: Resultsmentioning

confidence: 99%

“…Interventions in five studies were aimed at simultaneously increasing utilization and availability of immunization services [14,17,18,21,27]. Interventions included home-based education coupled with on-site vaccine administration, promotion of health education, and general improvement of immunization programs that involved assisting patients to understand and utilize health services as well as improving the services offered.…”

Section: Resultsmentioning

confidence: 99%

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Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature

Nelson

Wallace

Sodha

et al. 2016

Vaccine

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Introduction Immunization programs in developing countries increasingly face challenges to ensure equitable delivery of services within cities where rapid urban growth can result in informal settlements, poor living conditions, and heterogeneous populations. A number of strategies have been utilized in developing countries to ensure high community demand and equitable availability of urban immunization services; however, a synthesis of the literature on these strategies has not previously been undertaken. Methods We reviewed articles published in English in peer-reviewed journals between 1990 and 2013 that assessed interventions for improving routine immunization coverage in urban areas in low- and middle-income countries. We categorized the intervention in each study into one of three groups: (1) interventions aiming to increase utilization of immunization services; (2) interventions aiming to improve availability of immunization services by healthcare providers, or (3) combined availability and utilization interventions. We summarized the main quantitative outcomes from each study and effective practices from each intervention category. Results Fifteen studies were identified; 87% from the African, Eastern Mediterranean and Southeast Asian regions of the World Health Organization (WHO). Six studies were randomized controlled trials, eight were pre- and post-intervention evaluations, and one was a cross-sectional study. Four described interventions designed to improve availability of routine immunization services, six studies described interventions that aimed to increase utilization, and five studies aiming to improve both availability and utilization of services. All studies reported positive change in their primary outcome indicator, although seven different primary outcomes indicators were used across studies. Studies varied considerably with respect to the type of intervention assessed, study design, and length of intervention assessment. Conclusion Few studies have assessed interventions designed explicitly for the unique challenges facing immunization programs in urban areas. Further research on sustainability, scalability, and cost-effectiveness of interventions is needed to fill this gap.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature

Nelson

Wallace

Sodha

et al. 2016

Vaccine

View full text Add to dashboard Cite

show abstract

“…Bangladesh is the world’s most densely populated country with 16 million people living in its capital Dhaka and approximately one-third of city residents living in slums [34,35]. Slum residents lack reliable access to housing, water, sanitation, and health, and migrants are generally poorer, less educated, less knowledgeable about locally available services, and suffer worse health outcomes [3,5,8,36]. In this study, the majority of urban street children registered with mTika were not linked with registered mothers, but despite the challenge of migration and tracking families over time, vaccination coverage did increase in urban intervention areas.…”

Section: Discussionmentioning

confidence: 99%

Use of mobile phones for improving vaccination coverage among children living in rural hard-to-reach areas and urban streets of Bangladesh

Uddin

Shamsuzzaman

Horng

et al. 2016

Vaccine

112

115

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In Bangladesh, full vaccination rates among children living in rural hard-to-reach areas and urban streets are low. We conducted a quasi-experimental pre-post study of a 12-month mobile phone intervention to improve vaccination among 0–11 months old children in rural hard-to-reach and urban street dweller areas. Software named “mTika” was employed within the existing public health system to electronically register each child’s birth and remind mothers about upcoming vaccination dates with text messages. Android smart phones with mTika were provided to all health assistants/vaccinators and supervisors in intervention areas, while mothers used plain cell phones already owned by themselves or their families. Pre and post-intervention vaccination coverage was surveyed in intervention and control areas. Among children over 298 days old, full vaccination coverage actually decreased in control areas – rural baseline 65.9% to endline 55.2% and urban baseline 44.5% to endline 33.9% – while increasing in intervention areas from rural baseline 58.9% to endline 76*8%, difference +18.8% (95% CI 5.7–31.9) and urban baseline 40.7% to endline 57.1%, difference +16.5% (95% CI 3.9–29.0). Difference-in-difference (DID) estimates were +29.5% for rural intervention versus control areas and +27.1% for urban areas for full vaccination in children over 298 days old, and logistic regression adjusting for maternal education, mobile phone ownership, and sex of child showed intervention effect odds ratio (OR) of 3.8 (95% CI 1.5–9.2) in rural areas and 3.0 (95% CI 1.4–6.4) in urban areas. Among all age groups, intervention effects on age-appropriate vaccination coverage were positive: DIDs +13.1–30.5% and ORs 2.5–4.6 (p < 0.001 in all comparisons). Qualitative data showed the intervention was well-accepted. Our study demonstrated that a mobile phone intervention can improve vaccination coverage in rural hard-to-reach and urban street dweller communities in Bangladesh. This small-scale successful demonstration should serve as an example to other low-income countries with high mobile phone usage.

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“…Extended clinic hours for immunization would likely help these working mothers. Studies have found that extended hours can reduce dropouts and left-outs in urban areas 16 , 23 . In addition, making services more reliable, for example, by having regular stocks of vaccines, is crucial to ensuring the community's faith in service delivery.…”

Section: Discussionmentioning

confidence: 99%

Factors limiting immunization coverage in urban Dili, Timor-Leste

Amin

Oliveira

Cunha

et al. 2013

Glob Health Sci Pract

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Child immunization coverage in urban slums of Bangladesh: impact of an intervention package

Cited by 44 publications

References 3 publications

Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature

Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature

Use of mobile phones for improving vaccination coverage among children living in rural hard-to-reach areas and urban streets of Bangladesh

Factors limiting immunization coverage in urban Dili, Timor-Leste

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